wikidoc - User contributions [en]

Diarrhea resident survival guide (pediatrics)

2020-11-08T13:49:46Z

Mandana Safakhah: /* Causes */

__NOTOC__

{{CMG}} {{AE}}

{{SK}}

{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0";
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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align=center| {{fontcolor|#2B3B44|Diarrhea resident survival guide (pediatrics) Microchapters}}
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Diarrhea resident survival guide (pediatrics)#Overview|Overview]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Diarrhea resident survival guide (pediatrics)#Causes|Causes]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Diarrhea resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Diarrhea resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Diarrhea resident survival guide (pediatrics)#Treatment|Treatment]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Diarrhea resident survival guide (pediatrics)#Do's|Do's]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Diarrhea resident survival guide (pediatrics)#Don'ts|Don'ts]]
|}

==Overview==
[[Diarrhea]] remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. [[Diarrhea]] is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. [[Acute diarrhea]] is when [[diarrhea]] occurs for less than 3 weeks total. When [[diarrhea]] lasts longer than three weeks, it is considered to be [[chronic]].

==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. A wide range of underlying causes induce life threatening conditions for a child with diarrhea .Hence , [[physical examination]] plays a crucial role in assessing children with diarrhea in the first step .
* [[Cholera]]: [[Vibrio Cholera]] leads to a severe watery [[Diarrhea]] which can result in severe dehydration if left untreated.
* [[Surgical related causes]]: [[Intussusception]] which presents with red jelly diarrhea and an ill baby.

===Common Causes===
* [[Enteral infections]] including common viral, bacterial and parasitic infections.
* parenteral causes including infections elsewhere in the body : [[UTI]],[[Acute otitis media]], [[Sepsis]].
* [[Inflammatory ]] including [[IBD]],Allergy to cow's milk , [[whipples disease]].
* [[Malabsorption]] including [[celiac disease]] ,[[lactase deficiency]]
* Feed related
*[[Endocrine]] :[[Hypothyroidism]],[[Addison's disease]] ,[[Hyperparathyroidism]]'
*[[Neoplastic causes]]
*[[psychosocial]]

==FIRE: Focused Initial Rapid Evaluation==

==Complete Diagnostic Approach==
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | A01 | | | A01= }}
{{familytree | | | | |!| | | | }}
{{familytree | | | | B01 | | | B01= }}
{{familytree | | |,|-|^|-|.| | }}
{{familytree | | C01 | | C02 | C01= | C02= }}

{{familytree/end}}

==Treatment==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | A01 |A01= }}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01= }}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}
{{familytree | | | | | | | | | | |!| | | | |!| }}
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
{{familytree/end}}

==Do's==
* The content in this section is in bullet points.

==Don'ts==
* The content in this section is in bullet points.

==References==
{{Reflist|2}}

[[Category:Projects]]
[[Category:Resident survival guide]]
[[Category:Pediatrics]]

COVID-19 other diagnostic studies

2020-07-21T13:54:15Z

Mandana Safakhah: /* Other Diagnostic Studies */

__NOTOC__
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 
{{COVID-19}}
{{CMG}}; {{AE}} {{HK}} {{Mandana.Sa}}
==Overview==
Research laboratories have used isolation methods, [[electron microscopy]], [[serology]] and [[PCR|PCR-based assays]] to diagnose coronavirus infections for surveillance studies.

==Other Diagnostic Studies==
Specific laboratory tests may include:
* Virus isolation in cell culture.
* [[Polymerase chain reaction]] (PCR) assays that are more practical and available commercially .However, [[false negative]] cases have been reported by several studies. hence it is suggested to obtain three negative consecutive [[r-RT-PCR]] tests before discharging patients with covid-19 .<ref name="WangYu2020">{{cite journal|last1=Wang|first1=Guan|last2=Yu|first2=Na|last3=Xiao|first3=Weimin|last4=Zhao|first4=Chen|last5=Wang|first5=Zhenning|title=Consecutive false‐negative rRT‐PCR test results for SARS‐CoV‐2 in patients after clinical recovery from COVID‐19|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.26192}}</ref>

[[Image:true negative1.png|500px|thumb|center|time distribution of false and true negative of covid-19 pcr results<ref name="WangYu2020">{{cite journal|last1=Wang|first1=Guan|last2=Yu|first2=Na|last3=Xiao|first3=Weimin|last4=Zhao|first4=Chen|last5=Wang|first5=Zhenning|title=Consecutive false‐negative rRT‐PCR test results for SARS‐CoV‐2 in patients after clinical recovery from COVID‐19|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.26192}}</ref> ]]
* Serological testing for [[antibody|antibodies]] to human coronaviruses. Serological assays play an essential role in contact tracing among populations and confirming covid-19 cases when [[RNA]] negative patients presents late in the illness.<ref name="pmid32223179">{{cite journal| author=Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC | display-authors=etal| title=Diagnosing COVID-19: The Disease and Tools for Detection. | journal=ACS Nano | year= 2020 | volume= 14 | issue= 4 | pages= 3822-3835 | pmid=32223179 | doi=10.1021/acsnano.0c02624 | pmc=7144809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?adbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32223179 }} </ref> <ref name="pmid32245835">{{cite journal| author=Tang YW, Schmitz JE, Persing DH, Stratton CW| title=Laboratory Diagnosis of COVID-19: Current Issues and Challenges. | journal=J Clin Microbiol | year= 2020 | volume= 58 | issue= 6 | pages= | pmid=32245835 | doi=10.1128/JCM.00512-20 | pmc=7269383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32245835 }} </ref>

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires the collection of blood specimens.

==Gallery==

<gallery>

Image: Coronavirus21.jpeg| SEM reveals the “rosette-like” appearance of the matured coronavirus particles. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus20.jpeg| TEM revealed the presence of a number of infectious bronchitis virus (IBV) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus18.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus16.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus15.jpeg| TEM from a tissue culture isolate, revealing numbers of severe acute respiratory virus (SARS) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>
</gallery>
==References==
{{reflist|2}}

COVID-19 other diagnostic studies

2020-07-21T13:53:15Z

Mandana Safakhah: /* Other Diagnostic Studies */

__NOTOC__
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 
{{COVID-19}}
{{CMG}}; {{AE}} {{HK}} {{Mandana.Sa}}
==Overview==
Research laboratories have used isolation methods, [[electron microscopy]], [[serology]] and [[PCR|PCR-based assays]] to diagnose coronavirus infections for surveillance studies.

==Other Diagnostic Studies==
Specific laboratory tests may include:
* Virus isolation in cell culture.
* [[Polymerase chain reaction]] (PCR) assays that are more practical and available commercially .However, [[false negative]] cases have been reported by several studies. hence it is suggested to obtain three negative consecutive [[r-RT-PCR]] tests before discharging patients with covid-19 .<ref name="WangYu2020">{{cite journal|last1=Wang|first1=Guan|last2=Yu|first2=Na|last3=Xiao|first3=Weimin|last4=Zhao|first4=Chen|last5=Wang|first5=Zhenning|title=Consecutive false‐negative rRT‐PCR test results for SARS‐CoV‐2 in patients after clinical recovery from COVID‐19|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.26192}}</ref>

[[Image:true negative1.png|500px|thumb|center|time distribution of false and true negative of covid-19 pcr results]]<ref name="WangYu2020">{{cite journal|last1=Wang|first1=Guan|last2=Yu|first2=Na|last3=Xiao|first3=Weimin|last4=Zhao|first4=Chen|last5=Wang|first5=Zhenning|title=Consecutive false‐negative rRT‐PCR test results for SARS‐CoV‐2 in patients after clinical recovery from COVID‐19|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.26192}}</ref>
* Serological testing for [[antibody|antibodies]] to human coronaviruses. Serological assays play an essential role in contact tracing among populations and confirming covid-19 cases when [[RNA]] negative patients presents late in the illness.<ref name="pmid32223179">{{cite journal| author=Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC | display-authors=etal| title=Diagnosing COVID-19: The Disease and Tools for Detection. | journal=ACS Nano | year= 2020 | volume= 14 | issue= 4 | pages= 3822-3835 | pmid=32223179 | doi=10.1021/acsnano.0c02624 | pmc=7144809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?adbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32223179 }} </ref> <ref name="pmid32245835">{{cite journal| author=Tang YW, Schmitz JE, Persing DH, Stratton CW| title=Laboratory Diagnosis of COVID-19: Current Issues and Challenges. | journal=J Clin Microbiol | year= 2020 | volume= 58 | issue= 6 | pages= | pmid=32245835 | doi=10.1128/JCM.00512-20 | pmc=7269383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32245835 }} </ref>

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires the collection of blood specimens.

