New-onset refractory status epilepticus following the ChAdOx1 nCoV-19 vaccine

Abstract

Coronavirus is a novel human pathogen causing fulminant respiratory syndrome (COVID-19). Developing an effective and reliable vaccine was emergently pursued to control the dramatic spread of the global pandemic. The standard stages for vaccine development were unprecedentedly accelerated over a few months. We report a case of new-onset refractory status epilepticus (NORSE) after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. We attribute the occurrence of NORSE to the vaccine due to the temporal relationship and the lack of risk factors for epilepsy in the patient. This report adds to the literature a possible rare side effect of a COVID-19 vaccine and contributes to the extremely limited literature on potential neurological side effects of viral vector vaccines. Healthcare providers should be aware of the possibility of post-vaccination epilepsy. The patient had recurrent seizures that were refractory to conventional antiepileptic drug therapy with a dramatic response to immunotherapy with pulse steroids and plasmapheresis. This likely reflects an underlying autoimmune mechanism in the genesis of post-vaccination generalized seizures without fever. Further research is needed to probe and study the exact mechanism at a more molecular level.

Should patients with epilepsy be vaccinated against coronavirus disease 2019? A systematic review and meta-analysis

“…Fear of seizure worsening, and concerns about the adverse effects and efficacy rank among the leading causes of vaccination hesitancy. Cases of seizure onset after COVID-19 vaccination [31] , [39] , [40] might influence the clinicians’ decision to recommend vaccination in patients with epilepsy. However, our analysis showed that epilepsy related problems after COVID-19 vaccination such as increased seizure frequency and status epilepticus were uncommon in most of the included studies.…”

Adverse events following ChAdOx1 nCoV-19 (Covisheild) vaccine administered in two-dose regimen: A single centre experience from Sri Lanka

“…Although the generalised convulsions have proven to be associated with immunization, seizures following the ChAdOx1 nCoV-19 vaccine are rarely reported. [19][20][21] Two other hospitalized patients with high-grade fever and severe body aches made a complete recovery with symptomatic treatment and were discharged after a short period of hospital stay.…”

Estado Epiléptico Refractario de Aparición Reciente (NORSE): Revisión y actualización

“…Los autores de esta publicación teorizan que, al ingresar al SNC, el vector viral de la vacuna podría haber inducido una cascada inflamatoria con la consecuente epileptogénesis, simulando uno de los mecanismos por los que la infección por SARS-CoV-2 produce clínica neurológica. 43…”