COVID-19-associated seizure: Difference between revisions
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==Overview== | ==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> | 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><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/<nowiki>}}</nowiki></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]]'''. | 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]]'''. | ||
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==Historical Perspective== | ==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> | *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 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> | *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><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref> | ||
==Classification== | ==Classification== | ||
There isn't any established classification for '''covid-19 associated seizure'''. | There isn't any established classification for '''covid-19 associated seizure'''. | ||
==Pathophysiology== | ==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> | 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== | ==Causes== | ||
The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories: | 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]]'''. | *'''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> | *'''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== | ==Differentiating COVID-19-associated seizure from other Diseases== | ||
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*'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic | *'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic | ||
*Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple | *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> | *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== | ==Epidemiology and Demographics== | ||
Revision as of 23:56, 5 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mandana Safakhah, MD[2]
Synonyms and keywords:
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.[1]
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.[2]
- 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 .[3]
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.[4]
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 .[5]
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:
- 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.[6]
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
- ↑ {{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}
- ↑ {{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}
- ↑ {{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}
- ↑ {{https://pubmed.ncbi.nlm.nih.gov/32458193/}}
- ↑ {{https://www.ncbi.nlm.nih.gov/books/NBK430765/}}
- ↑ {{https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2}}