EEG findings in acutely ill patients investigated for SARS‐CoV‐2/COVID‐19: A small case series preliminary report

Abstract

Objective: Acute encephalopathy may occur in COVID-19-infected patients. We investigated whether medically indicated EEGs performed in acutely ill patients under investigation (PUIs) for COVID-19 report epileptiform abnormalities and whether these are more prevalent in COVID-19 positive than negative patients. Methods: In this retrospective case series, adult COVID-19 inpatient PUIs underwent EEGs for acute encephalopathy and/or seizure-like events. PUIs had 8-channel headband EEGs (Ceribell; 20 COVID-19 positive, 6 COVID-19 negative); 2 more COVID-19 patients had routine EEGs. Overall, 26 Ceribell EEGs, 4 routine and 7 continuous EEG studies were reviewed. EEGs were interpreted by board-certified clinical neurophysiologists (n = 16). EEG findings were correlated with demographic data, clinical presentation and history, and medication usage. Fisher's exact test was used. Results: We included 28 COVID-19 PUIs (30-83 years old), of whom 22 tested positive (63.6% males) and 6 tested negative (33.3% male). The most common indications for EEG, among COVID-19-positive vs COVID-19-negative patients, respectively, were new onset encephalopathy (68.2% vs 33.3%) and seizure-like events (14/22, 63.6%; 2/6, 33.3%), even among patients without prior history of seizures (11/17, 64.7%; 2/6, 33.3%). Sporadic epileptiform discharges (EDs) were present in 40.9% of COVID-19-positive and 16.7% of COVID-19-negative patients; frontal sharp waves were reported in 8/9 (88.9%) of COVID-19-positive patients with EDs and in 1/1 of COVID-19-negative patient with EDs. No electrographic seizures were captured, but 19/22 COVID-19-positive and 6/6 COVID-19-negative patients were given antiseizure medications and/or sedatives before the EEG. | 315GALANOPOULOU et AL. | METHODS | Study design, inclusion and exclusion criteria

Central Nervous System Manifestations Associated with COVID-19

“…Galanopoulou et al [ 63 ] studied 28 individuals suspected of COVID-19. Twenty-two were tested positive for SARS-CoV-2.…”

Seizure in patients with COVID-19

“…One small study of 22 patients with confirmed COVID-19 showed that the most common indications for EEG were new-onset encephalopathy and seizure-like events. Sporadic epileptiform discharges were present in 41% of the patients [8]. It is recommended to perform a continuous EEG monitoring in a patient who is in a critical medical condition, including those with COVID-19, and has a change in mental status to make sure that NCSE is not a part of the clinical scenario [9].…”

COVID-19-related encephalopathy presenting with aphasia resolving following tocilizumab treatment

“…Brain MRI revealed non-specific white matter hyperintensities, ruling out structural lesions which could justify neurological manifestations. The altered mental status might have been caused also by non-convulsive status epilepticus, a clinical condition already associated with COVID-19 (Le Guennec et al, 2020), yet was excluded by the EEG, which showed diffuse slowing with frontal sharp waves, a finding frequently reported in COVID-19-related encephalopathy (Galanopoulou et al, 2020;Pasini et al, 2020). Aphasia was accompanied by manifestations consistent with dysexecutive syndrome and behavioral symptoms, suggesting a frontal lobe dysfunction.…”