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1.
J Clin Neurophysiol ; 39(2): 159-165, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1868451

ABSTRACT

PURPOSE: Neurologic manifestations of coronavirus disease (COVID-19) such as encephalopathy and seizures have been described. To our knowledge, detailed EEG findings in COVID-19 have not yet been reported. This report adds to the scarce body of evidence. METHODS: We identified eight COVID-19 positive patients who underwent EEG monitoring in our hospital system. RESULTS: EEGs were most commonly ordered for an altered level of consciousness, a nonspecific neurologic manifestation. We observed generalized background slowing in all patients and generalized epileptiform discharges with triphasic morphology in three patients. Focal electrographic seizures were observed in one patient with a history of focal epilepsy and in another patient with no such history. Five of eight patients had a previous diagnosis of epilepsy, suggesting that pre-existing epilepsy can be a potential risk factor for COVID-19-associated neurological manifestations. Five of eight patients who underwent EEG experienced a fatal outcome of infection. CONCLUSIONS: Our findings underscore previous observations that neurologic manifestations are common in severe cases. COVID-19 patients with epilepsy may have an increased risk of neurological manifestations and abnormal EEG.


Subject(s)
COVID-19 , Epilepsies, Partial , Electroencephalography , Humans , SARS-CoV-2 , Seizures/diagnosis , Seizures/etiology
2.
Clin Neurophysiol ; 137: 102-112, 2022 05.
Article in English | MEDLINE | ID: covidwho-1729643

ABSTRACT

OBJECTIVE: To characterize continuous video electroencephalogram (VEEG) findings of hospitalized COVID-19 patients. METHODS: We performed a retrospective chart review of patients admitted at three New York City hospitals who underwent VEEG at the peak of the COVID-19 pandemic. Demographics, comorbidities, neuroimaging, VEEG indications and findings, treatment, and outcomes were collected. RESULTS: Of 93 patients monitored, 77% had severe COVID-19 and 40% died. Acute ischemic or hemorrhagic stroke was present in 26% and 15%, respectively. Most common VEEG indications were encephalopathy/coma (60%) and seizure-like movements (38%). Most common VEEG findings were generalized slowing (97%), generalized attenuation (31%), generalized periodic discharges (17%) and generalized sharp waves (15%). Epileptiform abnormalities were present in 43% and seizures in 8% of patients, all of whom had seizure risk factors. Factors associated with an epileptiform VEEG included increasing age (OR 1.07, p = 0.001) and hepatic/renal failure (OR 2.99, p = 0.03). CONCLUSIONS: Most COVID-19 patients who underwent VEEG monitoring had severe COVID-19 and over one-third had acute cerebral injury (e.g., stroke, anoxia). Seizures were uncommon. VEEG findings were nonspecific. SIGNIFICANCE: VEEG findings in this cohort of hospitalized COVID-19 patients were those often seen in critical illness. Seizures were uncommon and occurred in the setting of common seizure risk factors.


Subject(s)
COVID-19 , Pandemics , Electroencephalography/methods , Humans , Retrospective Studies , Seizures/diagnosis , Seizures/epidemiology
3.
Chest ; 161(2): e91-e96, 2022 02.
Article in English | MEDLINE | ID: covidwho-1664780

ABSTRACT

CASE PRESENTATION: A 54-year-old South African man with a medical history of type 2 diabetes mellitus, seizure disorder, OSA, and latent TB presented to the ER with gradually progressive dyspnea over months. He also reported occasional dry cough and fatigue at presentation but denied fever, chills, chest pain, leg swelling, palpitations, or lightheadedness. He was treated with a course of levofloxacin for presumed community-acquired pneumonia as an outpatient without improvement and had tested negative for COVID-19. He denied occupational or environmental exposures or sick contacts, though he had traveled back to South Africa 1 year before presentation. He had complex partial seizures for the past 22 years, which had been well controlled on phenytoin (300 mg daily). His other home medications included dulaglutide, sertraline, and atorvastatin and had no recent changes. He quit smoking 30 years ago after smoking one pack per day for 10 years.


