Abstracts

Rationale: Various neurological manifestations have been reported with COVID-19. Our study has 2 aims: 1) report the incidence of new onset epileptic seizures after discharge from the hospital following an inpatient admission for SARS-CoV-2 infection; 2) characterize seizure type, EEG findings, and epilepsy etiology for these patients.

Methods: This retrospective study analyzes a case series of patients previously admitted with COVID-19 to Montefiore hospitals in New York City. Inclusion criteria: 1) admission between 3/1/20 - 5/31/20, SARS-CoV-2 PCR nasopharyngeal swab positivity during admission, all ages/genders; 2) new-onset seizures after hospital discharge (6/2020 - 2/2021) reported in electronic medical record (EMR) using specific ICD-10 codes. Exclusion criteria: 1) prior reported seizures/epilepsy in EMR using specific ICD-9/10 codes (last 10 years); 2) new-onset seizures or mortality during admission. Patients who met inclusion/exclusion criteria had their charts individually reviewed and new-onset seizures/epilepsy are reported here only in those having high clinical suspicion of epileptic seizures.

Results: 2595 patients (2554 adults, 41 children) met inclusion/exclusion criteria. Of these, 26 patients, all adults, were reported as having new seizures/epilepsy or suspicion for seizures based on ICD-10 codes after their initial admission for COVID-19 and had their medical charts reviewed. Ten patients were confirmed to have new-onset epileptic seizures (high clinical suspicion), 16 had low suspicion for epileptic seizures (differential diagnoses: syncope, altered mental status). Four out of the 10 patients had provoked seizures, 6 had unprovoked seizures/epilepsy. The calculated incidence of new-onset epileptic seizures after hospital discharge for COVID-19 infection is 0.38% (10/2595), and 0.23% (6/2595) when only unprovoked epileptic seizures are considered. Median age was 69 (N=10, range 19 - 83), 60% female, 2 patients with prior history of subdural hematoma, 2 dementia, 6 hypertension, and 4 diabetes. Median duration of initial admission was 9 days (range 1 - 99), 2/10 patients were intubated. 50% of patients (5/10) had focal seizures, 50% of unknown type (5/10). 80% of patients had motor seizures (8/10), 20% nonmotor seizures (2/10). Seven out of 10 patients had EEG since initial admission, 3 showing focal seizures with frontal or central onset. Epilepsy etiology was structural (hemorrhage, stroke, tumor) in 50% (3/6), infectious (HSV) in 16.7% (1/6), unknown in 33.3% (2 out of 6 patients with no clear risk factors).

Conclusions: In our cohort, the incidence of new-onset epileptic seizures after discharge from a hospitalization for COVID-19 infection was 0.38% over the following 9 – 12 months. The incidence of new onset unprovoked seizures was 0.23%. These rates are higher than the literature-reported incidence of seizures in the general adult population (e.g. 0.05 - 0.1%). There are multiple competing seizure risk factors for these patients with new-onset seizures. In 2 patients there were no clear risk factors other than hospitalization for COVID-19.

Funding: Please list any funding that was received in support of this abstract.: Rapin / Oaklander funds, NINDS NS RO1 NS091170, U54 NS100064.