Focal status epilepticus as unique clinical feature of COVID-19: A case report

Vollono, Catello; Rollo, Eleonora; Romozzi, Marina; Frisullo, Giovanni; Servidei, Serenella; Borghetti, Alberto; Calabresi, Paolo

doi:10.1016/j.seizure.2020.04.009

Cited by 171 publications

(194 citation statements)

References 4 publications

(5 reference statements)

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“…33 In a recent case report, a 78-year-old female patient, later confirmed with SARS-CoV-2 infection, exhibited focal status epilepticus as the initial presenting symptom for COVID-19. 37 Although these reports may suggest a possible mechanistic link between the onset of seizures and COVID-19, in total only a relatively low number of cases with new onset or acute seizures have been reported so far. This has also been supported by a recent observational study, which did not detect new onset or acute seizures in a retrospective multicenter cohort study of >300 patients diagnosed with COVID-19, despite a significant proportion of patients with various risk factors such as hypoxia, acute cerebrovascular events, sepsis, imipenem use, and metabolic disturbances.…”

Section: Box 1 Search Strategy Profile Of the Reviewmentioning

confidence: 99%

“…From the 14 articles identified in the present review, eight do not report on testing the presence of SARS-CoV-2 infection in the CSF of patients exhibiting neurologic dysfunction. 33,[37][38][39][40][41][42][43] In addition, few reports do not mention whether the patient exhibiting seizures had a previous history of epilepsy or seizures. 27,40,41 There are other methodological limitations, including data collected only during the acute phase with lack of follow-ups, 38 the lack of diagnosis and reporting of mild neurological symptoms, 33 limited resources to treat critically ill patients, 42 and absence of electroencephalographic recordings 38 or advanced neuroimaging techniques such as magnetic resonance imaging (MRI) and other diagnostic techniques.…”

Section: Box 1 Search Strategy Profile Of the Reviewmentioning

confidence: 99%

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COVID‐19 and seizures: Is there a link?

et al. 2020

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The rapid spread of the SARS-CoV-2 pandemic poses particular challenges to the management of persons with chronic disease. Reports of a possible neuroinvasiveness of SARS-CoV-2 as well as pathophysiological mechanisms and indirect consequences in severe COVID-19 cases raise the question of whether the infection can be associated with an increased risk of seizure recurrence or the development of new onset and acute symptomatic seizures. Although the literature does not provide relevant evidence for seizure worsening in persons with epilepsy during the course of a SARS-CoV-2 infection, there are theoretical risks, for example, seizures triggered by fever. Moreover, a severe disease course and advanced disease stages can, for instance, result in hypoxic encephalopathy, cerebrovascular events, and cytokine storm, which may trigger the development of acute seizures. This is further confirmed by reports of occasional seizures in COVID-19 patients. Although the low number of reports so far suggests that the risk may be relatively low, the reports indicate that an early neurological manifestation with seizures should not be ruled out. In the context of these cases, we discuss possible pathophysiological mechanisms that may trigger ictogenesis in patients with SARS-CoV-2 infection.

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Section: Box 1 Search Strategy Profile Of the Reviewmentioning

confidence: 99%

Section: Box 1 Search Strategy Profile Of the Reviewmentioning

confidence: 99%

COVID‐19 and seizures: Is there a link?

et al. 2020

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“… 15 Another 78-year-old SARS-CoV-2 infected female patient had presented with focal myoclonic status epilepticus (SE). 16 She had preexisting well-controlled epilepsy as a sequel to herpes simplex virus-1 encephalitis that developed 2 years prior to the current presentation with MRI brain showing focal gliosis. She later developed respiratory symptoms and was tested positive for COVID-19, though she recovered well after conservative management.…”

Section: Introductionmentioning

confidence: 95%

Seizures and Epilepsy in Times of Corona Virus Disease 2019 Pandemic

Parihar¹,

Tripathi²,

Dhamija³

2020

J Epilepsy Res

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The end of the year 2019 was marked by novel coronavirus (severe acute respiratory syndrome coronavirus-2, SARS-CoV-2) outbreak in China that rapidly spread to the rest of the world. While the involvement of the lower respiratory system causing pneumonia is identified as the primary target of the virus, extra-pulmonary manifestations, especially of the central nervous system, are also being increasingly reported. Previous research on Middle East respiratory syndrome coronavirus and SARS-CoV have shown neurological involvement in human coronavirus infections. While several cases of seizures have been reported in patients with coronavirus disease 2019 (COVID-19) patients, there is no specific data to suggest an association of COVID-19 with epilepsy. Epilepsy patients on immunosuppressive medications may have a higher risk of contracting the viral infection. There can be an indirect relation of COVID-19 to epilepsy as the viral infection is associated with fever in most COVID-19 cases, which can lower seizure threshold. Additionally, inadequate sleep and stress due to ongoing pandemic of coronavirus can be another trigger for seizure precipitation in epilepsy patients. Drug compliance, availability of antiepileptic drugs, and drug interactions with COVID-19 experimental drugs are major concerns in epilepsy patients. Adopting telemedicine services and the use of epilepsy helplines may be important in assisting epilepsy patients and ensuring that treatment continues uninterrupted.

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“…One case of viral encephalitis with positive CSF for viral protein 10 was also reported; however, one case series did not find out positive CSF in their patients. 16 17 On case report presented two patients present with Miller-Fisher syndrome and polyneuritis cranialis. Similarly, one case report of myoclonic seizure was also reported in COVID-19-positive patient who had no respiratory symptom.…”

Section: Resultsmentioning

confidence: 99%

Neurological Involvement in COVID-19 Patients: A Narrative Review

Yadav

Srivastava

Bajpai

et al. 2020

JNRP

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Background Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belonging to the coronavirus family. The primary target of SARS-CoV-2 is peripheral mucosal cells of respiratory tract. Recent days have seen few cases where virus has affected extrapulmonary organ such as nervous system. Materials and Methods The present study was a narrative review done using techniques of systemic review, that is, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases such as PubMed (Medline) and Google Scholar were searched systematically for published article from December 1, 2019 to June 5, 2020. A total of 189 articles were initially selected by the authors. A final list of 17 articles was prepared and following information were extracted from selected studies: study design, main result, and limitations of the study. Results Majority of these article were descriptive studies describing spectrum of signs and symptoms among admitted patients. In majority of these studies, patients have developed symptoms suggestive of neurological involvement. Most common central nervous system symptoms reported were headache, followed by dizziness and confusion. Similarly, the most common peripheral nervous system involvement was loss of taste and smell. Conclusion The present study concludes that there are enough evidences to prove that SARS-CoV-2 infection affects both central and peripheral nervous system. Various mechanisms are proposed to explain the pathophysiology of neurological manifestations in COVID-19-positive patients that needs to be established and verified.

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Focal status epilepticus as unique clinical feature of COVID-19: A case report

Cited by 171 publications

References 4 publications

COVID‐19 and seizures: Is there a link?

COVID‐19 and seizures: Is there a link?

Seizures and Epilepsy in Times of Corona Virus Disease 2019 Pandemic

Neurological Involvement in COVID-19 Patients: A Narrative Review

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