COVID-19, de novo seizures, and epilepsy: a systematic review

Abstract

Objective We discuss the evidence on the occurrence of de novo seizures in patients with COVID-19, the consequences of this catastrophic disease in people with epilepsy (PWE), and the electroencephalographic (EEG) findings in patients with COVID-19. Methods This systematic review was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Scopus, and Embase from inception to August 15, 2020 were systematically searched. These key words were used: "COVID" AND "seizure" OR "epilepsy" OR "EEG" OR "status epilepticus" OR "electroencephalography". Results We could identify 62 related manuscripts. Many studies were case reports or case series of patients with COVID-19 and seizures. PWE showed more psychological distress than healthy controls. Many cases with new-onset focal seizures, serial seizures, and status epilepticus have been reported in the literature. EEG studies have been significantly ignored and underused globally. Conclusion Many PWE perceived significant disruption in the quality of care to them, and some people reported increase in their seizure frequency since the onset of the pandemic. Telemedicine is a helpful technology that may improve access to the needed care for PWE in these difficult times. De novo seizures may occur in people with COVID-19 and they may happen in a variety of forms. In addition to prolonged EEG monitoring, performing a through metabolic investigation, electrocardiogram, brain imaging, and a careful review of all medications are necessary steps. The susceptibility of PWE to contracting COVID-19 should be investigated further.

Factors Associated with COVID-19 Vaccine Hesitancy among People with Epilepsy in Lithuania

“…The ratio of confirmed cases of COVID-19 among the participants of our survey (eight cases in a sample of 111, or 7.2%) was similar to the one in the general population in Lithuania towards the end of the study (147,984 of confirmed cases in a population of 2,794,090 inhabitants, or 5.3%) [ 9 ]. However, COVID-19-related results (e.g., seizure exacerbation in one of the patients) are limited by a small sample size and the non-inclusion of severe or lethal COVID-19 cases, for which data are yet scant in the literature as well [ 6 , 10 ].…”

“…A deterioration of their physical and psychological condition was mostly associated with a lack of timely medical services, disrupted use or supply of antiseizure drugs (ASDs) and the consequences of strict lockdown measures, which induced mental health problems and were associated with seizure exacerbation [ 1 , 2 , 3 , 4 , 5 ]. While there is currently only limited evidence that COVID-19 is more severe or lethal in those with comorbid epilepsy, the spread of COVID-19 still exposes patients to a substantial risk of severe respiratory complications and often results in lockdowns, which disturb access to healthcare [ 6 , 7 , 8 ]. There were two periods of lockdown in Lithuania in 2020 (March–June and November–December) [ 9 ].…”

The course of COVID-19 infection in patients with multiple sclerosis–The experience of one center based on the population of Upper Silesia

“…In patients with COVID-19, de novo seizures were reported. 13 Electroencephalography (EEG) findings of patients with SARS-CoV-2 infection showed sporadic epileptiform activity (mostly frontal sharp waves) and generalized background slowing, particularly in patients with a decreased level of consciousness. 14 No abnormalities during the EEG recording were found.…”

COVID‐19 presentations and outcome in patients with epilepsy

“…with seizures (even in people without pre-existing epilepsy) in many previous studies. 12 Furthermore, this pandemic has caused significant disruption in the quality and availability of care to PWE, as well as increased stress and social isolation rates; these may contribute to exacerbation or breakthrough seizures in PWE. 11,13 Finally, some patients with COVID-19 may develop a seizure as a consequence of hypoxemia, organ failure, metabolic derangements, or drug-drug interactions.…”