Seizure and COVID-19: Association and review of potential mechanism

Narula, Naureen; Joseph, Rudman; Katyal, Nakul; Daouk, Aref; Acharya, Sudeep; Avula, Akshay; Maroun, Rabih

doi:10.1016/j.npbr.2020.10.001

Cited by 34 publications

(45 citation statements)

References 33 publications

(44 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…On the other hand, new onset seizures can occur in patients who have metabolic derangement due to systemic complications of COVID-19. Seizures can be due to structural insult in the brain which can be a new lesion after COVID infection as a result of an ischemic, inflammatory, or a potential direct viral encephalitis [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Seizure has been reported as a life-threatening neurological complication of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [ 1 , 2 ]. Potential mechanisms have been speculated to cause seizure in the setting of COVID-19 including encephalitis, cytokine storm, hypoxia, and metabolic derangement [ 3 ]. Here we report a case of COVID-19-related refractory status epilepticus with the presence of SARS-CoV-2 ribonucleic acid (RNA) in the cerebrospinal fluid (CSF).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

COVID-19-related refractory status epilepticus with the presence of SARS-CoV-2 (RNA) in the CSF: a case report

et al. 2021

View full text Add to dashboard Cite

Amongst the neurologic complications of COVID-19 disease, very few reports have shown the presence of the virus in the cerebrospinal fluid (CSF). Seizure and rarely status epilepticus can be associated with COVID-19 disease. Here we present a 73-year-old male with prior history of stroke who has never experienced seizure before. He had no systemic presentation of COVID-19 disease. The presenting symptoms were two consecutive generalized tonic-clonic seizures that after initial resolution turned into a nonconvulsive status epilepticus despite antiepileptic treatment (a presentation similar to NORSE (new-onset refractory status epilepticus)). There was no new lesion in the brain magnetic resonance imaging (MRI). The CSF analysis only showed an increased protein levels and positive reverse transcription polymerase chain reaction (RT-PCR) of 2019-nCoV. Patient recovered partially after anesthetic, IVIG, steroid, and remdesivir. To our knowledge, this is the first report of a refractory status epilepticus with the presence of SARS-CoV-2 ribonucleic acid (RNA) in the CSF.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19-related refractory status epilepticus with the presence of SARS-CoV-2 (RNA) in the CSF: a case report

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In the specific context of the direct viral action on the central nervous system, resulting in neurological symptoms, even though the majority of the analyzed cases did not present with RT-PCR positivity in cerebrospinal fluid 7,10,11,12,13,14,15,16 (either because of no availability of testing at the time, or low sensitivity -in one case, when repeated, results came out positive 17 ), two main pathways might be theorized: the targeting of the angiotensin-converting-enzyme-2 receptors, which are heavily present in the central nervous system, including brain cells, glial cells, and endothelial cells of the blood-brain barrier; or through the olfactory nerve, causing inflammation and demyelination 1,18,19 .…”

Section: Discussionmentioning

confidence: 99%

Electroencephalographic findings among inpatients with COVID-19 in a tertiary hospital from a middle-income country

Corazza

Tatsch

Barros

et al. 2021

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Background: In 2019, the world witnessed the emergence of a new type of coronavirus - the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The spectrum of coronavirus disease 2019 (COVID-19) is variable, and amongst its manifestations are neurological implications. Objective: This report aimed to describe electroencephalographic findings in COVID-19 patients from a general tertiary hospital in São Paulo, Brazil. Methods: It was a retrospective, observational, and non-interventional study. Data were collected anonymously, comprising inpatients from Mar 1 to Jun 30, 2020, either confirmed (positive RT-PCR) or probable cases (CO-RADS 4/5) who had performed EEG during hospitalization. Results: Twenty-eight patients were enrolled, 17 (60.7%) women and 11 men, with a median age of 58 (minimum and maximum: 18-86; IQR 23.5). COVID-19 diagnosis was confirmed in 22 (78.5%). Twenty-one patients (75%) had severe disease, requiring mechanical ventilation due to acute respiratory distress syndrome (ARDS); 16 (57.1%) patients developed adjunct sepsis throughout hospitalization. There was no specific pattern found for COVID-19 in EEG. No patients presented with status epilepticus or electrographic events; most patients developed an encephalopathic pattern, as seen in most studies, with a high prevalence of altered mental status as an indication for EEG. Adjunct sepsis was associated with higher mortality. Conclusions: EEG presents as a useful tool in the context of COVID-19, as in other conditions, to differentiate nonconvulsive status epilepticus (NCSE) from encephalopathy and other causes of mental status alterations. Further studies are required to analyze whether there might be a specific EEG pattern to the disease.