==Gallery==

<gallery>

Image: Coronavirus21.jpeg| SEM reveals the “rosette-like” appearance of the matured coronavirus particles. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus20.jpeg| TEM revealed the presence of a number of infectious bronchitis virus (IBV) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus18.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus16.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus15.jpeg| TEM from a tissue culture isolate, revealing numbers of severe acute respiratory virus (SARS) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>
</gallery>
==References==
{{reflist|2}}

COVID-19-associated seizure

2020-07-21T13:47:45Z

Mandana Safakhah: /* Pathophysiology */

__NOTOC__
{{SI}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

[[Seizure]] refers to an episode of [[symptom]]s due to abnormally excessive or synchronous [[neuronal]] activity in the [[brain]] followed by return to normal state. [[Seizures]] manifest as abnormal uncontrolled shaking movements that involve much of the [[body]] with loss of [[consciousness]], shaking movements of part of the [[body]] with variable level of [[consciousness]] or a subtle momentary loss of [[consciousness]]. As [[COVID-19]] (caused by [[SARS-CoV-2|SARS-Cov2]]) is now known to have several [[neurological]] [[complications]], [[seizure]] is one of the [[complications]] seen in a few cases so far. [[Brain]] waive activity can be seen on [[EEG]] to confirm diagnosis since structural changes are very rarely seen on [[brain]] [[imaging]]. Anti-[[seizure]] [[medications]] are used for symptomatic treatment of [[seizure]] along with [[treatment]] of [[COVID-19]].

==Historical Perspective==

*First case of seizure in [[COVID-19]] patient was a result of [[meningitis]]/[[encephalitis]] caused by [[SARS-CoV-2|SARS-CoV2]] and documented by Moriguchi et al in late February 2020 <ref name="pmid32251791">{{cite journal |vauthors=Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, Ueno M, Sakata H, Kondo K, Myose N, Nakao A, Takeda M, Haro H, Inoue O, Suzuki-Inoue K, Kubokawa K, Ogihara S, Sasaki T, Kinouchi H, Kojin H, Ito M, Onishi H, Shimizu T, Sasaki Y, Enomoto N, Ishihara H, Furuya S, Yamamoto T, Shimada S |title=A first case of meningitis/encephalitis associated with SARS-Coronavirus-2 |journal=Int. J. Infect. Dis. |volume=94 |issue= |pages=55–58 |date=May 2020 |pmid=32251791 |pmc=7195378 |doi=10.1016/j.ijid.2020.03.062 |url=}}</ref>.
*After that, more cases were reported with acute [[Seizure|seizures]] as a complication of COVID-19.<ref name="HepburnMullaguri2020">{{citejournal|last1=Hepburn|first1=Madihah|last2=Mullaguri|first2=Naresh|last3=George|first3=Pravin|last4=Hantus|first4=Stephen|last5=Punia|first5=Vineet|last6=Bhimraj|first6=Adarsh|last7=Newey|first7=Christopher R.|title=Acute Symptomatic Seizures in Critically Ill Patients with COVID-19: Is There an Association?|journal=Neurocritical Care|year=2020|issn=1541-6933|doi=10.1007/s12028-020-01006-1}}</ref><ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1059131120301151<nowiki>}}</nowiki></ref>
*In early February 2020, seizurelike activity was reported in two COVID-19 patients but the cause was acute [[anxiety]] disorder and [[electrolyte imbalance]] instead of viral damage by [[SARS-Cov-2]]<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>
*To view the historical perspective of COVID-19, [[COVID-19 historical perspective|click here]].

==Classification==

*There is no established classification for [[COVID-19]] associated [[seizure]].

==Pathophysiology==

*[[Neurological]] complications caused by [[COVID-19]] are through direct or indirect pathways.
*This includes [[hematogenous]] pathway, [[neuronal]] [[retrograde]] dissemination through [[olfactory bulb]], entry into to [[glial]] cells and [[neurons]] via [[ACE2]] receptor and impairment of [[gas]] exchange in [[lung]]s leading to [[anemia]], hence increasing [[anaerobic]] metabolites in [[brain]] resulting in [[cellular]] and interstitial [[edema]] <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
*[[Seizures]] in a patient with [[COVID-19]] may be due to primary [[virus]] [[infection]] or due to reactivation of the latent [[virus]].
*Infiltration of the [[brain]] [[tissue]] by the [[virus]] and subsequent production of [[toxins]] by the [[virus]] is one of the several mechanisms that can cause [[seizures]] in a [[COVID-19]] [[patient]]. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
*Production of [[inflammatory]] mediators by the brain may also trigger [[seizures]].
*[[Inflammatory]] [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by [[COVID-19]] include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes [[neuronal]] [[hyperexcitability]] and development of [[seizures]]. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]<ref name="AbboudAbboud2020">{{cite journal|last1=Abboud|first1=Hilal|last2=Abboud|first2=Fatima Zahra|last3=Kharbouch|first3=Hanane|last4=Arkha|first4=Yasser|last5=El Abbadi|first5=Najia|last6=El Ouahabi|first6=Abdessamad|title=COVID-19 and SARS-Cov-2 Infection: Pathophysiology and Clinical Effects on the Nervous System|journal=World Neurosurgery|volume=140|year=2020|pages=49–53|issn=18788750|doi=10.1016/j.wneu.2020.05.193}}</ref>

==Causes==

*Cause of COVID-19-associated seizure is viral infection by [[SARS-CoV-2]] and its consequences which include:<ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
**[[Hypoxia]]
**[[Metabolic]] derangement
**[[Organ failure]]
**[[Cerebral]] damage.<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>
**To view causes of COVID-19, [[COVID-19 causes|click here]].

==Differentiating COVID-19-associated seizure from other Diseases==

*For further information about the differential diagnosis, [[COVID-19-associated seizure differential diagnosis|click here]].
*To view the differential diagnosis of COVID-19, [[COVID-19 differential diagnosis|click here]].

==Epidemiology and Demographics==

*More data is required to comment on [[epidemiology]] and [[demographics]] of [[COVID-19]]-associated [[seizure]].
*One study, specifically investigated the neurological manifestations of [[COVID-19]] and documented [[CNS]] manifestations in 25% of the patients ([[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)]<ref name="MaoJin2020">{{cite journal|last1=Mao|first1=Ling|last2=Jin|first2=Huijuan|last3=Wang|first3=Mengdie|last4=Hu|first4=Yu|last5=Chen|first5=Shengcai|last6=He|first6=Quanwei|last7=Chang|first7=Jiang|last8=Hong|first8=Candong|last9=Zhou|first9=Yifan|last10=Wang|first10=David|last11=Miao|first11=Xiaoping|last12=Li|first12=Yanan|last13=Hu|first13=Bo|title=Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China|journal=JAMA Neurology|volume=77|issue=6|year=2020|pages=683|issn=2168-6149|doi=10.1001/jamaneurol.2020.1127}}</ref>

==Risk Factors==

*Several risk factors of [[seizure]] in [[COVID-19]] patients were considered in a multicenter [[restrospective]] study from Jan 18th to FEb 18th, 2020 in China.<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>
*[[Risk factor]]s that were studied include acute [[cerebrovascular disease]], [[traumatic brain injury]] (TBI), [[central nervous system]] (CNS) [[infection]], [[shock]], [[hypoxia]], severe [[metabolic disturbance]], [[multiple‐organ dysfunction syndrome]], [[sepsis]], and exposure to drugs or [[toxic]] substances.
*According to the study, [[hypoxia]] and [[imipenem]] were shown to be important risk factors, among several others, for [[seizure]] in a [[COVID-19]] patient.
*To view the risk factors of COVID-19, [[COVID-19 risk factors|click here]].

==Screening==

*There is insufficient evidence to recommend routine screening for [[COVID-19]] associated [[seizure]].

==Natural History, Complications, and Prognosis==

'''Natural History'''

*[[Seizure]] activity in a patient with or without [[COVID-19]] usually lasts for a few seconds to less than 5 minutes with return to normal after the [[seizure]] episode.
*If [[seizure]] episode lasts for more than 5 minutes it is called [[status epilepticus]].
*This is followed by a period of [[confusion]], called [[Postictal state|postictal period]] that can last 3-15 minutes and sometimes hours.

