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The authors of this study examined EEG abnormalities in 197 patients with active COVID-19 infection. Clinical seizures were observed in 38 patients (19.3%), 22 of whom had a prior history of CNS disorders, including 12 with epilepsy. Of the remaining 16 patients with seizures, 5 had an intracranial lesion on CT or MRI, and 10 had a medical condition lowering seizure threshold (electrolyte disturbance, anoxic brain injury, sepsis, acute respiratory distress syndrome). There were 19 patients who had electrographic seizures on continuous EEG; 11 of these patients had nonconvulsive status epilepticus, and 14 had either a history of CNS disorders or intracranial lesions. Only 1 patient had new-onset seizure without any CNS lesion or identifiable seizure risk factors. Epileptiform abnormalities were noted in 48.7% of patients on continuous EEG.
These data provide additional evidence regarding the prevalence of seizures in COVID-19 patients. There is little evidence to suggest that COVID-19 has a directly epileptogenic process. However, patients with a prior history of neurologic disorders and/or severe metabolic derangements have a higher risk of developing seizures in the setting of acute COVID-19 infection.
The aim was to determine the prevalence and risk factors for electrographic seizures and other electroencephalographic (EEG) patterns in patients with Coronavirus disease 2019 (COVID-19) undergoing clinically indicated continuous electroencephalogram (cEEG) monitoring and to assess whether EEG findings are associated with outcomes.
We identified 197 patients with COVID-19 referred for cEEG at 9 participating centers. Medical records and EEG reports were reviewed retrospectively to determine the incidence of and clinical risk factors for seizures and other epileptiform patterns. Multivariate Cox proportional hazards analysis assessed the relationship between EEG patterns and clinical outcomes.
Electrographic seizures were detected in 19 (9.6%) patients, including nonconvulsive status epilepticus (NCSE) in 11 (5.6%). Epileptiform abnormalities (either ictal or interictal) were present in 96 (48.7%). Preceding clinical seizures during hospitalization were associated with both electrographic seizures (36.4% in those with vs 8.1% in those without prior clinical seizures, odds ratio [OR] 6.51, p = 0.01) and NCSE (27.3% vs 4.3%, OR 8.34, p = 0.01). A pre-existing intracranial lesion on neuroimaging was associated with NCSE (14.3% vs 3.7%; OR 4.33, p = 0.02). In multivariate analysis of outcomes, electrographic seizures were an independent predictor of in-hospital mortality (hazard ratio [HR] 4.07 [1.44-11.51], p < 0.01). In competing risks analysis, hospital length of stay increased in the presence of NCSE (30 day proportion discharged with vs without NCSE: HR 0.21 [0.03-0.33] vs 0.43 [0.36-0.49]).
This multicenter retrospective cohort study demonstrates that seizures and other epileptiform abnormalities are common in patients with COVID-19 undergoing clinically indicated cEEG and are associated with adverse clinical outcomes. ANN NEUROL 2021.
Electroencephalographic Abnormalities Are Common in COVID-19 and Are Associated With Outcomes
Ann. Neurol 2021 Mar 11;[EPub Ahead of Print], L Lin, A Al-Faraj, N Ayub, P Bravo, S Das, L Ferlini, I Karakis, JW Lee, SS Mukerji, CR Newey, J Pathmanathan, M Abdennadher, C Casassa, N Gaspard, DM Goldenholz, EJ Gilmore, J Jing, JA Kim, EY Kimchi, HS Ladha, S Tobochnik, S Zafar, LJ Hirsch, MB Westover, MM Shafi