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Seizures in the Setting of COVID-19

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Abstract

Purpose of review

This review presents current available data relating to seizures in the context of COVID-19 infection from theorized pathophysiology to presentations and treatments. We also review the impact the COVID-19 pandemic has had on people with epilepsy (PWE) with special consideration of changes in healthcare access and COVID-19 vaccine.

Recent findings

PWE are not more susceptible to contracting COVID-19 infection; however, recent data suggests PWE are a potential high-risk population for more severe symptoms and ICU admission. Given drug-drug interactions, caution should be advised when using certain treatments for COVID-19 (i.e., antiviral medications) and anti-seizure medications (ASM). COVID-19 vaccines appear to be safe for PWE.

Summary

Acute symptomatic seizures and status epilepticus are an infrequent but severe acute neurological sequelae of COVID-19 infection in patients with and without epilepsy. The COVID-19 pandemic has had an enormous impact on PWE, resulting in changes to the way we deliver healthcare, decreases in admissions to the epilepsy monitoring unit, and delays in surgical treatments for epilepsy. Further research is needed to better understand, if any, the long-term consequences of COVID-19 infection in PWE.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Liotta EM, Batra A, Clark JR, Shlobin NA, Hoffman SC, Orban ZS, et al. Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol. 2020;7(11):2221–30. https://doi.org/10.1002/acn3.51210.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Misra S, Kolappa K, Prasad M, Radhakrishnan D, Thakur KT, Solomon T, et al. Frequency of neurologic manifestations in COVID-19: a systematic review and meta-analysis. Neurology. 2021;97(23):e2269–81. https://doi.org/10.1212/WNL.0000000000012930.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Rothstein A, Oldridge O, Schwennesen H, Do D, Cucchiara BL. Acute cerebrovascular events in hospitalized COVID-19 patients. Stroke; a journal of cerebral circulation. 2020;51(9):e219–22. https://doi.org/10.1161/STROKEAHA.120.030995.

    Article  CAS  Google Scholar 

  4. Kuroda N. Epilepsy and COVID-19: Updated evidence and narrative review. Epilepsy Behav. 2021;116:107785. https://doi.org/10.1016/j.yebeh.2021.107785.

  5. Tantillo GB, Jette N, Gururangan K, Agarwal P, Marcuse L, Singh A, et al. Electroencephalography at the height of a pandemic: EEG findings in patients with COVID-19. Clin Neurophysiol : official journal of the International Federation of Clinical Neurophysiology. 2022;137:102–12. https://doi.org/10.1016/j.clinph.2022.03.001.

    Article  Google Scholar 

  6. Nikbakht F, Mohammadkhanizadeh A, Mohammadi E. How does the COVID-19 cause seizure and epilepsy in patients? The potential mechanisms. Mult Scler Relat Disord. 2020;46:102535. https://doi.org/10.1016/j.msard.2020.102535.

  7. Asadi-Pooya AA, Kouhanjani MF, Nemati H, Emami A, Javanmardi F. A follow-up study of patients with COVID-19 presenting with seizures. Epilepsy Behav. 2021;122:108207. https://doi.org/10.1016/j.yebeh.2021.108207.

  8. Khedr EM, Shoyb A, Mohammaden M, Saber M. Acute symptomatic seizures and COVID-19: Hospital-based study. Epilepsy Res. 2021;174:106650. https://doi.org/10.1016/j.eplepsyres.2021.106650.

  9. Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia. 1993;34(3):453–68. https://doi.org/10.1111/j.1528-1157.1993.tb02586.x.

    Article  CAS  PubMed  Google Scholar 

  10. Kobaidze K, Shin YM, Japaridze M, Karakis I, Wu X. Posterior reversible leukoencephalopathy syndrome in a patient after acute COVID-19 infection. Case Rep Neurol Med. 2021;2021:5564802. https://doi.org/10.1155/2021/5564802.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lallana S, Siegler JE. Response to correspondence concerning “Posterior reversible encephalopathy syndrome (PRES) associated with COVID-19.” J Clin Neurosci. 2021;92:189–90. https://doi.org/10.1016/j.jocn.2021.08.006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. • Carroll E, Melmed KR, Frontera J, Placantonakis DG, Galetta S, Balcer L, et al. Cerebrospinal fluid findings in patients with seizure in the setting of COVID-19: a review of the literature. Seizure : the journal of the British Epilepsy Association. 2021;89:99–106. https://doi.org/10.1016/j.seizure.2021.05.003. Evidence of SARS-CoV-2 Viral RNA and antibodies are uncommonly detected in patients with COVID-19 infection and acute seizures.