'''Complications'''

*Complications of COVID-19-associated seizure include:
**[[Headache]]
**[[Tiredness]]
**Difficulty [[speaking]]
**[[Difficulty breathing]] (due to blockage of airway)
**Abnormal behavior
**[[Psychosis]]
**Injury to [[tongue]] due to [[bite]] during [[seizure]] activity
**[[Trauma]] due to sudden [[fall]] and/or [[loss of consciousness]]

'''Prognosis'''

*In general, after the first [[seizure]], subsequent [[seizure]] episodes can be predicted using [[EEG]] and [[brain imaging]].<ref name="pmid22963022">{{cite journal |vauthors=Wilden JA, Cohen-Gadol AA |title=Evaluation of first nonfebrile seizures |journal=Am Fam Physician |volume=86 |issue=4 |pages=334–40 |date=August 2012 |pmid=22963022 |doi= |url=}}</ref>
*[[Prognosis]] of seizure in a [[COVID-19]] patient is not known.
*However, if left untreated, [[seizure]] caused by acute brain event is known to have low risk of recurrence but higher risk of death compared to those with [[epilepsy]]. <ref name="pmid8965090">{{cite journal |vauthors=Sander JW, Shorvon SD |title=Epidemiology of the epilepsies |journal=J. Neurol. Neurosurg. Psychiatry |volume=61 |issue=5 |pages=433–43 |date=November 1996 |pmid=8965090 |pmc=1074036 |doi=10.1136/jnnp.61.5.433 |url=}}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

*The diagnosis of COVID-19-associated seizure is made through [[Electroencephalography|electroencephalogram]] ([[EEG]], brain waive activity).<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>

*Other diagnostic tests include:
**[[CT scan]] brain
**[[MRI]] brain
**Blood test
**[[Lumbar puncture]]
**[[Toxicology]] screening

===Symptoms===

'''Common symptoms:'''

*[[Staring]]
*[[Jerking]] movements of the [[Arm|arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems

===== Loss of [[bowel]] or [[bladder]] control =====

*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze

'''Less common symptoms:'''

*Nodding of [[head]] rhythmically, associated with lack of awareness
*Periods of rapid [[eye]] [[blinking]]

===Physical Examination===

*Physical examination of a patient with COVID-19-associated seizure include:

==== Vital Signs ====

*[[Vital signs]]: [[Tachycardia]] may be present.

===== HEENT =====

* Finding a [[bite]] to the side of the [[tongue]] (when present, is helpful in making the diagnosis).

===== Neuromuscular =====

*[[Postictal state|Postictal]] [[drowsiness]] or [[confusion]].

===Laboratory Findings===

*[[Postictal state|Postictal]] levels of the following may be elevated in a patient with [[seizures]]:
**[[Prolactin]] (within 20 minutes after a convulsive event)
**[[Lactate]] (within 1 to 2 hours)
**[[Ammonia]] (within several hours)
**[[Creatine kinase]] (especially 24 to 48 hours postictally)
**To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===

*There are no typical [[ECG]] findings associated with seizures in a [[COVID-19]] patient.
*To view the [[electrocardiogram]] findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===

*There are no [[X-rays|x-ray]] findings associated with [[COVID-19]] associated [[seizure]].
*To view the [[X-rays|x-ray]] finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===

*There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
*To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===

*[[CT]] [[brain]] may show structural lesions but majority of patients will show nothing.
*To view the [[CT scan]] findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===

*[[MRI]] brain may show structural lesions but majority of patients will show nothing.
*To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===

*There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
*To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===

*To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

*Development of [[seizures]] in a [[COVID-19]] patient requires urgent treatment.<ref name="pmid25174548">{{cite journal |vauthors=Ueda R, Saito Y, Ohno K, Maruta K, Matsunami K, Saiki Y, Sokota T, Sugihara S, Nishimura Y, Tamasaki A, Narita A, Imamura A, Maegaki Y |title=Effect of levetiracetam in acute encephalitis with refractory, repetitive partial seizures during acute and chronic phase |journal=Brain Dev. |volume=37 |issue=5 |pages=471–7 |date=May 2015 |pmid=25174548 |doi=10.1016/j.braindev.2014.08.003 |url=}}</ref><ref name="pmid32283294">{{cite journal |vauthors=Ye M, Ren Y, Lv T |title=Encephalitis as a clinical manifestation of COVID-19 |journal=Brain Behav. Immun. |volume= |issue= |pages= |date=April 2020 |pmid=32283294 |pmc=7146652 |doi=10.1016/j.bbi.2020.04.017 |url=}}</ref><ref name="pmid32416567" />
*After the cause of [[seizure]] is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], [[fever]], metabolic imbalance).
*Anti-seizure medication ([[levetiracetam]] 50-60 mg/kg/day) is often necessary.
*Anti-epileptics therapy with [[mannitol]] has been documented in decreasing [[cerebral edema]].
*For a single [[seizure]] less than 5 min rescue treatment with [[benzodiazepine]] is not needed.
*[[Intravenous]] antiseizure medication are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in [[respiratory]] and [[cardiac]] problems) and [[drug]] interactions (e.g., [[Carbamazepine]], [[Phenytoin]], [[Phenobarbital]] and [[Valproic acid]]).
*[[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions.
*In patients with more than one [[seizure]] (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with [[benzodiazepines]] in addition to ASM is needed.

===Surgery===

* Surgical intervention is not recommended for the management of [[COVID-19]] associated [[seizure]].

===Primary Prevention===

* There are no established measures for the [[primary prevention]] of [[seizures]] associated with [[COVID-19]].

===Secondary Prevention===

* There are no established measures for the [[secondary prevention]] of [[seizures]] associated with [[COVID-19]].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19 other diagnostic studies

2020-07-18T17:13:47Z

Mandana Safakhah:

__NOTOC__
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 
{{COVID-19}}
{{CMG}}; {{AE}} {{HK}} {{Mandana.Sa}}
==Overview==
Research laboratories have used isolation methods, [[electron microscopy]], [[serology]] and [[PCR|PCR-based assays]] to diagnose coronavirus infections for surveillance studies.

==Other Diagnostic Studies==
Specific laboratory tests may include:
* Virus isolation in cell culture.
* [[Polymerase chain reaction]] (PCR) assays that are more practical and available commercially .However, [[false negative]] cases have been reported by several studies. hence it is suggested to obtain three negative consecutive [[r-RT-PCR]] tests before discharging patients with covid-19 .<ref name="WangYu2020">{{cite journal|last1=Wang|first1=Guan|last2=Yu|first2=Na|last3=Xiao|first3=Weimin|last4=Zhao|first4=Chen|last5=Wang|first5=Zhenning|title=Consecutive false‐negative rRT‐PCR test results for SARS‐CoV‐2 in patients after clinical recovery from COVID‐19|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.26192}}</ref>

[[Image:true negative1.png|500px|thumb|center|time distribution of false and true negative of covid-19 pcr results]]
* Serological testing for [[antibody|antibodies]] to human coronaviruses. Serological assays play an essential role in contact tracing among populations and confirming covid-19 cases when [[RNA]] negative patients presents late in the illness.<ref name="pmid32223179">{{cite journal| author=Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC | display-authors=etal| title=Diagnosing COVID-19: The Disease and Tools for Detection. | journal=ACS Nano | year= 2020 | volume= 14 | issue= 4 | pages= 3822-3835 | pmid=32223179 | doi=10.1021/acsnano.0c02624 | pmc=7144809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?adbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32223179 }} </ref> <ref name="pmid32245835">{{cite journal| author=Tang YW, Schmitz JE, Persing DH, Stratton CW| title=Laboratory Diagnosis of COVID-19: Current Issues and Challenges. | journal=J Clin Microbiol | year= 2020 | volume= 58 | issue= 6 | pages= | pmid=32245835 | doi=10.1128/JCM.00512-20 | pmc=7269383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32245835 }} </ref>

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires the collection of blood specimens.

==Gallery==

<gallery>

Image: Coronavirus21.jpeg| SEM reveals the “rosette-like” appearance of the matured coronavirus particles. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus20.jpeg| TEM revealed the presence of a number of infectious bronchitis virus (IBV) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus18.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus16.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus15.jpeg| TEM from a tissue culture isolate, revealing numbers of severe acute respiratory virus (SARS) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>
</gallery>
==References==
{{reflist|2}}

COVID-19 other diagnostic studies

2020-07-18T17:10:09Z

Mandana Safakhah: /* Other Diagnostic Studies */

__NOTOC__
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 
{{COVID-19}}
{{CMG}}; {{AE}} {{HK}}

==Overview==
Research laboratories have used isolation methods, [[electron microscopy]], [[serology]] and [[PCR|PCR-based assays]] to diagnose coronavirus infections for surveillance studies.

==Other Diagnostic Studies==
Specific laboratory tests may include:
* Virus isolation in cell culture.
* [[Polymerase chain reaction]] (PCR) assays that are more practical and available commercially .However, [[false negative]] cases have been reported by several studies. hence it is suggested to obtain three negative consecutive [[r-RT-PCR]] tests before discharging patients with covid-19 .<ref name="WangYu2020">{{cite journal|last1=Wang|first1=Guan|last2=Yu|first2=Na|last3=Xiao|first3=Weimin|last4=Zhao|first4=Chen|last5=Wang|first5=Zhenning|title=Consecutive false‐negative rRT‐PCR test results for SARS‐CoV‐2 in patients after clinical recovery from COVID‐19|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.26192}}</ref>

[[Image:true negative1.png|500px|thumb|center|time distribution of false and true negative of covid-19 pcr results]]
* Serological testing for [[antibody|antibodies]] to human coronaviruses. Serological assays play an essential role in contact tracing among populations and confirming covid-19 cases when [[RNA]] negative patients presents late in the illness.<ref name="pmid32223179">{{cite journal| author=Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC | display-authors=etal| title=Diagnosing COVID-19: The Disease and Tools for Detection. | journal=ACS Nano | year= 2020 | volume= 14 | issue= 4 | pages= 3822-3835 | pmid=32223179 | doi=10.1021/acsnano.0c02624 | pmc=7144809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?adbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32223179 }} </ref> <ref name="pmid32245835">{{cite journal| author=Tang YW, Schmitz JE, Persing DH, Stratton CW| title=Laboratory Diagnosis of COVID-19: Current Issues and Challenges. | journal=J Clin Microbiol | year= 2020 | volume= 58 | issue= 6 | pages= | pmid=32245835 | doi=10.1128/JCM.00512-20 | pmc=7269383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32245835 }} </ref>

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires the collection of blood specimens.

