Report on <scp>Electroencephalographic</scp> Findings in Critically Ill Patients with <scp>COVID</scp>‐19

Vespignani, Hervé; Colas, Damien; Lavin, Bruce; Soufflet, Christine; Maillard, Louis; Pourcher, Valérie; Paccoud, Olivier; Medjebar, Samir; Frouin, Pierre Yves

doi:10.1002/ana.25814

Cited by 59 publications

(49 citation statements)

References 20 publications

(19 reference statements)

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“…While there has been concern that intranasal infection may be a potential route for coronavirus neuroinvasion 24 , there was no clear association between epileptiform findings and anosmia, nor was there a fronto-temporal predominance to suggest specifically limbic involvement. Other groups have noted frontally predominant abnormalities in patients with SARS-CoV-2 7,8,25,26 , but in at least one paper frontal slowing appeared similar to that seen in metabolic encephalopathies and correlated with systemic lab findings 7 . Although a few encephalitides are associated with suggestive EEG findings, such as very low frequency periodic complexes in measles-related subacute sclerosing panencephalitisis 27 or lateralized periodic epileptiform discharges in HSV encephalitis 28 , neither finding is necessarily specific.…”

Section: Sars-cov-2 and Epileptiform Eeg Findingsmentioning

confidence: 71%

“…One early series of patients with severe infection described neurologic findings of impaired consciousness (14.8%) and seizure (1.1%) 3 , while another noted that 27% of patients had seizure risk factors, though clinical seizures appeared rare 4 . However, routine EEG data to support or contextualize these concerns has been limited to smaller series [5][6][7][8] , with some series abstaining from EEGs altogether due to safety concerns 4 , including limited personal protective equipment (PPE), risks of technician exposure, and possible iatrogenic spread through personnel or equipment contamination. A paucity of EEGs could underestimate the rate of seizures and epileptiform activity in SARS-CoV-2, given reports of seizures in other coronavirus outbreaks 9 and reports of patients with SARS-CoV-2 with nonconvulsive or focal status epilepticus 10,11 .…”

Section: Introductionmentioning

confidence: 99%

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Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2

Ayub¹,

Cohen²,

Jin

et al. 2020

Preprint

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Background and Purpose Reports have suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes neurologic manifestations including encephalopathy and seizures. However, there has been relatively limited electrophysiology data to contextualize these specific concerns and to understand their associated clinical factors. Our objective was to identify EEG abnormalities present in patients with SARS-CoV-2, and to determine whether they reflect new or preexisting brain pathology. Methods We studied a consecutive series of hospitalized patients with SARS-CoV-2 who received an EEG, obtained using tailored safety protocols. Data from EEG reports and clinical records were analyzed to identify EEG abnormalities and possible clinical associations, including neurologic symptoms, new or preexisting brain pathology, and sedation practices. Results We identified 37 patients with SARS-CoV-2 who underwent EEG, of whom 14 had epileptiform findings (38%). Patients with epileptiform findings were more likely to have preexisting brain pathology (6/14, 43%) than patients without epileptiform findings (2/23, 9%; p=0.042). There were no clear differences in rates of acute brain pathology. One case of nonconvulsive status epilepticus was captured, but was not clearly a direct consequence of SARS-CoV-2. Abnormalities of background rhythms were common, and patients recently sedated were more likely to lack a posterior dominant rhythm (p=0.022). Conclusions Epileptiform abnormalities were common in patients with SARS-CoV-2 referred for EEG, but particularly in the context of preexisting brain pathology and sedation. These findings suggest that neurologic manifestations during SARS-CoV-2 infection may not solely relate to the infection itself, but rather may also reflect patients' broader, preexisting neurologic vulnerabilities.

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Section: Sars-cov-2 and Epileptiform Eeg Findingsmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2

Ayub¹,

Cohen²,

Jin

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…14,[27][28][29] A recent study reviewing EEG findings from a cohort of 26 critically ill patients who underwent EEG testing in France did not report any seizures, but highlighted findings consistent with encephalopathy in these patients. 30 As with infectious processes in general, patients with pre-existing epilepsy may experience seizure exacerbations in the setting of COVID-19. Of interest we found that 15% of patients without a history of epilepsy experienced clinical or EEG seizures, although it is likely that not all "clinically probable" seizures prior to EEG testing were true seizures, as there are mimics of seizures in the critically ill population (eg, myoclonus, movement disorders, or cardiac events).…”

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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“…Relatively small cohorts of patients with COVID-19 and EEG are published to date, with the patients in these studies only undergoing routine duration or reduced montage EEG recording, for the reasons discussed above, and less frequently continuous EEG monitoring. Several authors observed sporadic epileptiform abnormalities and periodic patterns of concern, including generalized periodic discharges, along with more expected patterns of generalized slowing ( 22 – 26 ). Due to centers taking precautions to avoid transmission risk by reducing staffing and utilization of EEG, as well as obtaining imaging, cases of electrographic seizures and NCSE may be less likely to be diagnosed and adequately imaged.…”

Section: Discussionmentioning

confidence: 99%

Acute Seizures Occurring in Association With SARS-CoV-2

et al. 2020

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Seizures are an infrequent and serious neurological complication of SARS-CoV-2 infection, with limited data describing the etiology and the clinical context in which these occur or the associated electrographic and imaging findings. This series details four cases of seizures occurring in patients with COVID-19 with distinct time points, underlying pathology, and proposed physiological mechanisms. An enhanced understanding of seizure manifestations in COVID-19 and their clinical course may allow for earlier detection and improved patient management.

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Report on Electroencephalographic Findings in Critically Ill Patients with COVID‐19

Cited by 59 publications

References 20 publications

Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2

Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2

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

Acute Seizures Occurring in Association With SARS-CoV-2

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