How to carry out and interpret EEG recordings in COVID-19 patients in ICU?

Gélisse, Philippe; Rossetti, Andrea O.; Genton, Pierre; Crespel, Arielle; Kaplan, Peter W.

doi:10.1016/j.clinph.2020.05.006

Cited by 45 publications

(45 citation statements)

References 36 publications

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“…This is important to keep in mind when weighing the potential benefits of EEG testing against the risks of spreading infection due to obtaining EEG recordings in this population, as discussed in a recent review on the topic. 35 Triage policies for the use of EEG in this population may be appropriate to ensure that high-risk patients are prioritized for EEG, while minimizing exposure of technologists and additional staff when risk for seizures is low.…”

Section: Discussionmentioning

confidence: 99%

Continuous EEG findings in patients with COVID‐19 infection admitted to a New York academic hospital system

et al. 2020

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Objective: There is evidence for central nervous system complications of coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Encephalopathy caused by or arising from seizures, especially nonconvulsive seizures (NCS), often requires electroencephalography (EEG) monitoring for diagnosis. The prevalence of seizures and other EEG abnormalities among COVID-19-infected patients is unknown. Methods: Medical records and EEG studies of patients hospitalized with confirmed COVID-19 infections over a 2-month period at a single US academic health system (four hospitals) were reviewed to describe the distribution of EEG findings including epileptiform abnormalities (seizures, periodic discharges, or nonperiodic epileptiform discharges). Factors including demographics, remote and acute brain injury, prior history of epilepsy, preceding seizures, critical illness severity scores, and interleukin 6 (IL-6) levels were compared to EEG findings to identify predictors of epileptiform EEG abnormalities. Results: Of 111 patients monitored, most were male (71%), middle-aged or older (median age 64 years), admitted to an intensive care unit (ICU; 77%), and comatose (70%). Excluding 11 patients monitored after cardiac arrest, the most frequent EEG finding was moderate generalized slowing (57%), but epileptiform findings were observed in 30% and seizures in 7% (4% with NCS). Three patients with EEG seizures did not have epilepsy or evidence of acute or remote brain injury, although all had clinical seizures prior to EEG. Only having epilepsy (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.4-21) or seizure(s) prior to EEG (OR 4.8, 95% CI 1.7-13) was independently associated with epileptiform EEG findings. Significance: Our study supports growing evidence that COVID-19 can affect the central nervous system, although seizures are unlikely a common cause of encephalopathy. Seizures and epileptiform activity on EEG occurred infrequently, and having 2098 |

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Section: Discussionmentioning

confidence: 99%

Continuous EEG findings in patients with COVID‐19 infection admitted to a New York academic hospital system

et al. 2020

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“…The diagnosis of COVID-19-related encephalitis can be extremely challenging, as the definitive diagnosis of viral encephalitis largely depends on virus isolation from CSF; this is difficult for COVID-19 because SARS-CoV-2 dissemination is transient and its CSF titer may be extremely low. Most of the patients of COVID-19, who had encephalopathy and underwent EEG, showed nonspecific findings [ 8 ]. Two case series involving CSF analysis data from 12 patients reported that the CSF had no white blood cells and the PCR assay for SARS-CoV-2 was negative in all the patients [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and the Brain: Acute Encephalitis as a Clinical Manifestation

Haider¹,

Siddiqa²,

Ali³

et al. 2020

Cureus

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Central nervous system (CNS) viral infections result in the clinical syndromes of aseptic meningitis or encephalitis. Although the primary target of coronavirus disease 2019 (COVID-19) is the respiratory system, it is increasingly being recognized as a neuropathogen. The hallmark clinical feature is altered mental status, ranging from mild confusion to deep coma. Most patients with encephalopathy or encephalitis are critically ill. We present a case of COVID-19-related encephalitis who presented with acute delirium and new-onset seizures. The patient responded well to treatment with intravenous immunoglobulins and rituximab.

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“…Nevertheless, patients with severe SARS-CoV-2 infection, especially those hospitalized in intensive care units, are at risk for subclinical seizures or nonconvulsive status epilepticus (NCSE), owing to polypharmacy, metabolic derangements, toxemia, hypoxic-anoxic brain injury, or less commonly stroke or encephalitis related to SARS-CoV-2 infection. Therefore, continuous video EEG monitoring may be warranted in selected cases, as delayed diagnosis and treatment of NCSE will increase morbidity and mortality [93].…”

Section: Epileptic Complicationsmentioning

confidence: 99%

Neurological involvement of coronavirus disease 2019: a systematic review

et al. 2020

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Background In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. Objective To clarify the neurological complications of SARS-CoV-2 infection including the potential mechanisms and therapeutic options. Methods We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 where neurological involvement was evident. Results We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.3 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n = 40) had cerebrovascular insults, 28% (n = 23) had neuromuscular disorders, and 23% of the patients (n = 19) had encephalitis or encephalopathy. Conclusions Neurological manifestations of COVID-19 are not rare, especially large vessel stroke, Guillain-Barre syndrome, and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of SARS-CoV-2 infection, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic.

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How to carry out and interpret EEG recordings in COVID-19 patients in ICU?

Cited by 45 publications

References 36 publications

Continuous EEG findings in patients with COVID‐19 infection admitted to a New York academic hospital system

Continuous EEG findings in patients with COVID‐19 infection admitted to a New York academic hospital system

COVID-19 and the Brain: Acute Encephalitis as a Clinical Manifestation

Neurological involvement of coronavirus disease 2019: a systematic review

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