Seizure as the presenting symptom of COVID-19: A retrospective case series

Abstract

Background: Coronavirus Disease 2019 (COVID-19) has rapidly become a global pandemic, with over 1.8 million confirmed cases worldwide to date. Preliminary reports suggest that the disease may present in diverse ways, including with neurological symptoms, but few published reports in the literature describe seizures in patients with COVID-19.

Objective: The objective of the study was to characterize the risk factors, clinical features, and outcomes of seizures in patients with COVID-19.

Methods: This is a retrospective case series. Cases were identified through a review of admissions and consultations to the neurology and neurocritical care services between April 1, 2020 and May 15, 2020.

Setting: The study setting was in a tertiary care, safety-net hospital in Boston, MA.

Participants: Patients presenting with seizures and COVID-19 during the study period were included in the study.

Results: Seven patients met inclusion criteria (5 females, 71%). Patients ranged in age from 37 to 88 years (median: 75 years). Three patients had a prior history of well-controlled epilepsy (43%), while 4 patients had new-onset seizures, including 2 patients with prior history of remote stroke. Three patients had no preceding symptoms of COVID-19 prior to presentation (57%), and in all cases, seizures were the symptom that prompted presentation to the emergency department, regardless of prior symptoms of COVID-19.

Conclusions: Provoking factors for seizures in patients with COVID-19 may include metabolic factors, systemic illness, and possibly direct effects of the virus. In endemic areas with community spread of COVID-19, clinicians should be vigilant for the infection in patients who present with seizures, which may precede respiratory symptoms or prompt presentation to medical care. Early testing, isolation, and contact tracking of these patients can prevent further transmission of the virus.

Keywords: COVID-19; Epilepsy; Neuroinfectious diseases; SARS-CoV-2; Seizure.

Fig. 1

Axial brain MRI for patient 7. A–D: T2-weighted fluid attenuated inversion recovery (FLAIR) sequences revealed prominent FLAIR hyperintensity involving the right frontal lobe and bilateral cerebellar hemispheres. E–G: Diffusion-weighted images revealed diffusion restriction involving the right frontal lobe without associated diffusion restriction of the cerebellum.