Electroencephalographic Abnormalities are Common inCOVID‐19 and are Associated with Outcomes

Abstract

The aim was to determine the prevalence and risk factors for electrographic seizures and other electroencephalographic (EEG) patterns in patients with Coronavirus disease 2019 (COVID-19) undergoing clinically indicated continuous electroencephalogram (cEEG) monitoring and to assess whether EEG findings are associated with outcomes. Methods: We identified 197 patients with COVID-19 referred for cEEG at 9 participating centers. Medical records and EEG reports were reviewed retrospectively to determine the incidence of and clinical risk factors for seizures and other epileptiform patterns. Multivariate Cox proportional hazards analysis assessed the relationship between EEG patterns and clinical outcomes. Results: Electrographic seizures were detected in 19 (9.6%) patients, including nonconvulsive status epilepticus (NCSE) in 11 (5.6%). Epileptiform abnormalities (either ictal or interictal) were present in 96 (48.7%). Preceding clinical seizures during hospitalization were associated with both electrographic seizures (36.4% in those with vs 8.1% in those without prior clinical seizures, odds ratio [OR] 6.51, p = 0.01) and NCSE (27.3% vs 4.3%, OR 8.34, p = 0.01). A pre-existing intracranial lesion on neuroimaging was associated with NCSE (14.3% vs 3.7%; OR 4.33, p = 0.02). In multivariate analysis of outcomes, electrographic seizures were an independent predictor of in-hospital mortality (hazard ratio ], p < 0.01). In competing risks analysis, hospital length of stay increased in the presence of NCSE (30 day proportion discharged with vs without NCSE: HR 0.21 [0.03-0.33] vs 0.43 [0.36-0.49]). Interpretation: This multicenter retrospective cohort study demonstrates that seizures and other epileptiform abnormalities are common in patients with COVID-19 undergoing clinically indicated cEEG and are associated with adverse clinical outcomes.

Neurochemical signs of astrocytic and neuronal injury in acute COVID-19 normalizes during long-term follow-up

“…Due to infection control measures present at the time of the study, further neuroimaging and EEG studies were limited and generally not available for this report. This raises the question of underestimating the burden of neurology morbidity [29] , although the presence or absence of ongoing neuronal injury may be accurately assessed with NfL [30] . In addition, the wasting of peripheral nerves, a recognized feature in ICU patients, may contribute to increased NfL concentrations, although it cannot explain an increase in GFAp [31] , [32] , [33] .…”

Neurochemical signs of astrocytic and neuronal injury in acute COVID‐19 normalizes during long‐term follow‐up

“…Due to infection control measures present at the time of the study, further neuroimaging and EEG studies were limited and generally not available for this report. This raises the question of underestimating the burden of neurology morbidity [29] , although the presence or absence of ongoing neuronal injury may be accurately assessed with NfL [30] . In addition, the wasting of peripheral nerves, a recognized feature in ICU patients, may contribute to increased NfL concentrations, although it cannot explain an increase in GFAp [31][32][33] .…”

Intermittent Frontal Rhythmic Discharges as an Electroencephalogram Biomarker of Acute SARS-CoV-2 Infection-Associated Encephalopathy in Children

“…To our knowledge, detection of isolated electrographic seizures without preceding or following clinical seizures is exceptionally rare [25,26]. However, a more recent review by Lin et al reported that up to 4% of clinically ill patients may have evidence of non-convulsive status epilepticus in EEG without associated clinical seizures, which highlights both the importance and underutilization of EEG in critically sick COVID-19 patients [27]. Of note, despite the presence of an overall 1% incidence of acute symptomatic seizures as a part of COVID-19 infection symptomatology, the incidence of short and long-term epilepsy in those patients is not yet known [28].…”