A presumed case of new-onset focal seizures as a delayed complication of COVID-19 infection

Abstract

Previously seizures have been reported as presenting neurological manifestation with COVID-19 infection. There is a growing literature on the delayed neurologic effects of COVID-19 infection. Here, we report a case with insidious onset of focal impaired awareness seizures associated with left temporal epileptiform interictal and ictal discharges consistent with focal epilepsy; occurring within a short time frame of the diagnosis of COVID-19 infection. This may be possibly a post COVID-19 inflammatory syndrome manifesting as new onset focal epilepsy with focal non-motor seizures with impaired awareness. As implicated by presentation with seizure as in our case, longterm follow-up studies are warranted to further investigate if the patients who acquire COVID-19 infection are at increased risk of developing epilepsy as a delayed manifestation.

Keywords: COVID-19; SARS-CoV-2; Temporal lobe epilepsy.

Fig. 1

Coronal T2 images of hippocampi (1.5 T, TR = 7094 ms, TE = 87.1 ms). No obvious sclerosis or atrophy was noted.

Fig. 2

Interictal EEG. An interictal EEG during sleep with standard 10–20 placement, bipolar montage, band-pass filter of 1–50 Hz, sensitivity 10 μV/mm, showing spike-slow wave discharges arising from the left temporal region.

Fig. 3

a–c. Serial ictal EEGs. a. Onset of seizure. EEG during sleep, with the same setting as mentioned in Fig. 1, showing a sharp wave discharge in the left anterior temporal region followed by diffuse background attenuation. The EKG channel showed significant tachycardia at the beginning of the seizure. b. Consolidation of seizure. An EEG epoch showing rhythmic 5–6 Hz sharp waves in the left anterior temporal region. These sharp discharges increased in amplitude and spread to the other temporal channels. This was then superimposed by dense EMG artifact from tonic phase. c. Termination of seizure. Generalized bursts of frontally dominant poly sharp-slow discharges leading to diffuse suppression of the background.