Incidence of Electrographic Seizures in Patients With COVID-19

Abstract

Critical illness and sepsis are commonly associated with subclinical seizures. COVID-19 frequently causes severe critical illness, but the incidence of electrographic seizures in patients with COVID-19 has been reported to be low. This retrospective case series assessed the incidence of and risks for electrographic seizures in patients hospitalized with COVID-19 who underwent continuous video electroencephalography monitoring (cvEEG) between March 1st, 2020 and June 30th, 2020. One hundred and twenty-two patients were initially identified who resulted SARS-CoV-2 nasopharyngeal RT-PCR swab positivity with any electroencephalography order placed in the EMR. Seventy-nine patients met study inclusion criteria: age ≥18 years, >1 h of cvEEG monitoring, and positive SARS-CoV-2 nasopharyngeal swab PCR. Six (8%) of the 79 patients suffered electrographic seizures (ES), three of whom suffered non-convulsive status epilepticus. Acute hyperkinetic movements were the most common reason for cvEEG in patients with ES (84%). None of the patients undergoing cvEEG for persistent coma (29% of all patients) had ES. Focal slowing (67 vs. 10%), sporadic interictal epileptiform discharges (EDs; 33 vs. 6%), and periodic/rhythmic EDs (67 vs. 1%) were proportionally more frequent among patients with electrographic seizures than those without these seizures. While 15% of patients without ES had generalized periodic discharges (GPDs) with triphasic morphology on EEG, none of the patients with ES had this pattern. Further study is required to assess the predictive values of these risk factors on electrographic seizure incidence and subsequent outcomes.

Electroencephalography at the height of a pandemic: EEG findings in patients with COVID-19

“…However, the predominance of generalized sharp waves and generalized epileptiform discharges observed in our cohort is comparable to the findings from another New York study at Montefiore ( Galanopoulou et al, 2020 ), which detected sporadic epileptiform discharges (but no seizures) in 41% of patients using primarily a reduced montage EEG with smaller numbers or routine and continuous EEG recordings. Our findings are also consistent with other New York based studies including one from Columbia University where 14% had GPDs with a similar number (8%) having electrographic seizures on continuous recordings ( Waters et al, 2021 ), as well as from a large cohort of 192 patients at Northwell using a mixture of continuous and routine recordings where the overall presence of epileptiform discharges was 39.6% with a prevalence of GPD’s of 19.3% and seizures of 4.1%. Our results also mirror those in other parts of the United States including a study in Michigan which reported high rates of generalized periodic discharges with triphasic morphology (21%), GRDA (18%) and non-triphasic GPDs (9%) and a comparable incidence of electrographic seizures (11%) on routine and continuous recordings ( Danoun et al, 2021 ) as well as a study from the Cleveland Clinic ( Louis et al, 2020 ), which reported GPDs and seizures in 32% and 9% of patients who underwent primarily continuous as well as routine EEG.…”

New Onset Seizures in Hospitalized COVID-19 Patients; A Systematic Review and Meta-Analysis

“…10,12,17-30 The frequency of new onset seizures in hospitalized COVID-19 patients who had EEG performed was 8.49% (95% confidential interval: .62-24.07, I 2 = 14%, 44/535 patients) (Figure 3). 31–38 The detailed description of studies utilized for the meta-analysis can be found in supplemental Table S2, which also includes clinical characteristics and diagnostic findings for these subjects.

Figure 2.Frequency of new onset seizures in hospitalized COVID-19 patients.

Figure 3.Frequency of seizures in COVID-19 patients for whom EEG monitoring was performed.

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“…10,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] The frequency of new onset seizures in hospitalized COVID-19 patients who had EEG performed was 8.49% (95% confidential interval: .62-24.07, I 2 = 14%, 44/535 patients) (Figure 3). [31][32][33][34][35][36][37][38] The detailed description of studies utilized for the meta-analysis can be found in supplemental Table S2, which also includes clinical characteristics and diagnostic findings for these subjects.…”

Manifestaciones neurológicas en pacientes con diagnóstico de COVID-19

“…Waters y colaboradores en una serie de casos retrospectiva analizaron 79 pacientes con movimiento anormales de los cuales el 6 pacientes el 8% mostraron actividad epileptiforme en el electroencefalograma, en este grupo de estudio la electroencefalografía mostró descargas (29) epileptiformes intermitentes en la zona temporal izquierda . En los pacientes que presentan convulsiones la mayoría de los reportes describen las características del líquido cefalorraquídeo como un patrón normal.…”