show abstract

“…Seizure was observed in 42 (9%) cases and was found to be higher in the non-survivor group than in the survivor group. This was explained in the literature by several hypothesized mechanisms, such as the hypoxic effect of COVID-19 [61] and the ability of SARS-COV-2 to enter the central nervous system through the angiotensin-converting-enzyme-2 (ACE-2) receptor cells or through the olfactory nerve [62][63][64].…”

Section: Plos Onementioning

confidence: 99%

Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

et al. 2021

View full text Add to dashboard Cite

Background The coronavirus disease (COVID-19) pandemic has severely affected African countries, specifically the countries, such as Libya, that are in constant conflict. Clinical and laboratory information, including mortality and associated risk factors in relation to hospital settings and available resources, about critically ill patients with COVID-19 in Africa is not available. This study aimed to determine the mortality and morbidity of COVID-19 patients in intensive care units (ICU) following 60 days after ICU admission, and explore the factors that influence in‐ICU mortality rate. Methods This is a multicenter prospective observational study among COVID-19 critical care patients in 11 ICUs in Libya from May 29th to December 30th 2020. Basic demographic data, clinical characteristics, laboratory values, admission Sequential Organ Failure Assessment (SOFA) score, quick SOFA, and clinical management were analyzed. Result We included 465 consecutive COVID-19 critically ill patients. The majority (67.1%) of the patients were older than 60 years, with a median (IQR) age of 69 (56.5–75); 240 (51.6%) were male. At 60 days of follow-up, 184 (39.6%) were discharged alive, while 281 (60.4%) died in the intensive care unit. The median (IQR) ICU length of stay was 7 days (4–10) and non-survivors had significantly shorter stay, 6 (3–10) days. The body mass index was 27.9 (24.1–31.6) kg/m2. At admission to the intensive care unit, quick SOFA median (IQR) score was 1 (1–2), whereas total SOFA score was 6 (4–7). In univariate analysis, the following parameters were significantly associated with increased/decreased hazard of mortality: increased age, BMI, white cell count, neutrophils, procalcitonin, cardiac troponin, C-reactive protein, ferritin, fibrinogen, prothrombin, and d-dimer levels were associated with higher risk of mortality. Decreased lymphocytes, and platelet count were associated with higher risk of mortality. Quick SOFA and total SOFA scores increase, emergency intubation, inotrope use, stress myocardiopathy, acute kidney injury, arrythmia, and seizure were associated with higher mortality. Conclusion Our study reported the highest mortality rate (60.4%) among critically ill patients with COVID-19 60 days post-ICU admission. Several factors were found to be predictive of mortality, which may help to identify patients at risk of mortality during the ongoing COVID-19 pandemic.

show abstract

Seizure and COVID-19: Association and review of potential mechanism

Cited by 34 publications

References 33 publications

COVID-19-related refractory status epilepticus with the presence of SARS-CoV-2 (RNA) in the CSF: a case report

COVID-19-related refractory status epilepticus with the presence of SARS-CoV-2 (RNA) in the CSF: a case report

Electroencephalographic findings among inpatients with COVID-19 in a tertiary hospital from a middle-income country

Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

Contact Info

Product

Resources

About