COVID-19-Induced Seizures: A Meta-Analysis of Case Series and Retrospective Cohorts

Abstract

The adverse events and complications of coronavirus disease 2019 (COVID-19) continue to challenge the medical profession despite the worldwide vaccination against the severe acute respiratory coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. Other than typical respiratory manifestations, COVID-19 also presents a wide range of neurological manifestations. This article underlines the pooled incidence of COVID-19-induced seizures in patients with epilepsy and without epilepsy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols, we conducted a bibliographical search, and an initial search revealed 1,375 articles. In total, 21 articles were included in the final analysis by following the inclusion criteria. A total of 11,526 patients from 21 published articles that met the predetermined search criteria were included. The median age of the patients was 61.9 years, of whom 51.5% were males. A total of 255 patients presented with seizures as the first manifestation of COVID-19 with a prevalence of 2.2% (95% confidence interval = 0.05-0.24, p < 0.01) (I 2 = 97%), of which 71 patients had previously been diagnosed with epilepsy. Among patients with epilepsy, 49 patients had seizures as an initial presentation of SARA-CoV-2 with an incidence of 72% (0.54-0.85, p = 0.1) (I 2 = 34). Although the incidence of COVID-19-induced seizures is not high compared to other neurological manifestations, seizure incidence in epileptic patients with COVID-19 is remarkably high. New-onset seizures in any patient should be considered a presentation of COVID-19 in the absence of other causative factors.

Association of seizure with COVID‐19 vaccines in persons with epilepsy: A systematic review and meta‐analysis

“…52 According to a meta-analysis of case-series and retrospective cohorts among 71 PwE, 49 patients presented with seizures as an initial manifestation of COVID-19 infection with an incidence of 69% (54% −85%, p = 0.10, I 2 = 34%), which is much higher than the rate we reached in the present meta-analysis. 52 Also, the COVID-19 pandemic dramatically impacted the lives of PwE, partly due to reduced quality and accessibility of care for PwE, hence the increased seizure frequency. On the other hand, the social isolation might have made PwE more susceptible to more perceived anxiety and depression, potentially linked to the increased seizure frequency.…”

“…Importantly, the chance of seizure activity‐related changes after COVID‐19 vaccines seems to be lower than COVID‐19 infection 52 . According to a meta‐analysis of case‐series and retrospective cohorts among 71 PwE, 49 patients presented with seizures as an initial manifestation of COVID‐19 infection with an incidence of 69% (54%−85%, p = 0.10, I 2 = 34%), which is much higher than the rate we reached in the present meta‐analysis 52 . Also, the COVID‐19 pandemic dramatically impacted the lives of PwE, partly due to reduced quality and accessibility of care for PwE, hence the increased seizure frequency.…”

Association of New-Onset Seizures With SARS-CoV-2 Vaccines

“…However, the risk of seizure occurrence after SARS-CoV-2 infection seems to be relatively high. 40 This jhas been observed for many other complications and other populations as well. For instance, in persons with epilepsy, the risk of increased seizure frequency after vaccinations seems to be less than that of SARS-CoV-2 infection.…”

“…The second study, 31 on the safety and efficacy of the Janssen vaccine, with a median follow-up of 121 days (range, 1-284 days), reported 9 new-onset seizures among 21 894 vaccine recipients (<0.1%) and 4 new-onset seizures among 21 882 placebo recipients (<0.1%). The last study, 34 on the safety and efficacy of the CoronaVac vaccine, with a median (IQR) follow-up of 43 days (36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48), reported 1 new-onset seizure among 6646 individuals (<0.1%) in the vaccine group and no events in the placebo group. After pooling the 3 studies, no statistical difference was identified between the vaccine and placebo groups (13/43 724 events [0.03%] in vaccine recipients and 5/40 612 events [0.012%] in placebo recipients; OR, 2.31; 95% CI, 0.86-6.23; P = .10, I 2 = 0%, τ2 = 0, Cochran Q P = .95) (Figure 3).…”

“…Indeed, seizures could be caused by induction of glutamate release and inhibition of the release of inhibitory neurotransmitters, triggered by proinflammatory cytokines in the brain, as also happens in SARS-CoV-2 infection. [40][41][42] Furthermore, SARS-CoV-2 vaccines could result in autoimmune encephalopathy, 43 which is commonly associated with seizures. 44 Of note, according to a case report, immune-mediated thrombotic thrombocytopenic purpura following SARS-CoV-2 vaccination could have caused seizure.…”