COVID-19-associated seizure

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mandana Safakhah, MD[2] Tayebah Chaudhry[3] Syed Musadiq Ali M.B.B.S.[4]

Synonyms and Keywords:

Overview

Seizure refers to an episode of symptoms 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-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

Classification

Pathophysiology


Pathophysiology [7]

Causes

Differentiating COVID-19-associated seizure from other Diseases

  • For further information about the differential diagnosis, click here.
  • To view the differential diagnosis of COVID-19, click here.

Epidemiology and Demographics

Risk Factors

Screening

  • There is insufficient evidence to recommend routine screening for COVID-19 associated seizure.

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Study of Choice

Symptoms

Common symptoms:

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

HEENT
  • Finding a bite to the side of the tongue (when present, is helpful in making the diagnosis).
Neuromuscular

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

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

MRI

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

Other Diagnostic Studies

  • To view other diagnostic studies for COVID-19, click here.

Treatment

Medical Therapy

Surgery

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

Primary Prevention

Secondary Prevention

References

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  2. "Acute Symptomatic Seizures in Critically Ill Patients with COVID-19: Is There an Association?" (2020). Neurocritical Care. doi:10.1007/s12028-020-01006-1. ISSN 1541-6933. 
  3. {{https://www.sciencedirect.com/science/article/pii/S1059131120301151}}
  4. {{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}
  5. {{https://pubmed.ncbi.nlm.nih.gov/32458193/}}
  6. 6.0 6.1 Karimi, Narges; Sharifi Razavi, Athena; Rouhani, Nima (2020). "Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report". Iranian Red Crescent Medical Journal. 22 (3). doi:10.5812/ircmj.102828. ISSN 2074-1804.
  7. Abboud, Hilal; Abboud, Fatima Zahra; Kharbouch, Hanane; Arkha, Yasser; El Abbadi, Najia; El Ouahabi, Abdessamad (2020). "COVID-19 and SARS-Cov-2 Infection: Pathophysiology and Clinical Effects on the Nervous System". World Neurosurgery. 140: 49–53. doi:10.1016/j.wneu.2020.05.193. ISSN 1878-8750.
  8. 8.0 8.1 Asadi-Pooya AA (July 2020). "Seizures associated with coronavirus infections". Seizure. 79: 49–52. doi:10.1016/j.seizure.2020.05.005. PMC 7212943 Check |pmc= value (help). PMID 32416567 Check |pmid= value (help).
  9. {{https://www.ncbi.nlm.nih.gov/books/NBK430765/}}
  10. Mao, Ling; Jin, Huijuan; Wang, Mengdie; Hu, Yu; Chen, Shengcai; He, Quanwei; Chang, Jiang; Hong, Candong; Zhou, Yifan; Wang, David; Miao, Xiaoping; Li, Yanan; Hu, Bo (2020). "Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China". JAMA Neurology. 77 (6): 683. doi:10.1001/jamaneurol.2020.1127. ISSN 2168-6149.
  11. {{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}
  12. Wilden JA, Cohen-Gadol AA (August 2012). "Evaluation of first nonfebrile seizures". Am Fam Physician. 86 (4): 334–40. PMID 22963022.
  13. Sander JW, Shorvon SD (November 1996). "Epidemiology of the epilepsies". J. Neurol. Neurosurg. Psychiatry. 61 (5): 433–43. doi:10.1136/jnnp.61.5.433. PMC 1074036. PMID 8965090.
  14. Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK (2020). "Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases". Neurodiagn J. 60 (2): 78–95. doi:10.1080/21646821.2020.1756132. PMC 7212538 Check |pmc= value (help). PMID 32374647 Check |pmid= value (help).
  15. 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 (May 2015). "Effect of levetiracetam in acute encephalitis with refractory, repetitive partial seizures during acute and chronic phase". Brain Dev. 37 (5): 471–7. doi:10.1016/j.braindev.2014.08.003. PMID 25174548.
  16. Ye M, Ren Y, Lv T (April 2020). "Encephalitis as a clinical manifestation of COVID-19". Brain Behav. Immun. doi:10.1016/j.bbi.2020.04.017. PMC 7146652 Check |pmc= value (help). PMID 32283294 Check |pmid= value (help).