COVID-19 May Induce Novel Seizures in Patients Without Epilepsy
Presenter: Neeraj Singh, MD
New COVID‐19 infections could cause novel seizures in patients without pre‐existing epilepsy. Seizures may only be seen in a minority of patients with COVID-19 infections, but most of these seizures are new onset, and these patients can have longer lengths of stay in the hospital and higher mortality rates.
According to the Centers for Disease Control and Prevention, COVID-19 patients have had multiple neurological sequelae, including seizures, strokes, and encephalopathy. However, there are varying reports on how often COVID-19 patients have novel seizures, defined as new-onset seizures in patients without a history of epilepsy and breakthrough seizures in patients with a history of epilepsy.
There are many hypotheses for the mechanism of how COVID-19 causes seizures. “One hypothesis is that a pro-inflammatory cytokine storm may increase glutamate and exacerbate apoptosis and neuronal necrosis, which can contribute to seizure onset. Additionally, COVID-19 infection can result in hypoxic encephalopathy and abnormal coagulation, leading to strokes, both of which can increase the risk of new-onset seizures,” said Neeraj Singh, MD, of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
A retrospective study conducted by Singh and colleagues included 917 patients from 13 New York City metropolitan area hospitals who had tested positive for COVID-19 by PCR and received a standard antipsychotic medication for any reason between February 14 and June 14, 2020, which was during the initial peak period of the city’s coronavirus pandemic.
These patients were divided into four groups, including patients with a history of epilepsy who presented with and without breakthrough seizures and patients without a history of epilepsy who presented with and without new-onset seizures. Researchers analyzed the onset of seizures, lengths of stay, and mortality rates, and calculated statistical significance with Fisher’s exact test and odds ratios.
Patients without a history of epilepsy had three times greater odds of having a new-onset seizure than patients with a history of epilepsy were to have a breakthrough seizure. “We found new-onset seizures were seen in 27% out of 466 patients without epilepsy, while breakthrough seizures were only seen in about 11% of 451 patients with a history of epilepsy, which was a significant difference,” said Singh.
Those patients who presented with new-onset seizures had a greater length of hospital stay (almost 27 days) than all patients with a history of epilepsy, including those with breakthrough seizures (almost 13 days) and those without breakthrough seizures (almost 11 days). However, there was no difference in length of stay between patients with a history of epilepsy who presented with breakthrough seizures and those who did not.
Patients with a history of epilepsy had similar mortality rates (22%) as those with no epilepsy history (25%). However, patients with novel seizures had a higher mortality rate (29% of 173 patients) than patients without novel seizures (23% of 742 patients). This difference was also significant.
Antiepileptic medications in patients with a history of epilepsy may confer a protective effect against breakthrough seizures. “However, some subclinical seizures may be misdiagnosed as encephalopathy when patients present with COVID-19 infections,” said Singh.
Further research is necessary to explore the mechanism by which COVID-19 infections cause new-onset seizures and identify subclinical seizures in the psychopathic patients with COVID-19 infections, said Singh.
Neeraj Singh, MD, has nothing to disclose.