Abstracts

Rationale:
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for current and ongoing pandemic of coronavirus disease 2019 (COVID-19). Coronaviruses including SARS-CoV-2 have been known to be neurotropic, resulting in a variety of neurological complications including acute cerebrovascular disease, ataxia and seizures. To date, available literature on COVID-19 suggests that there is a relatively low incidence of seizures and status epilepticus in COVID-19, and this is mainly seen in patients with severe systemic diseases. However, patients with COVID-19 can be susceptible to seizures due to systemic abnormalities including hypoxia, severe metabolic alterations, multi-organ failure, stroke, and environmental factors. As such, using retrospective data, we have studied the clinical characteristics of patients who had seizures during admission for COVID-19 at Ochsner-Louisiana State University Health Sciences Center, Shreveport (OLSU-S).
Method:
We reviewed all clinical data including epidemiology (especially history of seizures or history of cerebrovascular events), clinical features, laboratory data, hospital management and course from 75 patients admitted with a confirmed SARS-COV-2. We also studied EEG characteristics of patients who developed seizures during COVID-19 admission.
Results:
We screened 75 patients admitted to OLSU-S for the management of COVID-19 for new onset of seizures during the hospital course. 3 out of 75 (4%) patients had new onset seizures with EEG consisting of non-specific findings including no epileptiform discharges or evidence of nonconvulsive status epilepticus. These three patients with new onset seizures also had severe COVID features (as indicated by high SOFA [sequential organ failure assessment] scores). Laboratory data of these patients with new onset seizures revealed elevated d-dimers, elevated transaminases, elevated c-reactive protein and lactate dehydrogenase, and lymphopenia. Additionally, there were no identifiable epileptogenic triggers including hypoglycemia, abnormal electrolytes, medication or drug exposure or prior events in these three patients with new onset seizures. Interestingly, two out of the three patients with new onset seizures also had rapidly declining clinical phenotype resulting in their demise within two weeks of hospital admission.
Conclusion:
Our data confirms the low incidence of new onset seizures associated with COVID-19 hospital admissions at OLSU-S. New onset seizure in COVID-19 patients suggests adverse clinical phenotype with poor prognosis. Therefore, seizures are not typical in COVID-19 patients, however, should they occur in patients with critical medical condition and rapidly impaired mental status may have an adverse outcome including rapid death.  Based on our preliminary findings, additional evaluation should be provided (including diagnostic EEG and start of prophylactic anti-seizure medication if deemed necessary) for COVID-19 patients in which new onset seizures occur or there is a high clinical suspicion of seizures.
Funding:
:No funding