Outcomes of seizures, status epilepticus, and EEG findings in critically ill patient with COVID-19

Abstract

Objective Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a myriad of neurological manifestations and its effects on the nervous system are increasingly recognized. Seizures and status epilepticus (SE) are reported in the novel coronavirus disease (COVID-19), both new onset and worsening of existing epilepsy, however the exact prevalence is still unknown. The primary aim of this study was to correlate the presence of seizures, status epilepticus, and specific critical care EEG patterns with patient functional outcomes in those with COVID-19. Methods This is a retrospective, multicenter cohort of COVID-19 positive patients in Southeast Michigan who underwent electroencephalography (EEG) from March 12 th through May 15 th , 2020. All patients had confirmed nasopharyngeal PCR for COVID-19. EEG patterns were characterized per 2012 ACNS critical care EEG terminology. Clinical and demographic variables were collected by medical chart review. Outcomes were divided into recovered, recovered with disability, or deceased. Results Out of the total of 4100 patients hospitalized with COVID-19, 110 patients (2.68%) had EEG during their hospitalization; 64% were male, 67% were African American with mean age of 63 years (range 20-87). The majority (70%) had severe COVID-19 were intubated or had multiorgan failure. The median length of hospitalization was 26.5 days (IQR=15 to 44 days). During hospitalization, of the patients who had EEG, 21.8% had new onset seizure including 7% with status epilepticus, majority (87.5%) with no prior epilepsy. Forty-nine (45%) patients died in the hospital, 46 (42%) recovered but maintained a disability and 15 (14%) recovered without a disability. The EEG findings associated with outcomes were background slowing/attenuation (recovered 60% vs recovered/disabled 96% vs died 96%, p<0.001) and normal (recovered 27% vs recovered/disabled 0% vs died 1%, p<0.001). However, these findings were no longer significant after adjusting for severity of COVID-19. Conclusion In this large multi-center study from Southeast Michigan, one of the early COVID-19 epicenters in the US, none of the EEG findings were significantly correlated with outcomes in critically ill COVID-19 patients. Although seizures and status epilepticus could be encountered in COVID-19, the occurrence did not correlate with the patients’ functional outcome.

A follow-up study of patients with COVID-19 presenting with seizures

“…In the current study, we observed that seizures (as a presenting manifestation) in patients with COVID-19 are either acute symptomatic seizures (62.5%) or exacerbation of a pre-existing epilepsy/functional seizures (34.4%); only rarely a seizure heralds the beginning of an epileptic process (3.1%). Furthermore, a recent study showed that while seizures and status epilepticus could be encountered in patients with COVID-19, their occurrence did not correlate with the patients' functional outcome [13]. Our observation is consistent with that in previous studies [4,14] and it has important clinical implications.…”

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

“…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. In all of these studies, the most common reason for EEG monitoring was severely abnormal mental status followed by paroxysmal motor events concerning for seizures, and the proportion of patients on antiseizure medications was high (27-55%).…”

Analysis of neurology consultations in hospitalized patients with COVID-19

“…Epilepsy patients constituted a small proportion in both groups, and the majority of them had cerebral involvement. Increased seizure frequency and new-onset seizures during COVID-19 have been reported previously, and our data were similar to these [ 30 , 31 ].…”