Abstracts

Rationale:
The COVID-19 (SARS-CoV-2 infection) has multiple neurological manifestations and its effects on brain is being increasingly recognized. Thus far, limited information is available on new onset seizures, status epilepticus, together with EEG findings and outcomes in critically ill patients with COVID-19. The aim of this study was to assess the outcomes in patients with COVID-19 in correlation with the presence of seizures and status epilepticus.
Method:
Retrospective chart review was performed on 23 consecutive patients who had COVID-19 diagnosed with nasopharyngeal swabs, between March 12th and May 15th, 2020 and had EEG at Henry Ford Health System. Variables analyzed included basic demographics, presence of clinical seizures and status epilepticus, electrographic characteristics on EEG, co-morbidities and outcomes (if died or recovered). Fisher’s exact test was performed to assess for correlation of outcomes in those who has seizures or status epilepticus.
Results:
Of the 23 patients with COVID-19 who had EEG, 16(70%) were males, 16 (70%) had long term EEG and 7 (30%) had routine EEG.  A total of 17 (74%) had severe disease with respiratory failure and coma/stupor, 6 (26%) had moderate disease with encephalopathy, 5 (22%) had new onset stroke and 5 (22%) had reported new onset seizures. Three (13%) patients had status epilepticus, of which 2(67%) had a prior history of epilepsy. EEG of all the patients showed diffuse background slowing/attenuation. EEG in only 2 (9%) patients recorded focal seizures, 1 (4%) patient had generalized seizures and 1 (4%) recorded nonconvulsive status epilepticus. Otherwise, EEG in 2 (9%) showed focal epileptiform activity, 10 (43%) had rhythmic and periodic patterns and 5 (22%) had focal slowing/attenuation. No statistical significance was met with regards to short term outcomes when compared within gender (8/16 (50%) males and 2/7(29%) females died (p=0.405, Fisher's exact test)). Similarly, the presence of new onset seizure or status epilepticus did not significantly affect outcomes (2/6 (33%) of the patients with new onset seizures and/or status and 8/17 (47%) of the patients without seizure/status died (p=0.66, Fisher's exact test)).  Overall, a total of 11 (48%) patients died, 11 (48%) recovered to be discharged to subacute rehabilitation and 1 (4%) discharged home.
Conclusion:
In our cohort of moderate to severe COVID-19 patients who underwent EEG monitoring, 22 % patients reported clinical seizures prior to EEG recording, and 13% had status epilepticus. There was no statistically significant correlation between the presence of new onset seizures and status epilepticus in COVID-19 and the patient’s outcomes with regards to mortality.  Limitations of the study include small study sample. Larger population and multicenter studies would be beneficial to further address the overall outcome of seizures and status epilepticus in COVID-19.
Funding:
:No funding received.