==Gallery==

<gallery>

Image: Coronavirus21.jpeg| SEM reveals the “rosette-like” appearance of the matured coronavirus particles. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus20.jpeg| TEM revealed the presence of a number of infectious bronchitis virus (IBV) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus18.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus16.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus15.jpeg| TEM from a tissue culture isolate, revealing numbers of severe acute respiratory virus (SARS) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>
</gallery>
==References==
{{reflist|2}}

File:True negative1.png

2020-07-18T17:09:29Z

Mandana Safakhah:

COVID-19 other diagnostic studies

2020-07-18T17:01:08Z

Mandana Safakhah: /* Other Diagnostic Studies */

__NOTOC__
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 
{{COVID-19}}
{{CMG}}; {{AE}} {{HK}}

==Overview==
Research laboratories have used isolation methods, [[electron microscopy]], [[serology]] and [[PCR|PCR-based assays]] to diagnose coronavirus infections for surveillance studies.

==Other Diagnostic Studies==
Specific laboratory tests may include:
* Virus isolation in cell culture.
* [[Polymerase chain reaction]] (PCR) assays that are more practical and available commercially .However, [[false negative]] cases have been reported by several studies. hence it is suggested to obtain three negative consecutive [[r-RT-PCR]] tests before discharging patients with covid-19 .<ref name="WangYu2020">{{cite journal|last1=Wang|first1=Guan|last2=Yu|first2=Na|last3=Xiao|first3=Weimin|last4=Zhao|first4=Chen|last5=Wang|first5=Zhenning|title=Consecutive false‐negative rRT‐PCR test results for SARS‐CoV‐2 in patients after clinical recovery from COVID‐19|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.26192}}</ref>

* Serological testing for [[antibody|antibodies]] to human coronaviruses. Serological assays play an essential role in contact tracing among populations and confirming covid-19 cases when [[RNA]] negative patients presents late in the illness.<ref name="pmid32223179">{{cite journal| author=Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC | display-authors=etal| title=Diagnosing COVID-19: The Disease and Tools for Detection. | journal=ACS Nano | year= 2020 | volume= 14 | issue= 4 | pages= 3822-3835 | pmid=32223179 | doi=10.1021/acsnano.0c02624 | pmc=7144809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?adbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32223179 }} </ref> <ref name="pmid32245835">{{cite journal| author=Tang YW, Schmitz JE, Persing DH, Stratton CW| title=Laboratory Diagnosis of COVID-19: Current Issues and Challenges. | journal=J Clin Microbiol | year= 2020 | volume= 58 | issue= 6 | pages= | pmid=32245835 | doi=10.1128/JCM.00512-20 | pmc=7269383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32245835 }} </ref>

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires the collection of blood specimens.

==Gallery==

<gallery>

Image: Coronavirus21.jpeg| SEM reveals the “rosette-like” appearance of the matured coronavirus particles. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus20.jpeg| TEM revealed the presence of a number of infectious bronchitis virus (IBV) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus18.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus16.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus15.jpeg| TEM from a tissue culture isolate, revealing numbers of severe acute respiratory virus (SARS) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>
</gallery>
==References==
{{reflist|2}}

File:True negative.png

2020-07-18T16:54:19Z

Mandana Safakhah:

COVID-19 other diagnostic studies

2020-07-18T16:52:09Z

Mandana Safakhah: /* Other Diagnostic Studies */

__NOTOC__
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 
{{COVID-19}}
{{CMG}}; {{AE}} {{HK}}

==Overview==
Research laboratories have used isolation methods, [[electron microscopy]], [[serology]] and [[PCR|PCR-based assays]] to diagnose coronavirus infections for surveillance studies.

==Other Diagnostic Studies==
Specific laboratory tests may include:
* Virus isolation in cell culture.
* [[Polymerase chain reaction]] (PCR) assays that are more practical and available commercially .However, [[false negative]] cases have been reported by several studies. hence it is suggested to obtain three negative consecutive [[r-RT-PCR]] tests before discharging patients with covid-19 .<ref name="WangYu2020">{{cite journal|last1=Wang|first1=Guan|last2=Yu|first2=Na|last3=Xiao|first3=Weimin|last4=Zhao|first4=Chen|last5=Wang|first5=Zhenning|title=Consecutive false‐negative rRT‐PCR test results for SARS‐CoV‐2 in patients after clinical recovery from COVID‐19|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.26192}}</ref>

* Serological testing for [[antibody|antibodies]] to human coronaviruses. Serological assays play an essential role in contact tracing among populations and confirming covid-19 cases when [[RNA]] negative patients presents late in the illness.<ref name="pmid32223179">{{cite journal| author=Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC | display-authors=etal| title=Diagnosing COVID-19: The Disease and Tools for Detection. | journal=ACS Nano | year= 2020 | volume= 14 | issue= 4 | pages= 3822-3835 | pmid=32223179 | doi=10.1021/acsnano.0c02624 | pmc=7144809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?adbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32223179 }} </ref> <ref name="pmid32245835">{{cite journal| author=Tang YW, Schmitz JE, Persing DH, Stratton CW| title=Laboratory Diagnosis of COVID-19: Current Issues and Challenges. | journal=J Clin Microbiol | year= 2020 | volume= 58 | issue= 6 | pages= | pmid=32245835 | doi=10.1128/JCM.00512-20 | pmc=7269383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32245835 }} </ref>

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires the collection of blood specimens

==Gallery==

<gallery>

Image: Coronavirus21.jpeg| SEM reveals the “rosette-like” appearance of the matured coronavirus particles. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus20.jpeg| TEM revealed the presence of a number of infectious bronchitis virus (IBV) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus18.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus16.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus15.jpeg| TEM from a tissue culture isolate, revealing numbers of severe acute respiratory virus (SARS) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>
</gallery>
==References==
{{reflist|2}}

COVID-19 other diagnostic studies

2020-07-18T16:47:33Z

Mandana Safakhah: /* Other Diagnostic Studies */

__NOTOC__
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 
{{COVID-19}}
{{CMG}}; {{AE}} {{HK}}

==Overview==
Research laboratories have used isolation methods, [[electron microscopy]], [[serology]] and [[PCR|PCR-based assays]] to diagnose coronavirus infections for surveillance studies.

==Other Diagnostic Studies==
Specific laboratory tests may include:
* Virus isolation in cell culture.
* [[Polymerase chain reaction]] (PCR) assays that are more practical and available commercially .However, [[false negative]] cases have been reported by several studies, hence it is suggested to obtain three negative consecutive [[r-RT-PCR]] tests before discharging patients with covid-19 .<ref name="WangYu2020">{{cite journal|last1=Wang|first1=Guan|last2=Yu|first2=Na|last3=Xiao|first3=Weimin|last4=Zhao|first4=Chen|last5=Wang|first5=Zhenning|title=Consecutive false‐negative rRT‐PCR test results for SARS‐CoV‐2 in patients after clinical recovery from COVID‐19|journal=Journal of Medical Virology|year=2020|issn=0146-6615|doi=10.1002/jmv.26192}}</ref>

* Serological testing for [[antibody|antibodies]] to human coronaviruses. Serological assays play an essential role in contact tracing among populations and confirming covid-19 cases when [[RNA]] negative patients presents late in the illness.<ref name="pmid32223179">{{cite journal| author=Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC | display-authors=etal| title=Diagnosing COVID-19: The Disease and Tools for Detection. | journal=ACS Nano | year= 2020 | volume= 14 | issue= 4 | pages= 3822-3835 | pmid=32223179 | doi=10.1021/acsnano.0c02624 | pmc=7144809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?adbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32223179 }} </ref> <ref name="pmid32245835">{{cite journal| author=Tang YW, Schmitz JE, Persing DH, Stratton CW| title=Laboratory Diagnosis of COVID-19: Current Issues and Challenges. | journal=J Clin Microbiol | year= 2020 | volume= 58 | issue= 6 | pages= | pmid=32245835 | doi=10.1128/JCM.00512-20 | pmc=7269383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32245835 }} </ref>

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires the collection of blood specimens

==Gallery==

<gallery>

Image: Coronavirus21.jpeg| SEM reveals the “rosette-like” appearance of the matured coronavirus particles. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus20.jpeg| TEM revealed the presence of a number of infectious bronchitis virus (IBV) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus18.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus16.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus15.jpeg| TEM from a tissue culture isolate, revealing numbers of severe acute respiratory virus (SARS) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>
</gallery>
==References==
{{reflist|2}}

COVID-19 other diagnostic studies

2020-07-18T12:40:01Z

Mandana Safakhah: /* Other Diagnostic Studies */

__NOTOC__
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]''' 
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]''' 
{{COVID-19}}
{{CMG}}; {{AE}} {{HK}}

==Overview==
Research laboratories have used isolation methods, [[electron microscopy]], [[serology]] and [[PCR|PCR-based assays]] to diagnose coronavirus infections for surveillance studies.