Subject(s)
COVID-19/diagnosis , Drug Substitution/methods , Lacosamide/administration & dosage , Lung Diseases, Interstitial , Lung , Phenytoin , Seizures/drug therapy , Biopsy/methods , COVID-19/epidemiology , Diagnosis, Differential , Dyspnea/diagnosis , Dyspnea/etiology , Humans , Lung/diagnostic imaging , Lung/pathology , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Lung Diseases, Interstitial/therapy , Male , Middle Aged , Phenytoin/administration & dosage , Phenytoin/adverse effects , SARS-CoV-2 , Seizures/complications , Seizures/diagnosis , Tomography, X-Ray Computed/methods , Treatment Outcome , Voltage-Gated Sodium Channel Blockers/administration & dosage , Voltage-Gated Sodium Channel Blockers/adverse effects
4.
Epilepsia ; 63(1): 244-251, 2022 01.
Article in English | MEDLINE | ID: covidwho-1528372

ABSTRACT

OBJECTIVE: This study was undertaken to investigate the COVID-19 vaccine uptake rate and possible postvaccination effects in adults with epilepsy. METHODS: We invited adults with epilepsy attending three centers in China from July 24 to August 31, 2021 to participate in this study. We also asked age- and sex-matched controls among people attending for other chronic neuropsychiatric conditions and healthy controls accompanying people with illness attending the hospitals to participate. We excluded people who, under the national guidelines, had evident contradictions to vaccination. Participants were interviewed face-to-face using questionnaires. Vaccine uptake and postvaccine adverse events among the people with epilepsy were compared with those with neuropsychiatric conditions and controls. We also compared the willingness and reasons for hesitancy among unvaccinated participants. RESULTS: We enrolled 981 people, of whom 491 had epilepsy, 217 had other neuropsychiatric conditions, and 273 were controls. Forty-two percent of those with epilepsy had had the first dose of a vaccine, compared with 93% of controls and 84% of the people with neuropsychiatric conditions (p < .0001). The majority (93.8%) of those immunized had inactivated vaccines. Among the unvaccinated people with epilepsy, 59.6% were willing to have the vaccine. Their main reasons for hesitation were potential adverse effects (53.3%) and concerns about losing seizure control (47.0%). The incidence of adverse events in the epilepsy group was similar to controls. Nineteen people with epilepsy reported an increase in seizure frequency. No episode of status epilepticus or prolonged seizures was reported. Two controls had their first-ever seizure, which was unlikely related to the vaccine. SIGNIFICANCE: The vaccine uptake rate in people with epilepsy was lower than in their same-age controls. The postvaccination effect was no higher than in controls. We found no evidence suggesting worsening seizures after vaccination. Measurement and education focused on increasing the vaccination rate in epilepsy are warranted.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Epilepsy , Seizures , Vaccination/statistics & numerical data , Adult , COVID-19 Vaccines/adverse effects , Case-Control Studies , China , Epilepsy/diagnosis , Female , Humans , Male , SARS-CoV-2 , Seizures/diagnosis , Vaccines
5.
Clin Neurol Neurosurg ; 210: 106985, 2021 11.
Article in English | MEDLINE | ID: covidwho-1458745

