Afebrile benign convulsions with or without a reversible splenial lesion in two pediatric patients with COVID-19

Abstract

Background: Seizures in children with coronavirus disease 2019 (COVID-19) were markedly increased during the Omicron variant surge. Most seizures occurred with fever. New-onset afebrile seizures were rarely reported; therefore, their courses are not well-known.

Case presentation: Two patients (7 and 26 months of age, respectively) with COVID-19 showed recurrent afebrile seizures immediately after resolution of a fever lasting for 2-3 days. Bilateral convulsive seizures lasted for approximately 1 min/episode (6 of 7 total episodes) and occurred 3-4 times within 2-3 h. However, the patients were alert between seizures, which is in contrast to seizures occurring with encephalopathy or encephalitis. Only one episode required acute antiseizure medication. Brain magnetic resonance imaging showed a reversible splenial lesion in one patient. The serum uric acid level was slightly increased (7.8 mg/dL) in this patient. Electroencephalography findings were all normal. During the follow-up period, no seizures or developmental problems have been observed.

Conclusions: COVID-19-associated, afebrile benign convulsions with or without a reversible splenial lesion are similar to 'benign convulsions with mild gastroenteritis'; therefore, continuation of antiseizure medication does not seem necessary.

Keywords: COVID-19; Child; Infant; Reversible splenial lesion; Seizures.

Fig. 1

Brain magnetic resonance imaging (MRI) at the time of diagnosis (A–C) and 47 days after the first visit (D) in patient 2. Axial T2-weighted (A) and fluid-attenuated inversion recovery (FLAIR, B) images showed a 1-cm hyperintense lesion in the splenium of the corpus callosum. This lesion with diffusion restriction (C) on diffusion imaging at the time of diagnosis was not detected in the corpus callosal splenium 47 days after the first visit (D)