==Other Diagnostic Studies==
Specific laboratory tests may include:
* Virus isolation in cell culture.
* [[Polymerase chain reaction]] (PCR) assays that are more practical and available commercially.
* Serological testing for [[antibody|antibodies]] to human coronaviruses.<ref name="pmid32223179">{{cite journal| author=Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC | display-authors=etal| title=Diagnosing COVID-19: The Disease and Tools for Detection. | journal=ACS Nano | year= 2020 | volume= 14 | issue= 4 | pages= 3822-3835 | pmid=32223179 | doi=10.1021/acsnano.0c02624 | pmc=7144809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?adbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32223179 }} </ref> <ref name="pmid32245835">{{cite journal| author=Tang YW, Schmitz JE, Persing DH, Stratton CW| title=Laboratory Diagnosis of COVID-19: Current Issues and Challenges. | journal=J Clin Microbiol | year= 2020 | volume= 58 | issue= 6 | pages= | pmid=32245835 | doi=10.1128/JCM.00512-20 | pmc=7269383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32245835 }} </ref>

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires the collection of blood specimens.

==Gallery==

<gallery>

Image: Coronavirus21.jpeg| SEM reveals the “rosette-like” appearance of the matured coronavirus particles. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus20.jpeg| TEM revealed the presence of a number of infectious bronchitis virus (IBV) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus18.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus16.jpeg| Scanning electron micrograph reveals the prolific exportation of virus particles at the pseudopodial and cell surfaces. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>

Image: Coronavirus15.jpeg| TEM from a tissue culture isolate, revealing numbers of severe acute respiratory virus (SARS) virions. ''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref>
</gallery>
==References==
{{reflist|2}}

COVID-19 other diagnostic studies

2020-07-18T12:27:42Z

Mandana Safakhah: /* Other Diagnostic Studies */

User:Mandana Safakhah

2020-07-12T14:56:04Z

Mandana Safakhah:

==Mandana Safakhah,MD==
Contact: Email:mani.safakhah@gmail.com

==Medical Education and Honors==
* General practitioner graduated from SHAHID BEHESHTI university of medical science, TEHRAN, IRAN
* Free participant of The 5th world Healthcare student's symposium, Lausanne, Switzerland, with the title of ~Demystifying inter-professional collaboration 8-13th of Sep 2013
* Co-operation with international journal of Cancer Management (IJCM) magazine in cancer research Centre of Shahid Beheshti University of medical sciences
* Active participant in 7th Annual research conference of Shahid Beheshti University of medical sciences students, 17th of Dec 2011 Tehran, Iran.
* Active participant in 8th annual research conference of Shahid Beheshti University of medical sciences students, held on 16th of Dec 2012 by research committee of the university Tehran, Iran
* Member of health management medical student's olympiad team at SHAHID BEHESHTI university of medical sciences
* Free participant in AMEE 2014 MILAN, ITALY

==Experiences==
* Executive deputy in elderly care section, from April 2012 to March 2018, BE-SOOYE-FARDAYE-BEHTAR institute, SHAHRUD, Semnan, Iran
* National officer for SCORP (standing committee of patient’s rights and peace) from Jan 2014 to May 2014, Iranian medical students association [IFMSA] (IFMSA is a non-governmental organisation which is consisted of volunteer medical students worldwide and has 6 standing committees: SCOPH which promotes public health, SCORA for reproductive health and AIDS, SCOMA for medical education, SCORE which provides opportunities for medical students worldwide to do various researches in the field of medicine and collaborate with international professors, SCOPE which is responsible for exchanging medical students for rotations in hospitals worldwide and SCORP. Also IFMSA was founded in May 1951 and has 135 member organization).
* Administrative staff of the first national congress for cancer controlling comprehensive plan-4-6th of Feb/2014 in Tehran, Iran
* Conduction of the first seminar of preventing child abuse, protection of abused children and honoring the child's week oct,07, 2013 to oct,13, 2013 in the conference hall of children’s medical center hospital Tehran, Iran
* Working with cancer research center ,IRAN,TEHRAN on the first experience of Intra-Operative radiation therapy in patients with vertebrae malignant metastasis in IRAN as my thesis ,2019
* Remote clinical research fellow and editor in Wikidoc scholar program (BIDMC-Harvard Medical School), Boston, Massachusetts 2020

==Work experiences==
* Working as a clinical research physician in approved research projects in the research departments of the Health Management & Economics Research Center affiliated to Iran University of medical sciences in the domain of Economics of Cardiovascular Diseases, Economics of Cancer and Economics and Healthcare Policies in the field of Aging from 12th of March 2018 to 2th February 2020.
* Working as a full time clinical research physician at the Employees’ Health Cohort Study of Iran (EHCSIR) project from 12th March 2018 to 23th August 2019
* Worked as a gynecology and obstetrics resident in 1000 bed hospital in Tehran, Iran, from Sep 2019 till Nov 2019
* Worked as a general practitioner in respiratory clinic at Arad private hospital from 21/01/19

==Pages Authored/Co-authored==
<div style="-moz-column-count:2; column-count:2;">
[[Brown-Sequard syndrome]]
 [[COVID-19-associated seizure]]
</div>

COVID-19-associated seizure

2020-07-12T12:20:56Z

Mandana Safakhah: /* Historical Perspective */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]] <ref name="HepburnMullaguri2020">{{cite journal|last1=Hepburn|first1=Madihah|last2=Mullaguri|first2=Naresh|last3=George|first3=Pravin|last4=Hantus|first4=Stephen|last5=Punia|first5=Vineet|last6=Bhimraj|first6=Adarsh|last7=Newey|first7=Christopher R.|title=Acute Symptomatic Seizures in Critically Ill Patients with COVID-19: Is There an Association?|journal=Neurocritical Care|year=2020|issn=1541-6933|doi=10.1007/s12028-020-01006-1}}</ref>

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1059131120301151<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for covid-19 associated seizure.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June. .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref><nowiki>{{</nowiki> https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis<nowiki> }}</nowiki></ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T12:10:27Z

Mandana Safakhah: /* Historical Perspective */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1059131120301151<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for covid-19 associated seizure.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June. .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref><nowiki>{{</nowiki> https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis<nowiki> }}</nowiki></ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T12:06:54Z

Mandana Safakhah: /* Natural History, Complications, and Prognosis */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1059131120301151<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for covid-19 associated seizure.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June. .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref><nowiki>{{</nowiki> https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis<nowiki> }}</nowiki></ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T12:01:48Z

Mandana Safakhah: /* Natural History, Complications, and Prognosis */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1059131120301151<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for covid-19 associated seizure.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June. .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T11:45:46Z

Mandana Safakhah: /* Historical Perspective */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1059131120301151<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for covid-19 associated seizure.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref> .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T11:43:49Z

Mandana Safakhah: /* Historical Perspective */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref>{{https://www.sciencedirect.com/science/article/pii/S1059131120301151}}</ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for covid-19 associated seizure.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref> .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T11:42:41Z

Mandana Safakhah: /* Historical Perspective */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref>{{ https://www.sciencedirect.com/science/article/pii/S1059131120301151}}</ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for covid-19 associated seizure.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref> .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T11:32:04Z

Mandana Safakhah: /* Historical Perspective */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref name="pmidhttps://doi.org/10.1016/j.seizure.2020.04.009">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/j.seizure.2020.04.009 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for covid-19 associated seizure.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref> .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T11:13:06Z

Mandana Safakhah: /* Screening */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for covid-19 associated seizure.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref> .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T11:12:18Z

Mandana Safakhah: /* Risk Factors */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for covid-19 associated seizure.

==Screening==
There is insufficient evidence to recommend routine screening for '''covid-19 associated seizure'''.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref> .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-12T11:11:08Z

Mandana Safakhah: /* Natural History, Complications, and Prognosis */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com] {{sali}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by [[COVID-19]] are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for '''covid-19 associated seizure'''.

==Screening==
There is insufficient evidence to recommend routine screening for '''covid-19 associated seizure'''.

==Natural History, Complications, and Prognosis==
The global case fatality rate is currently estimated to be 4.6% according to WHO , 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref> .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

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{{WikiDoc Sources}}

COVID-19-associated Miller-Fischer syndrome

2020-07-11T11:44:28Z

Mandana Safakhah:

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{ArashMoosavi}}

{{SK}}

==Overview==

'''Miller Fisher Syndrome (MFS)''' is an acute peripheral neuropathy which can develop after exposure to a viral or bacterial infection. It includes triad of '''ophtalmoplegia''', '''areflexia''' and '''ataxia'''. In '''covid-19''' pandemic period, while '''covid-19''' typically presents with fever, SOB and respiratory symptoms, '''MFS''' with prior history of '''covid-19''' has been seen in several cases all around the world.
 One retrospective study in 214 patients has shown that 8.9 % of '''covid-19''' patients have reported peripheral neurological symptoms.