  13. Panariello A, Bassetti R, Radice A, Rossotti R, Puoti M, Corradin M, et al. Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: a case report. Brain Behav Immun. 2020;87:179–81. https://doi.org/10.1016/j.bbi.2020.05.054.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Monti G, Giovannini G, Marudi A, Bedin R, Melegari A, Simone AM, et al. Anti-NMDA receptor encephalitis presenting as new onset refractory status epilepticus in COVID-19. Seizure : the journal of the British Epilepsy Association. 2020;81:18–20. https://doi.org/10.1016/j.seizure.2020.07.006.

    Article  Google Scholar 

  15. Nagu P, Parashar A, Behl T, Mehta V. CNS implications of COVID-19: a comprehensive review. Rev Neurosci. 2021;32(2):219–34. https://doi.org/10.1515/revneuro-2020-0070.

    Article  CAS  PubMed  Google Scholar 

  16. Paterson RW, Brown RL, Benjamin L, Nortley R, Wiethoff S, Bharucha T, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain : a journal of neurology. 2020;143(10):3104–20. https://doi.org/10.1093/brain/awaa240.

    Article  PubMed  Google Scholar 

  17. Danoun OA, Zillgitt A, Hill C, Zutshi D, Harris D, Osman G, et al. Outcomes of seizures, status epilepticus, and EEG findings in critically ill patient with COVID-19. Epilepsy Behav. 2021;118:107923. https://doi.org/10.1016/j.yebeh.2021.107923.

  18. Emami A, Fadakar N, Akbari A, Lotfi M, Farazdaghi M, Javanmardi F, et al. Seizure in patients with COVID-19. Neurol Sci. 2020;41(11):3057–61. https://doi.org/10.1007/s10072-020-04731-9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dono F, Nucera B, Lanzone J, Evangelista G, Rinaldi F, Speranza R, et al. Status epilepticus and COVID-19: a systematic review. Epilepsy Behav. 2021;118:107887. https://doi.org/10.1016/j.yebeh.2021.107887.

  20. Lu L, Xiong W, Liu D, Liu J, Yang D, Li N, et al. New onset acute symptomatic seizure and risk factors in coronavirus disease 2019: a retrospective multicenter study. Epilepsia. 2020;61(6):e49–53. https://doi.org/10.1111/epi.16524.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Jageka C, Bhasin A, Kappagantu A, Brantz H, Ali R, Stopa B, Izzy S, Khawaja A. Meta-analysis of 175 patients with COVID-19 and seizures, status epilepticus, or cortical myoclonus: an individual patient data analysis.

  22. • Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020;382(17):1663–5. https://doi.org/10.1056/NEJMc2005073. Children are less likely to have symptomatic disease than adults, including seizures, when contracting COVID-19.

  23. Kurd M, Hashavya S, Benenson S, Gilboa T. Seizures as the main presenting manifestation of acute SARS-CoV-2 infection in children. Seizure : the journal of the British Epilepsy Association. 2021;92:89–93. https://doi.org/10.1016/j.seizure.2021.08.017.

    Article  Google Scholar 

  24. Kubota T, Gajera PK, Kuroda N. Meta-analysis of EEG findings in patients with COVID-19. Epilepsy Behav. 2021;115:107682. https://doi.org/10.1016/j.yebeh.2020.107682.

  25. LaMonte MP. Ceribell EEG shortens seizure diagnosis and workforce time and is useful for COVID isolation. Epilepsia Open. 2021;6(2):331–8. https://doi.org/10.1002/epi4.12474.

    Article  PubMed  PubMed Central  Google Scholar 

  26. • French JA, Brodie MJ, Caraballo R, Devinsky O, Ding D, Jehi L, et al. Keeping people with epilepsy safe during the COVID-19 pandemic. Neurology. 2020;94(23):1032–7. https://doi.org/10.1212/WNL.0000000000009632. Patients with Epilepsy were not likely to be more susceptible to contract COVID-19, per the International League Against Epilepsy (ILAE).

