Seizures in Children with SARS-CoV-2 Infection: Epidemiological, Clinical and Neurophysiological Characterization

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present with a wide variety of symptoms, including neurological manifestations. We investigated clinical, demographic, laboratory, neurophysiological and imaging characteristics of SARS-CoV-2-positive children with seizures and analyzed differences between children admitted during the periods with prevalent circulation of the Alpha/Delta and Omicron variants, respectively. Patients’ characteristics were analyzed according to the presence or absence of seizures and then according to the SARS-CoV-2 variants. Five-hundred and four SARS-CoV-2-positive patients were included: 93 (18.4%) with seizures and 411 (81.6%) without. Patients with seizures were older, had more commonly an underlying epilepsy and had more frequently altered C-reactive protein than those without seizures. Electroencephalography was abnormal in 5/38 cases. According to the SARS-CoV-2 variant, seizures were recorded in 4.7% of the total number of hospitalized patients during the Alpha/Delta period, and in 16.9% of patients admitted during the Omicron period. During the Alpha/Delta variants, seizures were more commonly observed in patients with epilepsy compared to those observed during the Omicron period. Our findings suggest that although SARS-CoV-2 may potentially trigger seizures, they are generally not severe and do not require intensive care admission.

Seizures in hospitalised paediatric patients with SARS-CoV-2 and comparison of severity with seizures in hospitalised paediatric patients with other respiratory viruses during the COVID-19 pandemic: a population-based cohort study

“… 5 6 8 Our finding of an increased prevalence of seizures in patients with SARS-CoV-2 during the omicron period is in line with other currently available studies. 8–10 We additionally showed that SARS-CoV-2 was related to significantly increased rate of seizures in the absence of fever and age >5 years compared with other RTIs, which suggests a more complex pathogenesis of seizures due to SARS-CoV-2 as compared with febrile seizures in children younger than 5 years old. 17 …”

“…It is currently unclear if SARS-CoV-2 and especially the omicron variant is more neurotropic compared with other viruses, or if the increased incidence of seizures in patients with SARS-CoV-2 during the omicron period is multifactorial with involvement of more epidemiological factors. 8 Our findings indicate that the omicron variant of SARS-CoV-2 may be more neurotropic than other viruses affecting the respiratory system. However, more data are warranted in order to understand if the omicron variant implicates seizures through enhanced activation of inflammatory response or through affecting more individuals because of its higher contagiousness resulting to more total admissions due to seizures, even if the overall prevalence of seizures in patients with SARS-CoV-2 per se would not be affected, at least during the study period.…”

“…However, more data are warranted in order to understand if the omicron variant implicates seizures through enhanced activation of inflammatory response or through affecting more individuals because of its higher contagiousness resulting to more total admissions due to seizures, even if the overall prevalence of seizures in patients with SARS-CoV-2 per se would not be affected, at least during the study period. 8 10 21 22 Awareness of an increasing risk of seizures and hospitalisation in patients with SARS-CoV-2 may also be taken under consideration prior to decision of vaccination of at-risk paediatric patients. Follow-up studies on SARS-CoV-2-related complications during longer periods and comparison with other RTIs are merited to be able to sort out contributing epidemiological factors to seizures, frequency of hospitalisation and accompanying severe neurological complications.…”

Analysis of risk factors for seizures and short-term reoccurrence of seizures in febrile children with SARS-CoV-2 infection: an observational study

“…With the gradual mutation of SARS-CoV-2, the Omicron variant dominates worldwide [2]. Recent studies have found an increase in the frequency of seizures in children during the Omicron epidemic [3][4]. In addition, a recent study reported severe neurological disease in several SARS-CoV-2 infected children with fever and seizures as the main clinical manifestations [5].However, the current studies on COVID-19 and seizures are few and mostly in febrile convulsions.Therefore, this study will not be limited to febrile seizures(FS), but will include patients who present with fever and seizures.This study will summarize the clinical features and severity of seizures in febrile children with SARS-CoV-2 infection, analysis of risk factors for recurrent seizures within a short period of time in children with SARS-CoV-2 infected febrile convulsions, and provide a detailed description of children with secondary severe neurological disease.…”

Seizures in febrile children with SARS-CoV-2 infection: clinical features, short-term follow-up

“…However, as the SARS-CoV-2 virus undergoes progressive mutations, the global prevalence of the Omicron variant has taken precedence [2]. Notably, recent investigations have shed light on an augmented frequency of seizure incidence in children amidst the ongoing Omicron epidemic [3][4]. In addition, a recent study reported severe neurological disease in several SARS-CoV-2 infected children, with fever and seizures as the main clinical manifestations [5].…”