Frequency of New Onset Seizures Amongst Adult Hospitalized Patients with COVID-19;A Systematic Review and Meta-Analysis

ABSTRACT

Objective: The objective of this study is to determine the frequency of seizures in adult hospitalized patients with COVID-19 without a prior history of epilepsy. Background: Infection with COVID-19 has been associated with neurological complications such as headache, dizziness, peripheral neuropathy, and acute vascular events. Acute onset seizures have been reported as a rare neurological complication in patients with COVID-19 infection. Design/Methods: PUBMED and EMBASE were searched from 12/01/2019 - 3/31/2021 in accordance with PRISMA guidelines, using the MESH terms ((Seizure) OR (Electroencephalography) OR (Status Epilepticus)) AND (COVID-19). The primary outcome was frequency of new onset seizure in hospitalized COVID-19 patients. Secondary outcomes were frequency of seizure in patients who had Electroencephalography (EEG) completed, risk of abnormal CerebroSpinal Fluid (CSF) results, and risk of abnormal imaging in patients with COVID-19. An inverse variance meta-analysis of single proportions was performed using the double arcsine method. A random effects model was used due to high inconsistency within the studies. Results: Ninety-four studies identifying 333 patients with COVID-19 and new onset seizures were included. Frequency of new onset seizures in adult hospitalized patients with COVID-19 was 0.71% ([95% confidential interval] [0.16-1.65], I2=89%, 147/28242 patients). Frequency of seizures in hospitalized COVID-19 patients who had EEG completed was 8.49% ([95% confidential interval] [0.62-24.07], I2=14%, 44/535 patients). The risk of abnormal imaging by either CT head, MRI or vessel imaging was 43.85% ([95% confidential interval] [17.47-72.27%], I2=58%, 58/128 patients). The risk of abnormal CSF results was 43.03% ([95% confidential interval] [4.28-88.35], I2=41%, 28/58 patients). Conclusions: The frequency of new onset seizures in patients with COVID-19 was 0.71% ([95% confidential interval] [0.16-1.65], I2=89%, 147/28242 patients). Slightly less than half of COVID-19 patients with seizures had evidence of structural abnormalities on head imaging as a complication from infection. A small percentage of patients with COVID-19 and seizures were diagnosed with acute viral encephalitis.