==Historical Perspective==

The first reported case of '''MFS''' with history of '''covid-19''' was detected on January 2020 in Shanghai, who was a middle-age woman diagnosed with '''MFS''' presented with areflexia, acute weakness in both legs and severe fatigue. Further reports were announced by medical groups in Spain and the USA which presented '''neuro-ophtalmological''' symptoms. <ref>{{Gutierrez-Ortiz C, Mendez A, Rodrigo-Rey S, et al. Miller Fisher syndrome and polyneuritis cranialis in COVID-19. Neurology 2020; April 17. doi: 10.1212/WNL.0000000000009619}} </ref>

==Classification==

'''MFS''' is a rare variant of [[Guillain-Barre syndrome]], characterized by '''ophtalmoplegia''', '''areflexia''' and '''ataxia'''.

==Pathophysiology==

'''MFS''' is related to dysfunction of third, forth and sixth cranial nerves. A typical serological finding in patients with '''MFS''' and prior history of '''covid-19''' is antibodies against '''GQ1b ganglioside''', though negative test for antibodies does not rule out the diagnosis. The presence of ophtalmoparesis in '''MFS''' is related to a action of '''anti-GQ1b antibodies''' on the neuromuscular junction between the cranial nerves and ocular muscle. '''ELISA test''' is positive in 70% to 90% of patients.<ref>{{https://pubmed.ncbi.nlm.nih.gov/10695710}}</ref>

==Causes==
Although '''MFS''' has been detected in some patients with '''covid-19''', other viral and bacterial infections can also cause '''MFS'''
*Influenza virus
*Cytomegalovirus
*Zika virus
*Mycoplasma
*Campylobacter

==Differentiating COVID-19-associated Miller-Fischer syndrome from other Diseases==
'''MFS''' must be differentiated from other diseases that cause ophthalmoplegia, areflexia, and ataxia, such as myasthenia gravis, botulism, diphtheria, brain stem stroke, brain stem encephalitis and basal meningitis. It is essential to rule out emergent neurological disorders like stroke or brain injury in patients with '''MFS''' symptoms.<ref>{{https://rarediseases.org/rare-diseases/miller-fisher-syndrome/}}</ref>

==Epidemiology and Demographics==
While the incidence of '''MFS''' is one or two person per million each year, the prevalence of '''MFS''' associated with '''covid-19''' is still unknown.

==Risk Factors==
There are no established risk factors for '''MFS''' associated with '''covid-19'''.

==Screening==
There is insufficient evidence to recommend routine screening for patients with MFS caused by covid-19.

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
Although the diagnosis of '''covid-19''' is based on respiratory symptoms, it can be associated with neurological symptoms, of which overlap the diagnosis of '''MFS'''. Consequently, in patient with prior history of '''covid-19''', other neurologic diseases should be ruled out and '''anti-GQ1b''' antibody test should be considered. Also, in new patients with suspicious symptoms for '''covid-19''' and neurological symptoms, nasal swab test and neurological examination should be considered.
 '''MRI''' may be performed as a part of diagnostic work up. Although in majority of cases no abnormality is detected, enlargement and prominent enhacement in orbits and retro-orbital region has been reported in some cases.<ref>{{http://www.ajnr.org/content/early/2020/05/28/ajnr.A6609}}</ref>. <ref>{{https://rarediseases.org/rare-diseases/miller-fisher-syndrome/}}</ref>

===History and Symptoms===
Symptoms of '''covid-19''' associated with '''MFS''' include:
* Respiratory system symptoms
** [[shortness of breath]]
** [[cough]]
* Neurological symptoms
** [[headache]]
** [[ataxia]]
** [[ophthalmoplegia]]
** [[areflexia]]
<ref>{{http://www.ajnr.org/content/early/2020/05/28/ajnr.A6609}}</ref>

===Physical Examination===
Patients with '''covid-19''' associated with '''MFS''' present various signs and symptoms related to systematic and neurological presentation. Hence physical examination should be performed based on signs and symptoms include:
====Vitals====
Abnormal signs associated with '''covid-19''':
* [[Tachycardia]]
* [[Tachypnea]]
* Fever
====neurological====
* [[Eye dropping]]
* [[Blurry vision]]
* [[Paresthesia]]
* Decreased sensation
* [[Myalgia]]
* Weakness of breathing muscle

===Laboratory Findings===
Laboratory findings consistent with the diagnosis of '''covid-19''' include positive [[PCR]] nasal swab.
 Laboratory test for neurological signs are not diagnostic and should be used with other clinical parameters. They are include:
* Ganglioside (GM1) Antibodies, IgG and IgM
* GD1b Antibody, IgM
* GQ1b Antibody, IgG

===Electrocardiogram===
There are no ECG findings associated with '''covid-19'''.

===X-ray===
'''CXR''' is less sensitive in detection of '''covid-19''' in comparison with '''CT'''. However, in some cases [[lung consolidation]] and patchy peripheral opacities corresponding to [[ground glass opacities]] has been reported.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141645/}}</ref>

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with '''covid-19'''.
 [[Lung Ultrasound]] may be helpful in evaluation of patients with '''covid-19'''. It indicates :
* Multiple [[B-lines]]
** Ranging from focal to diffuse with spared areas
* Irregular and thickened pleural lines
* Subpleural consolidations
* Alveolar consolidations
* Bilateral [[A-lines]]

===CT scan===
The preliminary findings of CT in '''COVID-19''' associated with '''MFS''' include:
* Bilateral [[Ground Glass Opacities]]
* Air space consolidation
* Bronchovascular thickening
* Traction bronchiectasis

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

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COVID-19-associated seizure

2020-07-11T10:45:22Z

Mandana Safakhah: /* Natural History, Complications, and Prognosis */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
* Neurological complications caused by COVID-19 are through direct or indirect pathways. This includes [[hematogenous]] pathway, neuronal retrograde dissemination through [[olfactory bulb]], entry into to glial cells and neurons via ACE2 receptor and impairment of gas exchange in lungs leading to [[anemia]], hence increasing anaerobic metabolites in brain resulting in cellular and interstitial edema <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
* Seizures in a patient with [[COVID-19]] may be due to primary virus infection or due to reactivation of the latent virus.
* Infiltration of the brain tissue by the virus and subsequent production of toxins by the virus is one of the several mechanisms that can cause seizures in a COVID-19 patient. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
* Production of [[inflammatory mediators]] by the brain may also trigger seizures.
* Inflammatory [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by COVID-19 include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes neuronal hyperexcitability and development of seizures. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>

[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from infectious causes, the differential diagnosis of seizures should include:
*[[Epilepsy]]
*Drug overdose
*Toxins
*Metabolic imbalance
*[[Febrile]] convulsions
*[[Psychogenic]] seizures
*[[Cerebral hypoxia]]

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for '''covid-19 associated seizure'''.

==Screening==
There is insufficient evidence to recommend routine screening for '''covid-19 associated seizure'''.

==Natural History, Complications, and Prognosis==
The '''global case fatality rate''' is currently estimated to be 4.6% according to '''WHO''' , 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref> .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output would be. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

The [[diagnosis]] of [[COVID]]-19-associated [[seizure]] is made through:
*Electroencephalogram ([[EEG]], brain waive activity)<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647 }} </ref>.

Other diagnostic tests include:

* [[CT scan]] brain
* [[MRI]] brain
* Blood test
* [[Lumbar puncture]]
* [[Toxicology]] screening

===History===

* [[Neurotropism]] is one common feature of [[coronaviruses]]<ref name="pmid30416428">{{cite journal| author=Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM| title=Neurologic Alterations Due to Respiratory Virus Infections. | journal=Front Cell Neurosci | year= 2018 | volume= 12 | issue= | pages= 386 | pmid=30416428 | doi=10.3389/fncel.2018.00386 | pmc=6212673 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30416428 }} </ref><ref name="pmid32104915">{{cite journal| author=Li YC, Bai WZ, Hashikawa T| title=The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. | journal=J Med Virol | year= 2020 | volume= 92 | issue= 6 | pages= 552-555 | pmid=32104915 | doi=10.1002/jmv.25728 | pmc=7228394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32104915 }} </ref>.
* [[COVID-19]] document [[CNS]] manifestations in 25% of the patients, [[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)<ref name="pmid32422545">{{cite journal| author=Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K| title=Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. | journal=Clin Neurol Neurosurg | year= 2020 | volume= 194 | issue= | pages= 105921 | pmid=32422545 | doi=10.1016/j.clineuro.2020.105921 | pmc=7227498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422545 }} </ref>.

