Status epilepticus and other EEG findings in patients with COVID-19: A case series

Abstract

Purpose: Neurological manifestations of COVID-19 infection include impaired consciousness, strokes, and seizures. Limited reports describing EEG abnormalities in patients with COVID-19 have been published. These articles reported nonspecific encephalopathic patterns, epileptiform discharges, and rarely seizures. Our primary aim was to assess EEG abnormalities in patients with COVID-19 and evaluate for epileptiform activity or seizures.

Methods: We identified five critically ill adult patients with COVID-19 who underwent EEG monitoring. All patients had Ceribell™ rapid response EEG initially and two continued with conventional long-term video EEG.

Results: All 5 patients had encephalopathy and 3 also had seizure-like movements, thus prompting EEG monitoring. EEGs all showed nonspecific markers of encephalopathy including diffuse slowing and generalized rhythmic delta activity. Two also had epileptiform discharges reaching 2-3 Hz at times, with one patient in nonconvulsive status epilepticus and the other developing clinical status epilepticus with myoclonic movements. EEG and clinical symptoms improved with anti-seizure medications.

Conclusion: Status epilepticus was present in 2 out of our cohort of 5 critically ill patients who underwent EEG monitoring. These findings highlight the importance of EEG monitoring in high-risk patients with COVID-19 and encephalopathy. EEG recordings in such patients can identify pathological patterns that will benefit from treatment with anti-seizure medications.

Keywords: COVID-19; Case series; EEG; Encephalopathy; Seizures.

Fig. 1

EEG recordings in the 5 patients with COVID-19 infection viewed in 10 s epochs. Rapid-EEG recordings are in a limited double banana montage viewed at a sensitivity of 50 μV, with the top 4 channels representing the left hemisphere and the bottom 4 channels representing the right hemisphere. Conventional EEG recordings are in double banana montage viewed at a sensitivity of 7 μV. (A) a. Initial rapid-EEG on the first patient showing 2−3 Hz bifrontal predominant spike and wave discharges. b. Conventional EEG showing improvement after starting on anti-seizure medications, with generalized rhythmic delta activity (GRDA) and occasional generalized periodic discharges (GPDs) at mostly 0.5−1 Hz. (B) Rapid-EEG on the second patient showing GPDs reaching 2−3 Hz at times. (C) Rapid-EEG on the third patient showing moderate-severe diffuse slowing and GRDA. (D) a. Initial rapid-EEG on the fourth patient showing severe diffuse slowing. b. Conventional EEG performed later showing moderate-severe diffuse slowing and GRDA. (E) Rapid-EEG on the fifth patient showing moderate diffuse slowing and GRDA.