  27. • Yoo J, Kim JH, Jeon J, Kim J, Song TJ. Risk of COVID-19 infection and of severe complications among people with epilepsy: a nationwide cohort study. Neurology. 2022;98(19):e1886–92. https://doi.org/10.1212/WNL.0000000000200195. In a large Korean study, having epilepsy is not associated with increased COVID-19 infection.

  28. • Siahaan YMT, Ketaren RJ, Hartoyo V, Hariyanto TI. Epilepsy and the risk of severe coronavirus disease 2019 outcomes: a systematic review, meta-analysis, and meta-regression. Epilepsy Behav. 2021;125:108437. https://doi.org/10.1016/j.yebeh.2021.108437. Meta-analysis of over 67,000 patients found patients with epilepsy at enhanced risk of severe COVID-19 infection.

  29. •• Jain S, Potschka H, Chandra PP, Tripathi M, Vohora D. Management of COVID-19 in patients with seizures: mechanisms of action of potential COVID-19 drug treatments and consideration for potential drug-drug interactions with anti-seizure medications. Epilepsy Res. 2021;174:106675. https://doi.org/10.1016/j.eplepsyres.2021.106675. Potential drug-drug interactions among anti-seizure medications and COVID-19 treatments are outlined in this paper.

  30. Cokley JA, Gidal BE, Keller JA, Vossler DG, Reviewed, approved by the AESTC, et al. Paxlovid(TM) information from FDA and guidance for AES members. Epilepsy Currents / American Epilepsy Society. 2022;22(3):201–4. https://doi.org/10.1177/15357597221088415.

  31. Asadi-Pooya AA, Attar A, Moghadami M, Karimzadeh I. Management of COVID-19 in people with epilepsy: drug considerations. Neurol Sci. 2020;41(8):2005–11. https://doi.org/10.1007/s10072-020-04549-5.

    Article  PubMed  PubMed Central  Google Scholar 

  32. von Wrede R, Pukropski J, Moskau-Hartmann S, Surges R, Baumgartner T. COVID-19 vaccination in patients with epilepsy: first experiences in a German tertiary epilepsy center. Epilepsy Behav. 2021;122:108160. https://doi.org/10.1016/j.yebeh.2021.108160.

  33. Massoud F, Ahmad SF, Hassan AM, Alexander KJ, Al-Hashel J, Arabi M. Safety and tolerability of the novel 2019 coronavirus disease (COVID-19) vaccines among people with epilepsy (PwE): a cross-sectional study. Seizure : the journal of the British Epilepsy Association. 2021;92:2–9. https://doi.org/10.1016/j.seizure.2021.08.001.

    Article  Google Scholar 

  34. Lin K, Huang H, Fang S, Zheng G, Fu K, Liu N, et al. Should patients with epilepsy be vaccinated against coronavirus disease 2019? A systematic review and meta-analysis. Epilepsy Behav. 2022;134:108822. https://doi.org/10.1016/j.yebeh.2022.108822.

  35. Fan HT, Lin YY, Chiang WF, Lin CY, Chen MH, Wu KA, et al. COVID-19 vaccine-induced encephalitis and status epilepticus. QJM. 2022;115(2):91–3. https://doi.org/10.1093/qjmed/hcab335.

    Article  CAS  PubMed  Google Scholar 

  36. Shyu S, Fan HT, Shang ST, Chan JS, Chiang WF, Chiu CC, et al. Clinical manifestation, management, and outcomes in patients with COVID-19 vaccine-induced acute encephalitis: two case reports and a literature review. Vaccines (Basel). 2022;10(8). https://doi.org/10.3390/vaccines10081230.

  37. Albert DVF, Das RR, Acharya JN, Lee JW, Pollard JR, Punia V, et al. The Impact of COVID-19 on epilepsy care: a survey of the American Epilepsy Society Membership. Epilepsy currents / American Epilepsy Society. 2020;20(5):316–24. https://doi.org/10.1177/1535759720956994.