===Symptoms===

General symptoms or [[aura]] in a patient with include:
*[[Staring]]
*[[Jerking]] movements of the [[arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems
*Loss of [[bowel]] or [[bladder]] control
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze
*Nodding your [[head]] rhythmically, when associated with loss of awareness or [[loss of consciousness]]
*Periods of rapid [[eye]] [[blinking]] and [[staring]]

===Physical Examination===
* Vital Signs: Tachycardia may be present.
* Postictal drowsiness or confusion.
* Finding a bite to the side of the tongue, when present, is helpful in making the diagnosis.

===Laboratory Findings===

[[Postictal]] levels of the following may be elevated in a patient with seizures:
* Prolactin (within 20 minutes after a convulsive event)
* Lactate (within 1 to 2 hours)
* Ammonia (within several hours)
* Creatine kinase (especially 24 to 48 hours postictally)
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].

===Electrocardiogram===
* There are no typical ECG findings associated with seizures in a COVID-19 patient.
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]]. 

===X-ray===
* There are no x-ray findings associated with COVID-19 associated seizure.
* * To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]]. 

===Echocardiography or Ultrasound===
* There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]]. 

===CT scan===
* CT brain may show structural lesions but majority of patients will show nothing.
* To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].

===MRI===
* MRI brain may show structural lesions but majority of patients will show nothing.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]]. 

===Other Imaging Findings===
* There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]]. 

===Other Diagnostic Studies===
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]]. 

==Treatment==
===Medical Therapy===

* Development of [[seizures]] in a COVID-19 patient requires urgent treatment.
* After the cause of seizure is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], fever, metabolic imbalance).
* [[Anti-seizure]] medication (ASM) is often necessary.
* For a single seizure less than 5 min rescue treatment with [[benzodiazepine]] is not needed. [[Intravenous]] ASM are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in respiratory and cardiac problems) and drug interactions (e.g., [[Carbamazepine]], Phenytoin, Phenobarbital and [[Valproic acid]]). <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* [[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
* In patients with more than one seizure (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with benzodiazepines in addition to ASM is needed. <ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>

===Surgery===
Surgical intervention is not recommended for the management of COVID-19 associated seizure.

===Primary Prevention===
There are no established measures for the primary prevention of seizures associated with COVID-19.

===Secondary Prevention===
There are no established measures for the secondary prevention of seizures associated with COVID-19.

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T16:52:39Z

Mandana Safakhah: /* Natural History, Complications, and Prognosis */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination through [[olfactory bulb]] ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
* blood brain barrier breakdown due to cytokine reaction as a part of viral infection
*Entry into to glial cells and neurons via ACE2 receptor and [[CNS]] attack
* Impairment of gas exchange in lungs and leading to [[anaemia]] ,hence increasing anaerobic metabolites in brain resulting cellular and interstitial oedema
*Prolonged [[prothrombin time]] induced by covid-19 may lead to [[cerebral hemorrhage]]

<ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1878875020311645#sec3<nowiki>}}</nowiki></ref>
[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for '''covid-19 associated seizure'''.

==Screening==
There is insufficient evidence to recommend routine screening for '''covid-19 associated seizure'''.

==Natural History, Complications, and Prognosis==
The '''global case fatality rate''' is currently estimated to be 4.6% according to '''WHO''' , 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref>
Also neurological complications of '''covid-19''' .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T16:51:49Z

Mandana Safakhah: /* Natural History, Complications, and Prognosis */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination through [[olfactory bulb]] ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
* blood brain barrier breakdown due to cytokine reaction as a part of viral infection
*Entry into to glial cells and neurons via ACE2 receptor and [[CNS]] attack
* Impairment of gas exchange in lungs and leading to [[anaemia]] ,hence increasing anaerobic metabolites in brain resulting cellular and interstitial oedema
*Prolonged [[prothrombin time]] induced by covid-19 may lead to [[cerebral hemorrhage]]

<ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1878875020311645#sec3<nowiki>}}</nowiki></ref>
[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for '''covid-19 associated seizure'''.

==Screening==
There is insufficient evidence to recommend routine screening for '''covid-19 associated seizure'''.

==Natural History, Complications, and Prognosis==
The '''global case fatality rate is currently estimated to be 4.6% according to '''WHO''', 9th,June.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis}}</ref>
Also neurological complications of '''covid-19''' .The covid-19 fatality rate depends on several factors such as:
*patient demographics
*availability of health care
*test limitation
Also , the more comorbidities the patient has ,the poorer covid-19 clinical output. Some of the prognostic factor of covid-19 are listed as below:
*Above 65 years old
*smoking
*male sex
*elevated inflammatory markers
*elevated D-Dimer
*elevated interleukin 6
*[[thrombocytopenia]]
* high neutrophil to lymphocyte ratio
*higher acute physiology and chronic health evaluation score.<ref>{{ https://bestpractice.bmj.com/topics/en-gb/3000168/prognosis }}</ref>

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T13:10:03Z

Mandana Safakhah: /* Screening */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination through [[olfactory bulb]] ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
* blood brain barrier breakdown due to cytokine reaction as a part of viral infection
*Entry into to glial cells and neurons via ACE2 receptor and [[CNS]] attack
* Impairment of gas exchange in lungs and leading to [[anaemia]] ,hence increasing anaerobic metabolites in brain resulting cellular and interstitial oedema
*Prolonged [[prothrombin time]] induced by covid-19 may lead to [[cerebral hemorrhage]]

<ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1878875020311645#sec3<nowiki>}}</nowiki></ref>
[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about covid- 19 associated seizure.

==Risk Factors==
There are no established risk factors for '''covid-19 associated seizure'''.

==Screening==
There is insufficient evidence to recommend routine screening for '''covid-19 associated seizure'''.

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T13:01:07Z

Mandana Safakhah: /* Risk Factors */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination through [[olfactory bulb]] ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
* blood brain barrier breakdown due to cytokine reaction as a part of viral infection
*Entry into to '''glial cells''' and '''neurons''' via '''ACE2 receptor''' and [[CNS]] attack
* Impairment of gas exchange in lungs and leading to [[anaemia]] ,hence increasing '''anaerobic metabolites''' in brain resulting '''cellular and interstitial oedema'''
*Prolonged [[prothrombin time]] induced by covid-19 may lead to [[cerebral hemorrhage]]
<ref>{{ https://www.sciencedirect.com/science/article/pii/S1878875020311645#sec3}}</ref>
[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about ''' covid- 19 associated seizure'''.

==Risk Factors==
There are no established risk factors for '''covid-19 associated seizure'''.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T12:59:04Z

Mandana Safakhah: /* Epidemiology and Demographics */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination through [[olfactory bulb]] ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
* blood brain barrier breakdown due to cytokine reaction as a part of viral infection
*Entry into to '''glial cells''' and '''neurons''' via '''ACE2 receptor''' and [[CNS]] attack
* Impairment of gas exchange in lungs and leading to [[anaemia]] ,hence increasing '''anaerobic metabolites''' in brain resulting '''cellular and interstitial oedema'''
*Prolonged [[prothrombin time]] induced by covid-19 may lead to [[cerebral hemorrhage]]
<ref>{{ https://www.sciencedirect.com/science/article/pii/S1878875020311645#sec3}}</ref>
[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==
By now there isn't any sufficient evidence for demographic and epidemiologic data about ''' covid- 19 associated seizure'''.

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T12:05:12Z

Mandana Safakhah: /* Pathophysiology */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination through [[olfactory bulb]] ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
* blood brain barrier breakdown due to cytokine reaction as a part of viral infection
*Entry into to '''glial cells''' and '''neurons''' via '''ACE2 receptor''' and [[CNS]] attack
* Impairment of gas exchange in lungs and leading to [[anaemia]] ,hence increasing '''anaerobic metabolites''' in brain resulting '''cellular and interstitial oedema'''
*Prolonged [[prothrombin time]] induced by covid-19 may lead to [[cerebral hemorrhage]]
<ref>{{ https://www.sciencedirect.com/science/article/pii/S1878875020311645#sec3}}</ref>
[[Image:covid 19 seizure.jpeg|200px|thumb|left|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T12:04:12Z

Mandana Safakhah: /* Pathophysiology */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination through [[olfactory bulb]] ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
* blood brain barrier breakdown due to cytokine reaction as a part of viral infection
*Entry into to '''glial cells''' and '''neurons''' via '''ACE2 receptor''' and [[CNS]] attack
* Impairment of gas exchange in lungs and leading to [[anaemia]] ,hence increasing '''anaerobic metabolites''' in brain resulting '''cellular and interstitial oedema'''
*Prolonged [[prothrombin time]] induced by covid-19 may lead to [[cerebral hemorrhage]]
<ref>{{ https://www.sciencedirect.com/science/article/pii/S1878875020311645#sec3}}</ref>
[[Image:covid 19 seizure.jpeg|200px|thumb|right|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T12:02:05Z