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), a global issue now, can have a variety of clinical manifestations. Hundreds of articles have discussed different aspects of this infectious disease, such as physiopathology, epidemiology, clinical manifestations and treatment protocols. Recently, neurological manifestations of the disease have been found to be pretty common among COVID-19 patients. Here, neurological symptoms of COVID-19 infection with a focus on non-cerebrovascular complications are discussed in a large study population. METHODS: Neurological symptoms of 891hospitalized COVID-19 patients from March to June 2020 in a major Hospital, Tehran, Iran, were reviewed. Demographic characteristics and neurological manifestations were analyzed. RESULTS: Among 891 hospitalized COVID-19 patients, the following symptoms were observed: headache (63.9%), sleeping problems (51.3%), hyposmia/anosmia (46%), dizziness (45.4%), hypogeusia (42.1%), memory issues (31.5%), auditory disturbances (17.5%), paralysis (3.7%) and seizures (1.7%). In 29.7% of the patients, a neurological symptom was the initiating symptoms of the infection. Females were more likely to show headache and dizziness compared to males (p value<0.05). Headache intensity was also higher in females compared to males (p value<0.05). Headache prevalence was lower in older patients (p value<0.05), while memory loss and impaired consciousness were higher by increasing age (p values=0.002 and 0.001, respectively). CONCLUSION: Neurological manifestations were common among COVID-19 patients under study. Headache, as the most common neurological symptom among COVID-19 patients, was the most prevalent and intense among the female population. Headache, dizziness, sleeping problems, hyposmia/anosmia and hypogeusia were common COVID-19 neurological manifestations, while memory issues, auditory disturbances, paralysis, and seizures were less common.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Hospitalization/trends , Nervous System Diseases/epidemiology , Nervous System Diseases/therapy , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , Child , Cross-Sectional Studies , Dizziness/diagnosis , Dizziness/epidemiology , Dizziness/therapy , Female , Headache/diagnosis , Headache/epidemiology , Headache/therapy , Humans , Iran/epidemiology , Male , Middle Aged , Nervous System Diseases/diagnosis , Retrospective Studies , Seizures/diagnosis , Seizures/epidemiology , Seizures/therapy , Young Adult
6.
Seizure ; 92: 89-93, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1373266

ABSTRACT

OBJECTIVES: To explore the rate, characteristics, risk factors, and prognosis of children presenting with seizures as the main symptom of acute COVID-19 (coronavirus disease 2019). METHODS: We conducted a systematic retrospective study to identify all children who presented to the emergency departments of a tertiary academic medical center between March 1st and December 31st 2020 and had a SARS-CoV-2 infection based on RT-PCR (reverse transcription-polymerase chain reaction) from nasopharyngeal swab. Clinical and demographic data were extracted from the electronic medical records and reviewed. RESULTS: Total of 175 children were diagnosed with acute SARS-CoV-2 infection in the emergency departments during the study period. Of those, 11 presented with seizures. Age ranged from six months to 17 years and 4 were girls. Five presented with status epilepticus and responded to loading doses of anti-seizure medications. Six had fever. Seven had prior history of neurological disorder. Full recovery was the rule. SIGNIFICANCE: Unlike in adults, seizures occur early and may be the main manifestation of acute COVID-19 in children. Seizures, including status epilepticus, may occur without fever even in children with no history of epilepsy and are not associated with severe disease. A high index of suspicion is required for early diagnosis thus infection control measures can be taken.


Subject(s)
COVID-19 , Status Epilepticus , Adult , Child , Female , Humans , Infant , Retrospective Studies , SARS-CoV-2 , Seizures/diagnosis , Seizures/drug therapy , Seizures/epidemiology
7.
Neurol Sci ; 43(3): 2015-2020, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1358105

ABSTRACT

BACKGROUND: Neurological manifestations of COVID-19 infection are well recognized. Seizures and status epilepticus (SE) have been reported as possible manifestations and/or complications of SARS-CoV-2 infection at different disease stages, but few data are known about the type, severity, treatment response, and recurrence. METHODS: Single-center retrospective case series. RESULTS: This case series describes four COVID-19-positive patients admitted to an Italian University Hospital, who developed status epilepticus during the active phase of disease, independently from the severity of respiratory symptoms. Two of them presented a relapse after resolution of the acute viral infection, a feature that has not been previously reported. CONCLUSIONS: Although a possible association between SE and COVID-19 has been reported, the exact etiopathogenetic mechanism remains still not understood. Our series adds new insights to shed further light on this controversial issue.


