Abstracts

Rationale:
Coronaviruses have tropism for neural cells and there is evidence for neurologic manifestations of COVID-19. There is currently a paucity of definitive data on EEG changes in patients infected with SARS-CoV-2., with contradictory present in the literature. By setting broad inclusion criteria, we hoped to gain a broader insight into the effects of COVID-19 infection on EEG and cerebral function.
Method:
We performed a retrospective chart review of SARS-CoV-2 positive patients admitted at our institution who underwent video EEG monitoring between 3/31-5/15/2020. Inclusion criteria, included SARS-CoV-2 positive status as confirmed by PCR titer, continuous video EEG monitoring for at least 12 hours and aged 18 years or older.
Results:
After IRB approval, 16 patients met inclusion criteria. The mean age was 61 years (range 33-78) and the most common comorbidities were obesity (15/16 patients), diabetes mellitus (9/16), and hypertension (7/16). Reasons for obtaining EEG were: altered mental status (11/16), abnormal movements (4/16), abnormal neuroimaging (2/16) and clinical status epilepticus (1/16). All patients required ICU level of care, with a mean APACHE II score of 20.6, subsequent multiorgan failure, and correspondingly prolonged hospital courses. All EEGs demonstrated an abnormal background, with an absent PDR in 10/16, absent sleep architecture in 13/16 and generalized background slowing in 16/16. Focal slowing was seen in 3/16 patients and discharges with triphasic morphology in 5/16. Epileptiform discharges were seen in one EEG of a patient with pre-existing epilepsy. No seizures were captured despite high clinical suspicion in 3/16 patients. Abnormal movements were noted in 4/16 patients without EEG correlate.
Conclusion:
Although there is compelling evidence that COVID-19 affects neurologic function and all recorded EEGs were abnormal, we did not detect any seizures or unique EEG pattern in this sample. The abnormal background/generalized slowing noted in every EEG suggests a non-specific encephalopathy in this critically ill group, with focal dysfunction noted in 3/16 patients. A variety of abnormal movements were captured in 4 patients with no EEG correlate, which could represent an infectious or autoimmune movement disorder. Long-term follow up of these patients and repeat EEG maybe useful. As the pandemic continues, our cohort grows and may yield further results.
Funding:
:None