Abstracts

Rationale: This study explores the relationship between the incidences of COVID-19 infections and new-onset or breakthrough epileptic seizures in the largest patient sample to date in a single New York-based hospital system. Since the advent of the COVID-19 pandemic, anecdotal reports have indicated a possible relationship between COVID-19 infections and new-onset and breakthrough seizures. We analyzed 917 patient admissions that were positive for COVID-19 infections and administration of antiepileptic medications between 14 February and 14 June 2020 within a single health system in New York City and adjacent counties.

Methods: Patients were included in this case control study if they were admitted to a hospital in the health system and had a confirmed positive test for COVID-19 infection during the admission. Only patients who were administered antiepileptic medications during the admission for any reason were included in this study. These patients were divided into those with and those without a known history of epilepsy. The incidences of new-onset and breakthrough seizures and mortality rates were compared between these groups using Pearson's chi-squared test, and then statistical significance with Fisher's exact test and odds ratios (OR) were calculated. One-way ANOVA and Tukey’s HSD test were used to compare the lengths of stay between patients with new-onset seizures and those without them.

Results: Patients without a known history of epilepsy had over three times greater odds of having new-onset seizures than patients with a known history of epilepsy were to have breakthrough seizures (p< 0.0001, OR=3.15) (Figure 1). Patients with new-onset seizures had a longer average length of stay (26.9 days) than all patients with a known history of epilepsy, whether they presented with breakthrough seizures (12.8 days, p< 0.0001) or did not (10.9 days, p< 0.0001). Mortality rates were higher among patients who had new-onset and breakthrough seizures than those who did not (p=0.03, OR=1.41) (Figure 2). There was no difference in mortality rates between all patients who had a history of epilepsy and those who did not, regardless of whether they had new-onset seizures (p >0.47) (Figure 2).

Conclusions: Among patients with COVID-19 infections, new-onset seizures were more likely than breakthrough seizures. Those patients with new-onset seizures had longer lengths of stay and higher mortality rates. Further research is needed to investigate the roles of proinflammatory cytokines, blood brain barrier permeability, hypoxia, and abnormal coagulation associated with COVID-19 infections in seizure onset.

Funding: Please list any funding that was received in support of this abstract.: None.