Covid-19 infection in known epileptic and non-epileptic children: what is the place of chloroquine sulfate? a case report

Atakla, Hugues Ghislain; Noudohounsi, Aïtchéou Cadnel Wilfried Houedenou; Barry, Louncény Fatoumata; Noudohounsi, Mahugnon Maurel Ulrich Dénis; Legba, Lauréano Déo-Gratias; Souaré, Ibrahima Sory; Kaba, Fatoumata; Houinato, Dismand Stéphan

doi:10.11604/pamj.2020.37.177.26066

Cited by 4 publications

(4 citation statements)

References 5 publications

(4 reference statements)

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“…The most commonly used treatment was benzodiazepine and all the patients fully recovered [10][11][12][13][14][15]. Our review of literature looking for diagnosed epilepsy and association with COVID-19 infection in the pediatric population using PubMed [16,17] showed two patients with known epilepsy with worsening seizures in the setting of COVID-19 infection. One patient was well managed on medication for epilepsy and fully recovered from COVID-19 infection.…”

Section: Discussionmentioning

confidence: 97%

New-Onset Seizures as an Acute Presentation With Atypical EEG Findings in a Previously Healthy Child With Asymptomatic COVID-19 Infection

Akbar¹,

Ahmad²

2022

Cureus

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Coronavirus disease 2019 (COVID-19) infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This infection usually presents with upper respiratory symptoms; however, it can also present with a wide variety of other multisystem and neurological symptoms, including seizures. There are several proposed mechanisms by which COVID-19 can cause systemic signs of infections, including neurological complications and seizures.This case report describes a pediatric patient without a previously documented history of epilepsy who was admitted for new-onset focal seizures with impaired consciousness. No other cause and triggers of seizures were found, and the child was tested positive for COVID-19 infection. The patient had six electroclinical seizures during EEG. Video EEG findings showed atypical features of onset of intermittent rhythmic delta activity (IRDA) slowing over the left hemisphere with evolution/generalization of rhythmic delta/theta activity and without clear typical generalized epileptiform discharges. These EEG findings correlated with a clinical change of behavior arrest, staring, and yawning. Similar spells were reported multiple times a day prior to the admission, and past EEG was normal. A review of current literature on COVID-19 and neurological manifestations in children, including new seizures and prior diagnosis of epilepsy, is also provided in this case report.The clinical experience in children with newly diagnosed or chronic epilepsy suggests that exacerbation of seizures, especially from systemic effects such as those caused by severe COVID-19 infection, will be a major concern.

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Section: Discussionmentioning

confidence: 97%

New-Onset Seizures as an Acute Presentation With Atypical EEG Findings in a Previously Healthy Child With Asymptomatic COVID-19 Infection

Akbar¹,

Ahmad²

2022

Cureus

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“…Essa condição dispõe de origens variadas, sendo as causas infecciosas as comumente relatadas em crianças, destacando a recente associação entre a COVID-19 e a ocorrência de convulsões sintomáticas agudas. Essas convulsões ocorrem por irritação cortical devido à ruptura da barreira hematoencefálica pela reação de várias citocinas presentes na infecção viral [26].…”

Section: Crises Epilépticasunclassified

“…Um estudo demonstrou o caso de três pacientes que apresentaram sintomas similares a crises epilépticas durante a infecção por COVID-19, como perda ou rebaixamento do nível de consciência, convulsões tônico-clônicas, mordedura lateral da língua, hipersalivação e incontinência urinária [26]. Apesar do quadro clínico neurológico semelhante, as seguintes diferenças foram apontadas: uma criança já possuía diagnóstico de epilepsia e as demais não apresentavam história pessoal ou familiar de episódios anteriores [26]. O estudo ainda afirmou que o SARS-COV-2 pode penetrar a barreira hematoencefálica, retardar a circulação cerebral e promover maior interação viral com receptores do tecido endotelial e glial, predispondo a crises epilépticas.…”

Section: Crises Epilépticasunclassified

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Complicações neurológicas da COVID-19 em crianças: revisão de escopo

