ABSTRACT
BackgroundNeurological manifestations of COVID-19 have only recently been described, with a paucity of literature reporting the potential relationship between COVID-19 and acute symptomatic seizures. Two prior studies found no clinical or electrographic seizures in their cohorts of COVID-19 patients with altered mental status (AMS) and clinical seizure-like events (SLEs). MethodsIn this retrospective cohort study, 22 critically-ill COVID-19 patients above the age of 18 years who underwent EEG (electroencephalography) monitoring between April 20th, 2020 and May 20th, 2020 were studied. 19 patients underwent continuous EEG (cEEG) for at least 24 hours, and 3 patients underwent routine EEGs (<1 hour). Demographics including age, gender, comorbid medical, and neurological conditions were collected. Clinical variables included EEG findings, anti-seizure medications, discharge disposition, and survival. Findings17 patients underwent EEG monitoring for unexplained altered mental status changes and 5 patients underwent monitoring for a seizure-like event. 5 patients had epileptiform abnormalities on EEG (4 patients on cEEG, 1 on routine EEG); and only 2 of 5 epileptic EEG patients had a prior history of epilepsy. 2 patients in our cohort had electrographic seizures in the absence of prior epilepsy history. No patients with epileptiform abnormalities or electrographic seizures had acutely abnormal neuroimaging on CT or MRI. InterpretationEncephalopathic COVID-19 positive patients had a range of EEG abnormalities, and a higher proportion of patients in this series had electrographic seizures than previous literature suggests. This may be influenced by the duration of monitoring with cEEG and the use of a 21 channel electrode system. cEEG findings may help to guide antiseizure medical therapy, as well as the workup of altered mental status in the setting of unremarkable neuroimaging. FundingNo funding was used for this study.
ABSTRACT
DISCLAIMERThis article does not represent the official recommendation of the Cleveland Clinic or Case Western Reserve University School of Medicine, nor has it yet been peer reviewed. We are releasing it early, pre-peer review, to allow for quick dissemination/vetting by the scientific/clinical community given the necessity for rapid conservation of personal protective equipment (PPE) during this dire global situation. We welcome feedback from the community. Personal protective equipment (PPE), including face shields, surgical masks, and N95 respirators, is crucially important to the safety of both patients and medical personnel, particularly in the event of an infectious pandemic. As the incidence of Coronavirus Disease (COVID-19) increases exponentially in the United States and worldwide, healthcare provider demand for these necessities is currently outpacing supply. As such, strategies to extend the lifespan of the supply of medical equipment as safely as possible are critically important. In the midst of the current pandemic, there has been a concerted effort to identify viable ways to conserve PPE, including decontamination after use. Some hospitals have already begun using UV-C light to decontaminate N95 respirators and other PPE, but many lack the space or equipment to implement existing protocols. In this study, we outline a procedure by which PPE may be decontaminated using ultraviolet (UV) radiation in biosafety cabinets (BSCs), a common element of many academic, public health, and hospital laboratories, and discuss the dose ranges needed for effective decontamination of critical PPE. We further discuss obstacles to this approach including the possibility that the UV radiation levels vary within BSCs. Effective decontamination of N95 respirator masks or surgical masks requires UV-C doses of greater than 1 Jcm-2, which would take a minimum of 4.3 hours per side when placing the N95 at the bottom of the BSCs tested in this study. Elevating the N95 mask by 48 cm (so that it lies 19 cm from the top of the BSC) would enable the delivery of germicidal doses of UV-C in 62 minutes per side. Effective decontamination of face shields likely requires a much lower UV-C dose, and may be achieved by placing the face shields at the bottom of the BSC for 20 minutes per side. Our results are intended to provide support to healthcare organizations looking for alternative methods to extend their reserves of PPE. We recognize that institutions will require robust quality control processes to guarantee the efficacy of any implemented decontamination protocol. We also recognize that in certain situations such institutional resources may not be available; while we subscribe to the general principle that some degree of decontamination is preferable to re-use without decontamination, we would strongly advise that in such cases at least some degree of on-site verification of UV dose delivery be performed.