Subject(s)
COVID-19 , Status Epilepticus , Humans , Retrospective Studies , SARS-CoV-2 , Seizures/diagnosis , Status Epilepticus/diagnosis , Status Epilepticus/etiology
8.
Epileptic Disord ; 23(2): 274-280, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1291312

ABSTRACT

The objective of this brief report is to review an assessment paradigm for conducting virtual neuropsychological pre-surgical evaluations in the context of the COVID-19 pandemic. A multidisciplinary epilepsy team at a Level 4 epilepsy center within a large children's academic medical center convened to discuss the challenges and possible solutions for Phase II evaluations for pediatric patients with pharmacoresistant epilepsy during the COVID-19 pandemic. The neuropsychologists explored evidence-based methods of virtual evaluation and developed a systematic decision-making process for youth requiring a Phase II evaluation. We propose models of assessment which prioritize teleneuropsychology when possible to reduce the risk of infection: (1) evaluation with directly administered tests through a completely virtual format; (2) virtual/in-person hybrid evaluation; and (3) clinical observation/interview in a virtual format supplemented by survey data. These models are illustrated by three cases. Using virtual assessment models, the team was able to meet the urgent patient care needs and collect useful data while minimizing the risk of virus spread. The paradigms presented may be useful examples for other multidisciplinary surgical teams interested in incorporating teleneuropsychology into their practices.


Subject(s)
COVID-19 , Drug Resistant Epilepsy/diagnosis , Drug Resistant Epilepsy/psychology , Pandemics , Telemedicine/methods , Adolescent , Child , Clinical Decision-Making , Drug Resistant Epilepsy/therapy , Epilepsies, Partial/diagnosis , Epilepsies, Partial/psychology , Epilepsies, Partial/therapy , Female , Humans , Infant , Models, Theoretical , Neuropsychological Tests , Patient Care Team , Seizures/diagnosis , Seizures/therapy , User-Computer Interface
9.
Neuropediatrics ; 52(4): 242-251, 2021 08.
Article in English | MEDLINE | ID: covidwho-1287846

ABSTRACT

Neurological emergencies account for about one-third of the highest severity codes attributed in emergency pediatric departments. About 75% of children with acute neurological symptoms presents with seizures, headache, or other paroxysmal events. Life-threatening conditions involve a minor proportion of patients (e.g., less than 15% of children with headache and less than 5% of children with febrile seizures). This review highlights updated insights about clinical features, diagnostic workup, and therapeutic management of pediatric neurological emergencies. Particularly, details will be provided about the most recent insights about headache, febrile seizures, status epilepticus, altered levels of consciousness, acute motor impairment, acute movement disorders, and functional disorders, as well as the role of diagnostic tools (e.g., neuroimaging, lumbar puncture, and electroencephalography), in the emergency setting. Moreover, the impact of the current novel coronavirus disease2019 (COVID-19) pandemic on the evaluation of pediatric neurologic emergencies will also be analyzed.


Subject(s)
Acute Disease , Headache/diagnosis , Seizures/diagnosis , Status Epilepticus/diagnosis , COVID-19 , Child , Emergencies , Headache/therapy , Humans , Pandemics , Pediatrics , Seizures/therapy , Status Epilepticus/therapy
10.
Neurodiagn J ; 61(2): 95-103, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1263635

