New-onset refractory status epilepticus following the ChAdOx1 nCoV-19 vaccine

Abstract

Coronavirus is a novel human pathogen causing fulminant respiratory syndrome (COVID-19). Developing an effective and reliable vaccine was emergently pursued to control the dramatic spread of the global pandemic. The standard stages for vaccine development were unprecedentedly accelerated over a few months. We report a case of new-onset refractory status epilepticus (NORSE) after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. We attribute the occurrence of NORSE to the vaccine due to the temporal relationship and the lack of risk factors for epilepsy in the patient. This report adds to the literature a possible rare side effect of a COVID-19 vaccine and contributes to the extremely limited literature on potential neurological side effects of viral vector vaccines. Healthcare providers should be aware of the possibility of post-vaccination epilepsy. The patient had recurrent seizures that were refractory to conventional antiepileptic drug therapy with a dramatic response to immunotherapy with pulse steroids and plasmapheresis. This likely reflects an underlying autoimmune mechanism in the genesis of post-vaccination generalized seizures without fever. Further research is needed to probe and study the exact mechanism at a more molecular level.

Keywords: COVID-19; ChAdOx1 nCoV-19; Seizure; Status epilepticus; Vaccine.

Fig. 1

Brain MRI showed a subtle increase in the signal on FLAIR images at bilateral hippocampi and insula that was correlating with postictal changes.

Fig. 2

Interictal EEG showing a moderate slowing of cerebral background with no evidence of epileptiform discharges.