New onset acute symptomatic seizure and risk factors in coronavirus disease 2019: A retrospective multicenter study

Abstract

Our aim was to clarify the incidence and risk of acute symptomatic seizures in people with coronavirus disease 2019 . This multicenter retrospective study enrolled people with COVID-19 from January 18 to February 18, 2020 at 42 government-designated hospitals in Hubei province, the epicenter of the epidemic in China; Sichuan province; and Chongqing municipality. Data were collected from medical records by 11 neurologists using a standard case report form. A total of 304 people were enrolled, of whom 108 had a severe condition. None in this cohort had a known history of epilepsy. Neither acute symptomatic seizures nor status epilepticus was observed. Two people had seizurelike symptoms during hospitalization due to acute stress reaction and hypocalcemia, and 84 (27%) had brain insults or metabolic imbalances during the disease course known to increase the risk of seizures. There was no evidence suggesting an additional risk of acute symptomatic seizures in people with COVID-19. Neither the virus nor potential risk factors for seizures seem to be significant risks for the occurrence of acute symptomatic seizures in COVID-19. K E Y W O R D Sacute symptomatic seizures, COVID-19, epilepsy, SARS-CoV-2 2 | LU et aL.

COVID‐19: A Global Threat to the Nervous System

“…Overall, 25% of patients had symptoms considered as evidence of CNS dysfunction, including dizziness (17%), headache (13%), impaired consciousness (7.5%), acute cerebrovascular disease (3%), ataxia (0.5%), and seizures (0.5%). Confirming this low incidence of seizures, no cases of status epilepticus or new onset seizures were reported in a large cohort of over 304 hospitalized patients with COVID-19 in Hubei Province, China, 12 although there have been isolated case reports describing seizures at presentation in both adult and pediatric patients with COVID-19. 13,14 In the series by Mao and colleagues, 11 the patients were subdivided based on the severity of their pneumonia and pulmonary impairment, and among those with "severe" disease (n = 88) the incidence of CNS symptoms was higher (31%) compared to the non-severe group (21%), although the results were not statistically significant (p = 0.09).…”

Neurological Involvement of Coronavirus Disease 2019: A Systematic Review

“…Lu et al studied 304 COVID-19 patients and concluded that none of these patients had acute symptomatic seizures or status epilepticus. [68] The current data are too limited to make any conclusions about the effects of COVID-19 on developing seizures.…”

Neurological manifestations of COVID-19: A systematic review

“…Seizures in patients with COVID-19 might occur in consequence of direct brain infection, but only single reports of patients with seizures exist so far. Thus, current evidence does not suggest an additional risk of seizures in COVID-19 [41]. Encephalopathy, rather than encephalitis, may occur due to indirect mechanism of neuropathogenicity, such as hypoxic encephalopathy found in deceased COVID-19 patients [26].…”

“…However, CSF and cerebral MRI analyses were not performed in the patient with encephalitis, leaving insecurity about diagnostic accuracy [33]. Neither acute symptomatic seizures, nor status epilepticus were observed in a more extensive retrospective study involving 304 COVID-19 patients [41].…”