ABSTRACT

Due to the coronavirus disease 2019 (COVID-19) pandemic, the state of Texas-limited elective procedures to conserve beds and personal protective equipment (PPE); therefore, between March 22 and May 18, 2020, admission to the epilepsy monitoring unit (EMU) was limited only to urgent and emergent cases. We evaluated clinical characteristics and outcomes of these patients who were admitted to the EMU. Nineteen patients were admitted (one patient twice) with average age of 36.26 years (11 female) and average length of stay 3 days (range: 2-9 days). At least one event was captured on continuous EEG (cEEG) and video monitoring in all 20 admissions (atypical in one). One patient had both epileptic (ES) and psychogenic non-epileptic seizures (PNES) while 10 had PNES and 9 had ES. In 8 of 9 patients with ES, medications were changed, while in 5 patients with PNES, anti-epileptic drugs (AED) were stopped; the remaining 5 were not on medications. Of the 14 patients who had seen an epileptologist pre-admission, 13 (or 93%) had their diagnosis confirmed by EMU stay; a statistically significant finding. While typically an elective admission, in the setting of the COVID-19 pandemic, urgent and emergent EMU admissions were required for increased seizure or event frequency. In the vast majority of patients (13 of 19), admission lead to medication changes to either better control seizures or to change therapeutics as appropriate when PNES was identified.


Subject(s)
COVID-19/prevention & control , Epilepsy , Hospitalization/legislation & jurisprudence , Adult , Aged , Clinical Decision-Making , Epilepsy/diagnosis , Epilepsy/therapy , Female , Hospital Units , Humans , Male , Middle Aged , Monitoring, Physiologic , SARS-CoV-2 , Seizures/diagnosis , Seizures/therapy , Young Adult
11.
J Psychosom Res ; 147: 110514, 2021 08.
Article in English | MEDLINE | ID: covidwho-1230633

ABSTRACT

OBJECTIVE: We investigated whether the COVID-19 pandemic has affected the clinical characteristics of patients with functional seizure (FS) (at the time of diagnosis). METHODS: In a retrospective study of a prospectively developed and maintained database, all patients diagnosed with FS before and during the COVID-19 pandemic were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from December 2008 until February 2021. RESULTS: Three hundred and eighty-eight patients were studied. Three hundred and sixty-four patients (94%) were diagnosed before and 24 persons (6%) during the pandemic. Patients diagnosed during the COVID-19 pandemic less frequently had generalized motor seizures [odds ratio (OR): 0.30, 95% confidence interval (CI): 0.12-0.77; p = 0.012] and had higher seizure frequencies (OR: 1.00, 95% CI: 1.00-1.01; p = 0.044). Functional seizures were inversely associated with the education level as a trend during the COVID-19 pandemic (OR: 0.36, 95% CI: 0.13-1.01; p = 0.052). CONCLUSION: The COVID-19 pandemic has affected the characteristics of patients with FS (at the time of diagnosis). Larger and multi-center studies are needed to investigate the links and associations between the COVID-19 pandemic and characteristics of FS.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Pandemics , Seizures/complications , Adult , Ambulatory Care Facilities , Educational Status , Electroencephalography , Humans , Male , Middle Aged , Odds Ratio , Retrospective Studies , Seizures/diagnosis , Seizures/psychology , Young Adult
12.
Epilepsia Open ; 6(2): 437-442, 2021 06.
Article in English | MEDLINE | ID: covidwho-1222614

