Asadi-Pooya[1] notes that acute symptomatic seizures may occur in patients secondary to a wide range of causes, including hypoxia, organ failure, metabolic and/or electrolyte imbalances[1], and were reported in both SARS and MERS. He recommends a seizure management strategy in critically ill COVID-19 patients depending on the number of seizures and the presence of status epilepticus (SE). Non-convulsive status epilepticus should be considered in critically ill patients with a deterioration in mental state and the cause of SE should always be sought. Attention should be paid to potential ASM and COVID-19 therapy drug-drug interactions, and the possible need for ASM dose adjustment in event of COVID-19-related cardiac, hepatic or renal dysfunction.
In a review of neurological features of SARS-CoV-2, Whittaker et al[2] report a retrospective study of 214 hospitalised SARS-CoV-2-positive patients in Wuhan, China with an observed seizure frequency of just 0.5%, and three case reports of seizures occurring with meningoencephalitis.
Yasri and Wiwanikit[3] described the COVID-19 landscape in Thailand. Of 1,978 patients with confirmed SARS-CoV-2 infection, one (0.05%) had a history of epilepsy and did not experience any seizures during the clinical course of COVID-19.
Garazzino et al[4] reported results of an Italian multicentre study of SARS-CoV-2 infection in 168 children, where five (3%) had seizures (three had a known history of epilepsy, one had febrile seizures in infancy, and one developed febrile seizures at the onset of COVID-19; SARS-CoV-2 encephalitis was excluded).
Key points:
- Acute symptomatic seizures occurred during the SARS and MERS outbreaks, and have been reported with meningoencephalitis in the context of SARS-CoV-2 infection.
- Overall, seizures seem uncommon with SARS-CoV-2 infection, even in people with an established history of epilepsy.
- COVID19-related organ dysfunction may require dose adjustment of anti-seizure medicines (ASMs), and potential drug-drug interactions between ASMs and COVID-19 therapies should be actively sought.
References:
1. Asadi-Pooya AA. Seizures Associated with Coronavirus Infections. Seizure. 2020 Jul;79:49-52. doi: 10.1016/j.seizure.2020.05.005.
2. Whittaker A, Anson M, Harky A. Neurological Manifestations of COVID-19: A Systematic Review and Current Update. Acta Neurol Scand. 2020 Jul;142(1):14-22. doi: 10.1111/ane.13266.
3. Yasri S, Wiwanikit V. COVID-19 and Epilepsy. Ann Indian Acad Neurol. 2020 Apr;23(Suppl 1):S43. doi: 10.4103/aian.AIAN_254_20.
4. Garazzino S, Montagnani C, Donà D, et al. Multicentre Italian Study of SARS-CoV-2 Infection in Children and Adolescents, Preliminary Data as at 10 April 2020. Euro Surveill. 2020 May;25(18):2000600. doi: 10.2807/1560-7917.ES.2020.25.18.2000600.