Electroencephalographic Abnormalites in SARS-CoV-2 Patients

Abstract

Viral infection with SARS-CoV-2 has a neurological tropism that may induce an encephalopathy. In this context, electroencephalographic exploration (EEG) is indicated as a diagnostic argument correlated with lumbar puncture, biology, and imaging. We performed a retrospective analysis of 42 patients explored by EEG and infected by COVID-19, according to the EEG abnormalities and clinical signs that motivated the examination. Confusion and epileptic seizures were the most common clinical indications, with 64% of the patients displaying these symptoms. The EEG was altered in 85% of the cases of confusion, in 57% of the cases of epileptic symptoms (general or focal seizure or prolonged loss of contact) and 20% of the cases of malaise or brief loss of consciousness. Nine EEG (21%) were in favor of an encephalopathy, two had de novo alterations in persistent consciousness and two had alterations in general states of confusion; one was very agitated and without history of epilepsy and combined eyelids clonia while a second one exhibited unconsciousness with left hemicorpus clonus. Two were being investigated for delayed awakening without sedation for more than 24 h. All of these patients were diagnosed COVID-19, some of them with associated mild to severe respiratory disorders. This work shows the interest of the EEG in exploring COVID-19 patients suffering from neurological or general symptoms looking for cerebral alteration.

SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders

“…COVID-19 patients displaying general states of confusion, agitation, unconsciousness altered mental state and seizure have prompted diagnostic testing [ 136 , 137 ]. Upon receiving a electroencephalograph, a common diagnostic tool for encephalopathy, 21% were indicative of encephalopathy [ 136 ]. This diagnosis increased to 74% in critical patients [ 138 ].…”

Seizures and COVID-19: Results from the Spanish Society of Neurology’s COVID-19 registry

“…Thorough assessment is necessary to establish a correct diagnosis. EEG is particularly useful in differentiating encephalopathy, a very common syndrome in COVID-19 patients, from non-convulsive status epilepticus [20] , [21] , [22] , and also in detecting subtle or subclinical seizures.…”

COVID-19 and Seizures

“…Altered mental status and seizures are the most common indication for EEG. Most of patients performed routine EEG, with a few cases submitted to continuous video-EEG monitoring [42,58]. A systematic review found that continuous EEG studies reported more abnormalities than routine EEG [59].…”

“…One study showed that brain reactivity was reduced or absent more often in COVID-19 patients with poor prognosis [27,60]. Confusion and seizures seem to be the most frequent predictors of encephalopathy [58].…”

“…It is difficult to relate EEG findings with CSF and neuroimaging findings as just a few patients underwent a complete screening for all modalities. One study was able to obtain records of thoracic CT scan, CSF SARS-CoV-2 PCR, and EEG of a subgroup of 13 patients, and no correlations were found between those variables [58].…”