ABSTRACT

OBJECTIVE: Hyperventilation (HV) is one of the main and basic activation methods during ambulatory electroencephalogram (EEG), unless medical reasons contraindicate it. During the COVID-19 pandemic, with the high risk of human-to-human infection, local guidelines and recommendations have been developed that suggest not to perform the HV maneuver routinely. Our objective was to characterize patients who present positive HV in an epilepsy center. METHODS: We analyzed retrospectively all the ambulatory EEGs performed during one year in our specialized ambulatory child and adolescent epilepsy center, and describe patients with positive maneuver. RESULTS: A total of 305 EEGs were performed. Patients under 3 years and 11 months were excluded as well as all patients that did not fill up the criteria for epilepsy diagnosis. From the 252 EEGs that were included in the study, 194 EEGs (77%) were classified as abnormal and 58 (23%) as normal. From these same 252 EEGs, 150 EEG finished correctly the HV maneuver. Physiological slowing response was found in 54 EEGs (36%), no changes (negative) in 83 (55%), and abnormal response (positive) in 13 EEGs (9%). The 13 HV-positive EEGs showed 4 patients with an increase of epileptiform activity, 3 patients experienced an increase of basal preregistered abnormal slowing, and 6 EEGs showed trigger of bilaterally synchronous and symmetric 2-4 Hz spike-and-slow wave discharges and absences. None of these last 6 patients needed more than 3 minutes to elicit the paroxysmal discharge. SIGNIFICANCE: Based on these findings and according with other studies, the low positivity and high specificity of the HV maneuver support the idea that HV could be excluded during the COVID-19 pandemic situation, and also reevaluate whether it could be changed to a complementary maneuver, restricted only for cases where absence epilepsy is suspected. Larger studies will be needed to reaffirm this proposal.


Subject(s)
Ambulatory Care , COVID-19 , Electroencephalography/methods , Epilepsy, Absence , Adolescent , Ambulatory Care/methods , Ambulatory Care/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , Child , Chile/epidemiology , Diagnostic Techniques, Neurological/standards , Diagnostic Techniques, Neurological/trends , Epilepsy, Absence/diagnosis , Epilepsy, Absence/epidemiology , Epilepsy, Absence/physiopathology , Female , Humans , Hyperventilation , Male , Retrospective Studies , SARS-CoV-2 , Seizures/diagnosis , Seizures/physiopathology , Sensitivity and Specificity
13.
Ann Neurol ; 89(5): 872-883, 2021 05.
Article in English | MEDLINE | ID: covidwho-1148790

ABSTRACT

OBJECTIVE: 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. METHODS: 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. RESULTS: 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]). INTERPRETATION: 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;89:872-883.


Subject(s)
COVID-19/epidemiology , COVID-19/physiopathology , Electroencephalography/trends , Seizures/epidemiology , Seizures/physiopathology , Aged , COVID-19/diagnosis , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Seizures/diagnosis , Treatment Outcome
14.
Minerva Anestesiol ; 87(10): 1139-1145, 2021 10.
Article in English | MEDLINE | ID: covidwho-1124950

ABSTRACT

Continuous video-EEG (cEEG, lasting hours to several days) is increasingly used in ICU patients, as it is more sensitive than routine video-EEG (rEEG, lasting 20-30 min) to detect seizures or status epilepticus, and allows more frequent changes in therapeutic regimens. However, cEEG is more resource-consuming, and its relationship to outcome compared to repeated rEEG has only been formally assessed very recently in a randomized controlled trial, which did not show any significant difference in terms of long-term mortality or functional outcome. Awaiting more refined trials, it seems therefore that using repeated rEEG in ICU patients may represent a reasonable alternative in resource-limited settings. Prolonged EEG has been used recently in patients with severe COVID-19 infection, the proportion of seizures seems albeit relatively low, and similar to ICU patients with medical conditions. As a timely EEG recording is recommended in the ICU in any case, recent technical developments may ease its use in clinical practice.


Subject(s)
COVID-19 , Electroencephalography , Humans , Intensive Care Units , Monitoring, Physiologic , SARS-CoV-2 , Seizures/diagnosis
15.
J Investig Med High Impact Case Rep ; 9: 2324709620986302, 2021.
Article in English | MEDLINE | ID: covidwho-1112425

ABSTRACT

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.