    Article  Google Scholar 

  38. Wirrell EC, Grinspan ZM, Knupp KG, Jiang Y, Hammeed B, Mytinger JR, et al. Care delivery for children with epilepsy during the COVID-19 pandemic: an international survey of clinicians. J Child Neurol. 2020;35(13):924–33. https://doi.org/10.1177/0883073820940189.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Krysl D, Beniczky S, Franceschetti S, Arzimanoglou A. The COVID-19 outbreak and approaches to performing EEG in Europe. Epileptic disorders : international epilepsy journal with videotape. 2020;22(5):548–54. https://doi.org/10.1684/epd.2020.1208.

    Article  PubMed  Google Scholar 

  40. •• Ahrens SM, Ostendorf AP, Lado FA, Arnold ST, Bai S, Bensalem-Owen MK, et al. Impact of the COVID-19 pandemic on epilepsy center practice in the United States. Neurology. 2022;98(19):e1893–901. https://doi.org/10.1212/WNL.0000000000200285. The COVID-19 pandemic has caused delays in epilepsy management through delays in video EEG admissions, adjustment of medications and delays in surgical interventions.

  41. Beniczky S, Husain A, Ikeda A, Alabri H, Helen Cross J, Wilmshurst J, et al. Importance of access to epilepsy monitoring units during the COVID-19 pandemic: consensus statement of the International League against epilepsy and the International Federation of Clinical Neurophysiology. Clin Neurophysiol : official journal of the International Federation of Clinical Neurophysiology. 2021;132(9):2248–50. https://doi.org/10.1016/j.clinph.2021.05.001.

    Article  Google Scholar 

  42. Sapkota S, Caruso E, Kobau R, Radhakrishnan L, Jobst B, DeVies J, et al. Seizure- or epilepsy-related emergency department visits before and during the COVID-19 pandemic - United States, 2019–2021. MMWR Morb Mortal Wkly Rep. 2022;71(21):703–8. https://doi.org/10.15585/mmwr.mm7121a2.

  43. Panda PK, Dawman L, Panda P, Sharawat IK. Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country. Seizure : the journal of the British Epilepsy Association. 2020;81:29–35. https://doi.org/10.1016/j.seizure.2020.07.013.

    Article  Google Scholar 

  44. Casares M, Wombles C, Skinner HJ, Westerveld M, Gireesh ED. Telehealth perceptions in patients with epilepsy and providers during the COVID-19 pandemic. Epilepsy Behav. 2020;112:107394. https://doi.org/10.1016/j.yebeh.2020.107394.

  45. Datta P, Barrett W, Bentzinger M, Jasinski T, Jayagopal LA, Mahoney A, et al. Ambulatory care for epilepsy via telemedicine during the COVID-19 pandemic. Epilepsy Behav. 2021;116:107740. https://doi.org/10.1016/j.yebeh.2020.107740.

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Authors and Affiliations

  1. Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Brigitte Reina MD, Michael L. Fitzpatrick MD, George W. Culler IV MD & Barbara C. Jobst MD

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  2. Michael L. Fitzpatrick MD
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Correspondence to Barbara C. Jobst MD.

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Brigitte Reina, Michael L. Fitzpatrick, and George W. Culler declare that they have no potential conflicts of interest. Barbara C. Jobst has no conflicts of interest related to the topic discussed in this review.

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Key points

• Seizures and status epilepticus may occur in patients with COVID-19 infection.

• Acute symptomatic seizures generally occur because of acute brain injury related to systemic pro-inflammatory, hypercoagulable states, and severe metabolic derangements.

• People with epilepsy are not more susceptible to COVID-19 infection; however, they may be at higher risk for more severe COVID-19 infection.

• Clinicians should be aware of potential drug-drug interactions among treatments for COVID-19 and anti-seizure medications.

• COVID-19 pandemic globally affected people with epilepsy due to barriers to access care both routine as well as delaying surgical therapies for epilepsy.

• Implementation of telemedicine has been well received by both clinicians and people with epilepsy to reduce the barriers to healthcare that patients faced early in the pandemic.

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Reina, B., Fitzpatrick, M.L., Culler, G.W. et al. Seizures in the Setting of COVID-19. Curr Treat Options Neurol 25, 407–417 (2023). https://doi.org/10.1007/s11940-023-00767-2

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