Continuous Electroencephalography Characteristics and Acute Symptomatic Seizures in COVID-19 Patients

Louis, Shreya; Dhawan, Andrew; Newey, Christopher; Nair, Dileep; Jehi, Lara; Hantus, Stephen; Punia, Vineet

Objective As concerns regarding neurological manifestations in COVID-19 (coronavirus disease 2019) patients increase, limited data exists on continuous electroencephalography (cEEG) findings in these patients. We present a retrospective cohort study of cEEG monitoring in COVID-19 patients to better explore this knowledge gap. Methods Among 22 COVID-19 patients, 19 underwent cEEGs, and 3 underwent routine EEGs (<1 hour). Demographic and clinical variables, including comorbid conditions, discharge disposition, survival and cEEG findings, were collected. Results cEEG was performed for evaluation of altered mental status (n=17) or seizure-like events (n=5). Five patients, including 2 with epilepsy, had epileptiform abnormalities on cEEG. Two patients had electrographic seizures without a prior epilepsy history. There were no acute neuroimaging findings. Periodic discharges were noted in one-third of patients and encephalopathic EEG findings were not associated with IV anesthetic use. Conclusions Interictal epileptiform abnormalities in the absence of prior epilepsy history were rare. However, the discovery of asymptomatic seizures in two of twenty-two patients was higher than previously reported and is therefore of concern. Significance cEEG monitoring in COVID-19 patients may aid in better understanding an epileptogenic potential of SARS-CoV2 infection. Nevertheless, larger studies utilizing cEEG are required to better examine acute epileptic risk in COVID-19 patients.