Subject(s)
Brain/diagnostic imaging , COVID-19/epidemiology , Limbic Encephalitis/epidemiology , Pandemics , SARS-CoV-2 , Seizures/etiology , Comorbidity , Electroencephalography , Humans , Limbic Encephalitis/complications , Magnetic Resonance Imaging , Male , Middle Aged , Seizures/diagnosis
18.
Neurol Sci ; 42(2): 415-431, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-942542

ABSTRACT

OBJECTIVE: We discuss the evidence on the occurrence of de novo seizures in patients with COVID-19, the consequences of this catastrophic disease in people with epilepsy (PWE), and the electroencephalographic (EEG) findings in patients with COVID-19. METHODS: This systematic review was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Scopus, and Embase from inception to August 15, 2020 were systematically searched. These key words were used: "COVID" AND "seizure" OR "epilepsy" OR "EEG" OR "status epilepticus" OR "electroencephalography". RESULTS: We could identify 62 related manuscripts. Many studies were case reports or case series of patients with COVID-19 and seizures. PWE showed more psychological distress than healthy controls. Many cases with new-onset focal seizures, serial seizures, and status epilepticus have been reported in the literature. EEG studies have been significantly ignored and underused globally. CONCLUSION: Many PWE perceived significant disruption in the quality of care to them, and some people reported increase in their seizure frequency since the onset of the pandemic. Telemedicine is a helpful technology that may improve access to the needed care for PWE in these difficult times. De novo seizures may occur in people with COVID-19 and they may happen in a variety of forms. In addition to prolonged EEG monitoring, performing a through metabolic investigation, electrocardiogram, brain imaging, and a careful review of all medications are necessary steps. The susceptibility of PWE to contracting COVID-19 should be investigated further.


Subject(s)
COVID-19 , Electroencephalography , Epilepsy , Seizures , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , Epilepsy/diagnosis , Epilepsy/physiopathology , Humans , Seizures/diagnosis , Seizures/etiology , Seizures/physiopathology
19.
Seizure ; 83: 234-241, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-872486

ABSTRACT

OBJECTIVE: We performed a systematic review of the literature to synthesize the data on EEG findings in COVID-19. Frontal EEG patterns are reported to be a characteristic finding in COVID-19 encephalopathy. Although several reports of EEG abnormalities are available, there is lack of clarity about typical findings. METHODS: Research databases were queried with the terms "COVID" OR "coronavirus" OR "SARS" AND "EEG". Available data was analyzed from 617 patients with EEG findings reported in 84 studies. RESULTS: The median age was 61.3 years (IQR 45-69, 33.3 % female). Common EEG indications were altered mental status (61.7 %), seizure-like events (31.2 %), and cardiac arrest (3.5 %). Abnormal EEG findings (n = 543, 88.0 %) were sub-classified into three groups: (1) Background abnormalities: diffuse slowing (n = 423, 68.6 %), focal slowing (n = 105, 17.0 %), and absent posterior dominant rhythm (n = 63, 10.2 %). (2) Periodic and rhythmic EEG patterns: generalized periodic discharges (n = 35, 5.7 %), lateralized/multifocal periodic discharges (n = 24, 3.9 %), generalized rhythmic activity (n = 32, 5.2 %). (3) Epileptiform changes: focal (n = 35, 5.7 %), generalized (n = 27, 4.4 %), seizures/status epilepticus (n = 34, 5.5 %). Frontal EEG patterns comprised of approximately a third of all findings. In studies that utilized continuous EEG, 96.8 % (n = 243) of the 251 patients were reported to have abnormalities compared to 85.0 % (n = 311) patients who did not undergo continuous EEG monitoring (χ2 = 22.8, p =< 0.001). SIGNIFICANCE: EEG abnormalities are common in COVID-19 related encephalopathy and correlates with disease severity, preexisting neurological conditions including epilepsy and prolonged EEG monitoring. Frontal findings are frequent and have been proposed as a biomarker for COVID-19 encephalopathy.


Subject(s)
COVID-19/physiopathology , Electroencephalography , Epilepsy/physiopathology , COVID-19/virology , Electroencephalography/methods , Epilepsy/diagnosis , Humans , Monitoring, Physiologic/methods , SARS-CoV-2/pathogenicity , Seizures/diagnosis , Seizures/physiopathology
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