Dantas¹,

Queiroz²,

Silva³

et al. 2022

Enferm Bras

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Introdução: Na criança, os casos de COVID-19, infecção causada pelo novo Coronavirus ou SARS-CoV-2, são geralmente mais discretos, com taxa de incidência e gravidade bem menores quando comparadas a outras faixas etárias, entretanto há evidências de que possa atingir os sistemas nervoso central e periférico, com possibilidade de resultar em inúmeras deficiências. Objetivo: Identificar as principais complicações neurológicas da COVID-19 em crianças a partir da literatura internacional. Métodos: Revisão de escopo realizada em base de dados eletrônicas. A busca na literatura ocorreu em janeiro de 2021. Para a construção da questão de pesquisa, adotou-se a estratégia PICO. O processo de seleção dos estudos foi realizado por meio das recomendações da Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA). A amostra foi composta por 14 artigos. Resultados: A análise identificou que as complicações neurológicas mais comuns são: infecções e inflamações do sistema nervoso central, síndrome de Guillain-Barré, edema pulmonar neurogênico e crises epilépticas. Conclusão: Observou-se que o SARS-CoV-2 pode acarretar sérias complicações neurológicas em crianças infectadas, sendo as mais descritas nos estudos avaliados: infecções do SNC, inflamações do SNC, síndrome de Guillain-Barré, edema pulmonar neurogênico e crises epilépticas.

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Azithromycin/chloroquine

2021

Reactions Weekly

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Azithromycin/chloroquine Various toxicities following off label use: 3 case reportsIn a case series, three patients aged 11-16 years [including two males; not all sexes stated] were described, who developed seizure, generalised tonic clonic seizure, clonic seizures or focal epilepsy during off label treatment with chloroquine for COVID-19 infection [routes not stated; not all duration of treatments to reaction onsets stated].Case 1: A 14-year-old boy was admitted to the emergency room for loss of consciousness, recurrent tonic-clonic seizures and post critical confusion for 4 hours before admission. He was epileptic since the age of 9 years, and was receiving sodium valproate regularly for epileptic seizure. Prior to the admission, he had developed flu-like syndrome, which was treated unsuccessfully with paracetamol [acetaminophen] and ascorbic acid. At current presentation, he was transferred to the ICU. While in hospital, he presented with recurrent paroxysmal seizures within a short period of time, without return to normal consciousness between seizures. A diagnosis of status with septic shock was made. The status epilepticus was treated with clonazepam, phenobarbital and thiopental sodium [thiopental]. The intercritical EEG tracing suggested multifocal epilepsy. The COVID-19 PCR confirmatory test was positive. Subsequently, he was started on off label chloroquine 500 mg/day [chloroquine sulfate]. Chloroquine was discontinued as recommended by the neurologist due to the paroxysmal recurrence of seizures. Afterwards, he received corticosteroid therapy and rest of the management was symptomatic. After one month without seizures, he was discharged.Case 2: An 11-year-old patient was confirmed positive for COVID-19 infection and started receiving off-label treatment with chloroquine 500 mg/day [chloroquine sulfate] and azithromycin 250 mg/day. After one week of treatment, the patient experienced loss of consciousness with generalized tonic-clonic seizure. The patient also developed lateral biting of the tongue, hyper salivation and loss of urine. Clinical examination was notable for respiratory difficulty and tachycardia. Neurological examination showed persistent mental confusion for more than one hour. Other biological parameters reveal a non-specific inflammatory syndrome. An electrocardiogram (ECG) revealed a heart rhythm disorder. Chloroquine was stopped and clonazepam was initiated. Benzodiazepam [unspecified] was also added. Background antiepileptic levitracetam [Keppra] was added following the second seizure. The patient recovered from COVID-19 infection. After absence of seizure for 3 weeks, a brain scan and EEG were found normal. The patient was discharged with recommendation of neurological surveillance.Case 3: A 16-year-old boy was diagnosed with COVID-19 and started receiving off label treatment with chloroquine 500 mg/day [chloroquine sulfate] and azithromycin 250 mg/day. After 4 days of treatment, he experienced a loss of consciousness with Bravais Jacksonian clonic seizures of the right hemicorps....

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Covid-19 infection in known epileptic and non-epileptic children: what is the place of chloroquine sulfate? a case report

Cited by 4 publications

References 5 publications

New-Onset Seizures as an Acute Presentation With Atypical EEG Findings in a Previously Healthy Child With Asymptomatic COVID-19 Infection

New-Onset Seizures as an Acute Presentation With Atypical EEG Findings in a Previously Healthy Child With Asymptomatic COVID-19 Infection

Complicações neurológicas da COVID-19 em crianças: revisão de escopo

Azithromycin/chloroquine

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