New-onset status epilepticus in SARS-CoV-2 infection: a case series

Abstract

Background: Neurological manifestations of COVID-19 infection are well recognized. Seizures and status epilepticus (SE) have been reported as possible manifestations and/or complications of SARS-CoV-2 infection at different disease stages, but few data are known about the type, severity, treatment response, and recurrence.

Methods: Single-center retrospective case series.

Results: This case series describes four COVID-19-positive patients admitted to an Italian University Hospital, who developed status epilepticus during the active phase of disease, independently from the severity of respiratory symptoms. Two of them presented a relapse after resolution of the acute viral infection, a feature that has not been previously reported.

Conclusions: Although a possible association between SE and COVID-19 has been reported, the exact etiopathogenetic mechanism remains still not understood. Our series adds new insights to shed further light on this controversial issue.

Keywords: EEG; Epilepsy; Recurrent SE; SARS-CoV-2 infection; Status epilepticus.

Fig. 1

EEG recordings of patient no. 1 (A) and patient no. 4 (B). Panel A shows slow background activity with 1- to 2.5-Hz generalized sharp/triphasic waves predominant on the left fronto-parietal region. Panel B presents 2-Hz sharp-waves and sharp-and-slow-wave complexes on the left parietal region with diffusion to ipsilateral temporal region. Longitudinal EEG montage according to the 10/20 International System + ECG, LFF: 70 Hz, HFF: 0.3 Hz, sensitivity 100 µV/mm

Fig. 2

Radiological findings of patient no. 1 with anti-Zic4 positivity. Brain magnetic resonance imaging (MRI): fluid-attenuated inversion recovery (FLAIR) images revealed hyperintensity in the middle cerebellar peduncles (A), pons (B), and bilateral basal ganglia (C). At 2-month follow-up, FLAIR hyperintensities globally reduced in the same regions (D, E, F) with an increase of cortical atrophy

Fig. 3

EEG characteristics of patient no. 2 (A, B) and patient no. 3 (C, D). Patient no. 2: panel A shows slow background activity with continuous bursts of 3-Hz sharp-waves over the left hemisphere (first SE); panel B demonstrates generalized 3–3.5-Hz sharp-waves (SE relapse). Patient #3: panel C shows diffuse slow background activity with 2–2.5-Hz spike-and-wave and sharp-and-slow-wave complexes over bilateral frontal regions with right prevalence (electrodes Fp2, F4, and F8) (first SE); panel D reports continuous 2-Hz sharp waves on the right parietal region with contralateral diffusion (SE relapse). Longitudinal EEG montage according to the 10/20 International System + ECG, LFF: 70 Hz, HFF: 0.3 Hz, sensitivity 100 µV/mm