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Preliminary findings from a retrospective sample series in the Bronx, New York.
Daniel J. Correa, MD, MScSince the first reports of COVID-19 emerged, it became clear that beyond the respiratory and multi-system organ failure, with resultant mortality, SARS-CoV-2/ COVID-19 infection often involved brain and nerves.1-6 In a report of 214 patients from Wuhan, China published in JAMA Neurology, neurological involvement was more common in severely affected patients with COVID-19 (45.5%) than those with less severe illness (30.2%), and included acute stroke, impaired consciousness, muscle injury, and rarely seizures (1 patient), or peripheral neuropathies.1 A retrospective comparison of patients who either had recovered and were discharged or were deceased showed more prevalent impairment of consciousness among those who were eventually deceased (22%) compared with those who recovered (1%).2 Altered mental status has been recognized as a neurological manifestation of acutely ill patients admitted with COVID-19; the multiple metabolic or cardiorespiratory disturbances, the progressing viral infection, cytokine storm, or coagulopathies contribute to the abnormal mental status. Awareness and recognition of neurological involvement is essential to guide treatment decisions as the pandemic unfolds.
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While there were several case reports of seizures (new onset or re-emergent) in patients with COVID-19,7 a report published in Epilepsia on a larger group of 304 patients from Hubei, China concluded that “there was no evidence suggesting an additional risk of acute symptomatic seizures in people with COVID-19.”8 Our experience has been somewhat different. In our hospital network in New York, which was at the epicenter of the COVID-19 pandemic in the United States, we encountered numerous patients with neurological manifestations, including patients with seizures. Whether direct transmission of the virus to the central nervous system (CNS) also plays a role in the CNS manifestations or seizures is unclear.Offering quality care for patients with seizures and epilepsy during the COVID-19 pandemic has been the preoccupation of many physicians treating these patients and consensus recommendations have been made.9 The electroencephalogram (EEG) is one of the main tools used in the evaluation of patients with seizures and epilepsy. Limiting the risk of infection to the EEG technologists, while also offering adequate EEG studies for patients with seizures is important, and using simplified EEG montages has been proposed.10