Seizures in COVID-19: the relationship between biomarkers and prognosis

Abstract

Objective To assess the prevalence of seizure, associated risk factors, and prognosis in patients with SARS-CoV-2 infection and identify predictive biomarkers in SARS-CoV-2 patients with seizure. Methods A cohort of 17,806 patients with SARS-CoV-2 infection admitted to two university hospitals in Adana between March 11, 2020 and January 1, 2021 was analyzed retrospectively. The patients’ demographic characteristics, laboratory findings, and systemic and neurological symptoms at admission and on the day of seizure onset were evaluated. Results Neurological findings were detected in 877 of the 17,806 patients. Of these, 45 patients (0.25%) had seizure (status epilepticus in 4/45 patients, 8.9%). Patients with seizure had a mean age of 55.3 years (range 17–88) and 57.8% were male. Seizure was more common in the 18–44 (24.4%) and ≥ 65 age groups (44.4%) and in those with multiple comorbidity. The case fatality rate for patients with seizure among all SARS-CoV-2 patients was 0.135% (95% CI 80.86–188.71). However, no patient with a previous diagnosis of epilepsy died during SARS-CoV-2 infection. High neutrophil, platelet, and ferritin levels and low lymphocyte and calcium levels on the day of seizure development compared to admission were associated with higher mortality ( p = 0.004, 0.008, 0.028, 0003, and 0.002, respectively). Conclusions Seizures are not uncommon during SARS-CoV-2 infection, with a higher risk of mortality in older patients and those with higher inflammatory markers.

Clinical outcomes of patients with seizure admitted for COVID-19: Findings from the Philippine CORONA study

“…However, the presence of new-onset seizure among these patients was associated with a significantly higher risk for more severe COVID-19 infection, mortality, and use of a ventilator. These findings were consistent with the other studies that reported a good outcome with no significant increase in mortality rate among PWE with COVID-19 patients and a higher mortality risk among COVID-19 patients with new-onset seizure [ 17 , 18 , 32 ]. Among deceased PWE who were infected with SARS-CoV2, the possible cause of death was related to the underlying comorbidities, which were all risk factors for severe COVID-19 infection [ 26 ].…”

“…The reported risk factors for mortality among COVID-19 patients with seizure were respiratory and cancer morbidities and an EEG done on the third week of COVID-19 evolution [ 17 , 28 ]. The identified biomarkers for mortality among COVID-19 patients with seizure were high peripheral neutrophil count, high platelet levels, high ferritin levels, low lymphocyte count, and low calcium levels [ 18 ]. For the EEG findings in these patients, the most frequent were generalized slow waves [ 28 , 29 ].…”

“…Although there are numerous published studies on seizure and COVID-19 infection, only a small fraction of these studies, excluding case reports and case series, focused on the outcome of hospitalized patients infected with SARS-CoV2 with concomitant seizure or epilepsy in terms of mortality, functional outcome, and duration of hospitalization [ [17] , [18] , [19] , [20] , [21] ]. Published data were from studies completed in the United States, Spain, Iran, and Turkey, with no study emanating from Southeast Asia on seizure and COVID-19 outcomes.…”

The outcome and risk factors associated with central and peripheral nervous system involvement in hospitalized COVID-19 patients: a retrospective cohort study

“…However, in a Swedish study performed by Westman et al, no increased risk of epilepsy was found, indicating that comorbidities may be partly responsible for the increased risk of seizures observed in COVID-19 patients, acting as confounding factors ( 35 ). The mechanism is not fully understood as it may be due to blood–brain barrier alterations secondary to inflammation that can lead to an increase in excitatory neurotransmitters, as well as ion imbalance, hypoxia, or hypoglycemia ( 36 – 38 ).…”

SARS‑CoV‑2 and Seizure: An Insight Into the Pathophysiology

“…Neurological symptoms are common in COVID-19 patients. In a study of 17806 patients with SARS-CoV-2 admitted to 2 university hospitals in Adana City between March 11, 2020, and January 1, 2021, Boz et al observed that patients with higher inflammatory markers and older patients were more likely to experience seizures during SARS-CoV-2 infection ( 3 ).…”