COVID-19 associated encephalopathy: Is there a specific EEG pattern?

Vellieux, Geoffroy; Rouvel-Tallec, Anny; Jaquet, Pierre; Grinea, Alexandra; Sonneville, Romain; d’Ortho, Marie-Pia

doi:10.1016/j.clinph.2020.06.005

Cited by 47 publications

(53 citation statements)

References 2 publications

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“…While there has been concern that intranasal infection may be a potential route for coronavirus neuroinvasion 24 , there was no clear association between epileptiform findings and anosmia, nor was there a fronto-temporal predominance to suggest specifically limbic involvement. Other groups have noted frontally predominant abnormalities in patients with SARS-CoV-2 7,8,25,26 , but in at least one paper frontal slowing appeared similar to that seen in metabolic encephalopathies and correlated with systemic lab findings 7 . Although a few encephalitides are associated with suggestive EEG findings, such as very low frequency periodic complexes in measles-related subacute sclerosing panencephalitisis 27 or lateralized periodic epileptiform discharges in HSV encephalitis 28 , neither finding is necessarily specific.…”

Section: Sars-cov-2 and Epileptiform Eeg Findingsmentioning

confidence: 71%

Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2

Ayub¹,

Cohen²,

Jin

et al. 2020

Preprint

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Background and Purpose Reports have suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes neurologic manifestations including encephalopathy and seizures. However, there has been relatively limited electrophysiology data to contextualize these specific concerns and to understand their associated clinical factors. Our objective was to identify EEG abnormalities present in patients with SARS-CoV-2, and to determine whether they reflect new or preexisting brain pathology. Methods We studied a consecutive series of hospitalized patients with SARS-CoV-2 who received an EEG, obtained using tailored safety protocols. Data from EEG reports and clinical records were analyzed to identify EEG abnormalities and possible clinical associations, including neurologic symptoms, new or preexisting brain pathology, and sedation practices. Results We identified 37 patients with SARS-CoV-2 who underwent EEG, of whom 14 had epileptiform findings (38%). Patients with epileptiform findings were more likely to have preexisting brain pathology (6/14, 43%) than patients without epileptiform findings (2/23, 9%; p=0.042). There were no clear differences in rates of acute brain pathology. One case of nonconvulsive status epilepticus was captured, but was not clearly a direct consequence of SARS-CoV-2. Abnormalities of background rhythms were common, and patients recently sedated were more likely to lack a posterior dominant rhythm (p=0.022). Conclusions Epileptiform abnormalities were common in patients with SARS-CoV-2 referred for EEG, but particularly in the context of preexisting brain pathology and sedation. These findings suggest that neurologic manifestations during SARS-CoV-2 infection may not solely relate to the infection itself, but rather may also reflect patients' broader, preexisting neurologic vulnerabilities.

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Section: Sars-cov-2 and Epileptiform Eeg Findingsmentioning

confidence: 71%

Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2

Ayub¹,

Cohen²,

Jin

et al. 2020

Preprint

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“…Vellieux et al recently reported two coronavirus disease 2019 (COVID-19) patients showing a unique EEG pattern, i.e., non-reactive bifrontal monomorphic diphasic periodic delta waves, and suggested that this pattern could be typical of COVID-19 brain dysfunction ( Vellieux et al, 2020 ).…”

mentioning

confidence: 99%

“…EEG findings in SARS-CoV-2 infection have been rarely reported and largely considered non-specific ( Flamand et al, 2020 , Vellieux et al, 2020 ). Indeed, EEG in acute encephalopathies may reveal different degrees of background slowing, with or without triphasic waves and FIRDA and these patterns are believed to reflect an underlying structural or metabolic disorder; however, there is limited evidence linking specific EEG abnormalities with plausible causative factors.…”

mentioning

confidence: 99%

EEG findings in COVID-19 related encephalopathy

Pasini

Bisulli

Volpi

et al. 2020

Clinical Neurophysiology

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“…Relatively small cohorts of patients with COVID-19 and EEG are published to date, with the patients in these studies only undergoing routine duration or reduced montage EEG recording, for the reasons discussed above, and less frequently continuous EEG monitoring. Several authors observed sporadic epileptiform abnormalities and periodic patterns of concern, including generalized periodic discharges, along with more expected patterns of generalized slowing ( 22 – 26 ). Due to centers taking precautions to avoid transmission risk by reducing staffing and utilization of EEG, as well as obtaining imaging, cases of electrographic seizures and NCSE may be less likely to be diagnosed and adequately imaged.…”

Section: Discussionmentioning

confidence: 99%

Acute Seizures Occurring in Association With SARS-CoV-2

et al. 2020

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Seizures are an infrequent and serious neurological complication of SARS-CoV-2 infection, with limited data describing the etiology and the clinical context in which these occur or the associated electrographic and imaging findings. This series details four cases of seizures occurring in patients with COVID-19 with distinct time points, underlying pathology, and proposed physiological mechanisms. An enhanced understanding of seizure manifestations in COVID-19 and their clinical course may allow for earlier detection and improved patient management.

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COVID-19 associated encephalopathy: Is there a specific EEG pattern?

Cited by 47 publications

References 2 publications

Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2

Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2

EEG findings in COVID-19 related encephalopathy

Acute Seizures Occurring in Association With SARS-CoV-2

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