Non-convulsive status epilepticus in a patient with COVID-19 infection

Rodrigo-Armenteros, Patricia; Uterga-Valiente, Juan María; Zabala-Del-Arco, Juncal; Taramundi-Argüeso, Silvia; Erburu-Iriarte, Markel; Antón-Méndez, Lander; Gómez-Muga, Juan José; García-Moncó, Juan Carlos

doi:10.1016/j.clinph.2020.08.005

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…No patient in the sample presented with status epilepticus or frontal epileptiform discharges, which have been proposed as biomarkers for COVID-19 24 , given their apparent predominance in focal discharges 1,8,12,16,20,26,27,28,29,30,31,32,33 and originating status epilepticus.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalographic findings among inpatients with COVID-19 in a tertiary hospital from a middle-income country

Corazza

Tatsch

Barros

et al. 2021

Arq. Neuro-Psiquiatr.

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Background: In 2019, the world witnessed the emergence of a new type of coronavirus - the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The spectrum of coronavirus disease 2019 (COVID-19) is variable, and amongst its manifestations are neurological implications. Objective: This report aimed to describe electroencephalographic findings in COVID-19 patients from a general tertiary hospital in São Paulo, Brazil. Methods: It was a retrospective, observational, and non-interventional study. Data were collected anonymously, comprising inpatients from Mar 1 to Jun 30, 2020, either confirmed (positive RT-PCR) or probable cases (CO-RADS 4/5) who had performed EEG during hospitalization. Results: Twenty-eight patients were enrolled, 17 (60.7%) women and 11 men, with a median age of 58 (minimum and maximum: 18-86; IQR 23.5). COVID-19 diagnosis was confirmed in 22 (78.5%). Twenty-one patients (75%) had severe disease, requiring mechanical ventilation due to acute respiratory distress syndrome (ARDS); 16 (57.1%) patients developed adjunct sepsis throughout hospitalization. There was no specific pattern found for COVID-19 in EEG. No patients presented with status epilepticus or electrographic events; most patients developed an encephalopathic pattern, as seen in most studies, with a high prevalence of altered mental status as an indication for EEG. Adjunct sepsis was associated with higher mortality. Conclusions: EEG presents as a useful tool in the context of COVID-19, as in other conditions, to differentiate nonconvulsive status epilepticus (NCSE) from encephalopathy and other causes of mental status alterations. Further studies are required to analyze whether there might be a specific EEG pattern to the disease.

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Section: Discussionmentioning

confidence: 99%

Electroencephalographic findings among inpatients with COVID-19 in a tertiary hospital from a middle-income country

Corazza

Tatsch

Barros

et al. 2021

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

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“…One EEG in the series of five patients reported byChen et al (2020) showed a bifrontal SE, and another one revealed a generalized NCSE. Finally, the EEG of the patient reported byRodrigo-Armenteros et al (2020) showed a bilateral frontotemporal NCSE.…”

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confidence: 85%

COVID-19-Associated Neurological Manifestations: An Emerging Electroencephalographic Literature

et al. 2021

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide since the end of year 2019 and is currently responsive for coronavirus infectious disease 2019 (COVID-19). The first reports considered COVID-19 as a respiratory tract disease responsible for pneumonia, but numerous studies rapidly emerged to warn the medical community of COVID-19-associated neurological manifestations, including encephalopathy at the acute phase and other postinfectious manifestations. Using standard visual analysis or spectral analysis, recent studies reported electroencephalographic (EEG) findings of COVID-19 patients with various neurological symptoms. Most EEG recordings were normal or revealed non-specific abnormalities, such as focal or generalized slowing, interictal epileptic figures, seizures, or status epilepticus. Interestingly, novel EEG abnormalities over frontal areas were also described at the acute phase. Underlying mechanisms leading to brain injury in COVID-19 are still unknown and matters of debate. These frontal EEG abnormalities could emphasize the hypothesis whereby SARS-CoV-2 enters the central nervous system (CNS) through olfactory structures and then spreads in CNS via frontal lobes. This hypothesis is reinforced by the presence of anosmia in a significant proportion of COVID-19 patients and by neuroimaging studies confirming orbitofrontal abnormalities. COVID-19 represents a new viral disease characterized by not only respiratory symptoms but also a systemic invasion associated with extra-respiratory signs. Neurological symptoms must be the focus of our attention, and functional brain evaluation with EEG is crucial, in combination with anatomical and functional brain imaging, to better understand its pathophysiology. Evolution of symptoms together with EEG patterns at the distance of the acute episode should also be scrutinized.

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“…He received hydroxychloroquine (200 mg twice-daily) for 7 days and Lopinavir–Ritonavir (200 mg/50 mg twice-daily) for 15 days. He developed a severe respiratory distress syndrome and was treated with dexamethasone (20 mg daily for 5 days) and tocilizumab (600 mg) with progressive improvement but developed an encephalopathy secondary to nonconvulsive status epilepticus that has been described elsewhere[ 4 ]. Blood tests showed an intense systemic inflammatory response with c-reactive protein of 309 mg/L (normal, < 10 mg/L), lactic dehydrogenase 613 U/L (< 280 U/L), ferritin 5700 ng/mL (< 300 ng/mL), and D-dimer 9550 ng/mL (< 250 ng/mL).…”

Section: Case Reportmentioning

confidence: 99%