Mandana Safakhah: /* Pathophysiology */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination through [[olfactory bulb]] ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
* blood brain barrier breakdown due to cytokine reaction as a part of viral infection
*Entry into to '''glial cells''' and '''neurons''' via '''ACE2 receptor''' and [[CNS]] attack
* Impairment of gas exchange in lungs and leading to [[anaemia]] ,hence increasing '''anaerobic metabolites''' in brain resulting '''cellular and interstitial oedema'''
*Prolonged [[prothrombin time]] induced by covid-19 may lead to [[cerebral hemorrhage]]
<ref>{{ https://www.sciencedirect.com/science/article/pii/S1878875020311645#sec3}}</ref>
[[Image:covid 19 seizure.jpeg|right|Pathophysiology]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T11:58:11Z

Mandana Safakhah: /* Pathophysiology */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination through [[olfactory bulb]] ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
* blood brain barrier breakdown due to cytokine reaction as a part of viral infection
*Entry into to '''glial cells''' and '''neurons''' via '''ACE2 receptor''' and [[CNS]] attack
* Impairment of gas exchange in lungs and leading to [[anaemia]] ,hence increasing '''anaerobic metabolites''' in brain resulting '''cellular and interstitial oedema'''
*Prolonged [[prothrombin time]] induced by covid-19 may lead to [[cerebral hemorrhage]]
<ref>{{ https://www.sciencedirect.com/science/article/pii/S1878875020311645#sec3}}</ref>
[[Image:covid 19 seizure.jpeg|right|]]

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

File:Covid 19 seizure.jpeg

2020-07-10T11:27:39Z

Mandana Safakhah:

COVID-19-associated seizure

2020-07-10T10:59:16Z

Mandana Safakhah: /* Pathophysiology */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting covid -19 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
on the other hand, there are some slim evidences supporting the multifactorial origin of covid-19 associated seizure including:
*blood brain barrier breakdown due to cytokine reaction as a part of viral infection.

==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T10:37:13Z

Mandana Safakhah: /* Historical Perspective */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==
* two male patients, non-epileptic were hospitalised with covid-19 signs and symptoms, March 2020 ,Ohio, U.S.A. During their hospital stay they developed [[encephalopathy]] and [[seizures]], controlled by [[levetiracetam]]

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T10:24:56Z

Mandana Safakhah: /* Historical Perspective */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==

*A women with the past medical history of seizure following [[herpetic encephalitis]] ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-10T10:18:53Z

Mandana Safakhah: /* Overview */

__NOTOC__
{{COVID-19}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

Coronaviruses impacts are not always restricted to respiratory system and they have potential for neuroinvasion under specific circumstances.
Neurological manifestations such as [[dizziness]],[[headache]] ,[[anosmia]] as well as case reports with [[encephalitis]] ,[[stroke]],[[epileptic seizures]] associated with covid-19, have been reported.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for covid 19 in Italy, 23rd of april 2020.<ref><nowiki>{{</nowiki>https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext<nowiki>}}</nowiki></ref>

*Also, a cohort multicentre study was done in China, April 2020, demonstrating that COVID 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with the acute respiratory phase of COVID 19.Although ,some seizure-like reactions are seen because of acute reaction to stress or hypocalcemia .<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>

==Classification==
There isn't any established classification for covid-19 associated seizure.
==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect [[CNS]] through two direct ways:[[haematogenous]] and neuronal retrograde dissemination ,the exact neurotropic mechanisms of this virus are yet to be known.<ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
==Causes==

The aetiology of [[seizure]] regardless whether it is covid-19 or not ,is divided into two categories:

*'<nowiki/>''Provoked seizures''' : '''''these seizures usually have a temporary trigger such as ''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '',fever, sleep deprivation and [[stroke]].
*Unprovoked seizures: In this catrgory ,there isn't any obvious cause or precipitating factor .<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of the seizure, the differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-syncope with secondary jerking movement-Involuntary movement disorders and other neurological conditions
*Drop attack:[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-Idiopathic
*Transient focal motor and sensory attack :[[tics]]-tonic spasms of multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref><nowiki>{{</nowiki>https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2<nowiki>}}</nowiki></ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-01T23:37:30Z

Mandana Safakhah:

__NOTOC__
{{SI}}

{{CMG}}; {{AE}}{{Mandana.Sa}}

{{SK}}

==Overview==

While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>

various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>

*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>

==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.

.

==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>

.

==Causes==

The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
*'''Unprovoked seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
*'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
*Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref>{{ https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2}}</ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-01T23:34:08Z

Mandana Safakhah: /* Differentiating COVID-19-associated seizure from other Diseases */

__NOTOC__
{{SI}}

{{CMG}}; {{AE}}

{{SK}}

==Overview==

While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>

various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>

*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>

==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.

.

==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>

.

==Causes==

The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
*'''Unprovoked seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
*'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
*Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref>{{ https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2}}</ref>

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-01T23:33:06Z

Mandana Safakhah: /* Differentiating COVID-19-associated seizure from other Diseases */

__NOTOC__
{{SI}}

{{CMG}}; {{AE}}

{{SK}}

==Overview==

While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>

various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>

*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>

==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.

.

==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>

.

==Causes==

The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
*'''Unprovoked seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

*Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
*'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
*Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-01T23:31:13Z

Mandana Safakhah: /* Differentiating COVID-19-associated seizure from other Diseases */

__NOTOC__
{{SI}}

{{CMG}}; {{AE}}

{{SK}}

==Overview==

While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>

various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>

*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>

==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.

.

==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>

.

==Causes==

The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
*'''Unprovoked seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder
Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple
:Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-01T23:30:06Z

Mandana Safakhah: /* Differentiating COVID-19-associated seizure from other Diseases */

__NOTOC__
{{SI}}

{{CMG}}; {{AE}}

{{SK}}

==Overview==

While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>

various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>

*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>

==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.

.

==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>

.

==Causes==

The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
*'''Unprovoked seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder
Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple
:Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-01T23:28:42Z

Mandana Safakhah: /* Differentiating COVID-19-associated seizure from other Diseases */

__NOTOC__
{{SI}}

{{CMG}}; {{AE}}

{{SK}}

==Overview==

While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>

various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>

*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>

==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.

.

==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>

.

==Causes==

The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
*'''Unprovoked seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:

{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder
Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple
:Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-01T23:26:39Z

Mandana Safakhah: /* Epidemiology and Demographics */

__NOTOC__
{{SI}}

{{CMG}}; {{AE}}

{{SK}}

==Overview==

While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>

various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>

*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>

==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.

.

==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>

.

==Causes==

The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
*'''Unprovoked seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:

{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple sclerosis]]'''-'''paroxysmal muscle movements'''
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}:Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions

==Epidemiology and Demographics==

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-01T23:25:57Z

Mandana Safakhah: /* Differentiating COVID-19-associated seizure from other Diseases */

__NOTOC__
{{SI}}

{{CMG}}; {{AE}}

{{SK}}

==Overview==

While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>

various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>

*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>

==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.

.

==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>

.

==Causes==

The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
*'''Unprovoked seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:

{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple sclerosis]]'''-'''paroxysmal muscle movements'''
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}:Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions

==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.

OR

In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.

OR

In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.

Patients of all age groups may develop [disease name].

OR

The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.

OR

[Disease name] commonly affects individuals younger than/older than [number of years] years of age.

OR

[Chronic disease name] is usually first diagnosed among [age group].

OR

[Acute disease name] commonly affects [age group].

There is no racial predilection to [disease name].

OR

[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].

[Disease name] affects men and women equally.

OR

[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.

The majority of [disease name] cases are reported in [geographical region].

OR

[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

COVID-19-associated seizure

2020-07-01T23:22:09Z

Mandana Safakhah: /* Differentiating COVID-19-associated seizure from other Diseases */

__NOTOC__
{{SI}}

{{CMG}}; {{AE}}

{{SK}}

==Overview==

While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>

various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.

==Historical Perspective==

*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>

*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>

==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.

.

==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>

.

==Causes==

The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
*'''Unprovoked seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>

==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:

{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder

{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple sclerosis]]'''-'''paroxysmal muscle movements'''
{| style="border: 2px solid #4479BA; align="left"
! style="width: 400px; background: #4479BA;"|{{fontcolor|#FFF|200px}}:Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions

==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.

OR

In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.

OR

In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.

Patients of all age groups may develop [disease name].

OR

The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.

OR

[Disease name] commonly affects individuals younger than/older than [number of years] years of age.

OR

[Chronic disease name] is usually first diagnosed among [age group].

OR

[Acute disease name] commonly affects [age group].

There is no racial predilection to [disease name].

OR

[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].

[Disease name] affects men and women equally.

OR

[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.

The majority of [disease name] cases are reported in [geographical region].

OR

[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].

==Risk Factors==
There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

==Diagnosis==
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

===Electrocardiogram===
There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===X-ray===
There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===CT scan===
There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===MRI===
There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

===Other Imaging Findings===
There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

===Surgery===
Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

===Primary Prevention===
There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}