Status epilepticus and COVID-19: A systematic review

Abstract

Purpose: In March 2020, the World Health Organization declared the SARS-CoV-2 infection-related coronavirus Disease (COVID-19) a pandemic. During the first and second waves of the pandemic spread, there have been several reports of COVID-19-associated neurological manifestations, including acute seizures and status epilepticus (SE). In this systematic review, we summarized the available data on clinical features, diagnosis, and therapy of COVID-19-related SE.

Methods: We performed a systematic search of the literature to identify data on demographics, clinical, neurophysiological, and neuroradiological data of patients with COVID-19-related SE. We used regression models (linear or logistic) with a stepwise forward method to identify features associated with mortality or severity of SE.

Results: Thirty-nine articles were included with a total of 47 cases of SE associated with COVID-19. Age, time between the acute respiratory phase of SARS-CoV-2 infection and SE onset, and hospitalization correlated with a higher SE severity as assessed by quantitative validated scales.

Conclusions: SE can be a neurological manifestation of SARS-CoV-2 infection. Although a possible association between SE and COVID-19 has been reported, the exact mechanisms are still not fully understood. Systemic inflammatory syndrome due to cytokine release could play a role in COVID-19-related SE.

Keywords: Epilepsy; Pandemic; SARS-CoV-2 infection; Status epilepticus.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram describing the search from literature; 844 records were screened, from which 39 articles (24 case reports and 15 retrospective studies) were selected. SE: status epilepticus.

Fig. 2

A) A multiple linear regression model showed that severity of STESS score was influenced by the number of ASMs (p = 0.007), IHO of SE (p = 0.001), age (p = 0.048), TtSE (p = 0.005). B) U Mann–Whitney test showed that patients who survived were younger (median age = 49,5, IQR 35–63) than those who did not (median age = 71, IQR 50–69) (p < 0.02). C) The relation between EMSE and age was further confirmed using an ANOVA comparing the variance of EMSE score among age groups (0–30 years, 30–65 years, over 65 years), with higher mean EMSE scores in the older group (p < 0.001).