Meta-analysis of EEG findings in patients with COVID-19

Abstract

Objective: To perform a systematic review and meta-analysis to summarize and quantitatively evaluate the electroencephalogram (EEG) findings in patients with coronavirus disease 2019 (COVID-19).

Methods: The MEDLINE, CENTRAL, and ClinicalTrials.Gov databases were comprehensively assessed and searched for observational studies with EEG findings in patients with COVID-19. Pooled proportions of EEG findings with 95% confidence intervals (CIs) were assessed using a random effects model. The quality of assessment for each study, heterogeneity between the studies, and publication bias were also evaluated.

Results: In total, 12 studies with 308 patients were included in the meta-analysis. Abnormal background activity and generalized slowing in the pooled proportions were common findings among the patients with COVID-19 (96.1% [95% CI: 89.4-99.9]; I² = 60%; p < 0.01 and 92.3% [95% CI: 81.2-99.3]; I² = 74%; p < 0.01, respectively). The proportion of patients with epileptiform discharges (EDs) was 20.3% ([95% CI: 9.85-32.9]; I² = 78%; p < 0.01). The proportion of EDs varied between patients with a history of epilepsy or seizures (59.5% [95% CI: 33.9-83.2]; I² = 0%; p = 0.49) and patients without them (22.4% [95% CI: 10.4-36.4]; I² = 46%; p = 0.07). The findings of seizures and status epilepticus on EEG were observed in 2.05% ([95% CI: 0.02-6.04]; I² = 39%; p = 0.08) and 0.80% ([95% CI: 0.00.-3.69]; I² = 28%; p = 0.17) of the patients, respectively.

Conclusion: The proportion of abnormal background activity in patients with COVID-19 was high (96.1%). Epileptiform discharges were present in 20.3% of the cases and the proportion varied between people who had a history of epilepsy/seizure and those who did not. However, the proportion of seizures and status epilepticus on EEG was low (2.05% and 0. 80%, respectively).

Keywords: COVID-19; EEG; Epilepsy; Neurology; Seizure; Status epilepticus.

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram of this research.

Fig. 2

Random-effects meta-analysis of the pooled proportions of (A) abnormal background activity, (B) generalized slowing, and (C) discontinuous/burst-attenuation or suppression/suppression (DC/BAS/S). 95% C.I. = 95% confidence intervals.

Fig. 3

Random-effects meta-analysis of the pooled proportions of (A) generalized periodic discharges (GPDs), (B) lateralized periodic discharges (LPDs), (C) generalized rhythmic delta activity (GRDA), and (D) lateralized rhythmic delta activity (LRDA). 95% C.I. = 95% confidence intervals.

Fig. 4

Random-effects meta-analysis of the pooled proportion of focal slowing. 95% C.I. = 95% confidence intervals.

Fig. 5

Random-effects meta-analysis of the pooled proportions of (A) epileptiform discharges (EDs), (B) EDs in patients with a history of epilepsy or seizure (PWES), and (C) EDs in patients without a history of epilepsy or seizure (PwoES). 95% C.I. = 95% confidence intervals.

Fig. 6

Random-effects meta-analysis of the pooled proportions of (A) electrographic seizure and (B) electrographic status epilepticus. 95% C.I. = 95% confidence intervals.

Fig. 7

Funnel plots of the meta-analysis of (A) abnormal background activity, (B) generalized slowing, (C) generalized periodic discharges, (D) generalized rhythmic delta activity, and (E) lateralized rhythmic delta activity.

Fig. 8

Funnel plots of the meta-analysis of (A) focal slowing, (B) epileptiform discharges, (C) electrographic seizure, and (D) electrographic status epilepticus.