Abstracts

Rationale: COVID-19, caused by infection with SARS-CoV-2 virus, can be associated with encephalopathy, seizures and abnormal EEG. We sought to identify clinical and electrographic characteristics associated with seizures in COVID-19 patients.

Methods: Retrospective study of 64 COVID positive patients that were placed on cEEG between February 10, 2020 to June 10, 2020 at NYPH/Weill Cornell Medical Center. Patients with positive COVID test were included in the study. A single patient was excluded due to reportedly positive COIVD test in outside hospital that was unavailable for review. 28 baseline demographics & 30 EEG features (including but not limited to continuity, frequency, amplitude, focal slowing, epileptiform discharges (EDs), periodic patterns) were collected and analyzed using correlation analysis to determine association with seizures. Outcomes were analyzed using Fisher’s exact test for categorical variables, and Wilcoxon rank sum test for continuous variables. P values were corrected for multiple comparisons.

Results: Only clinical variables associated with seizures on cEEG were administration of antibiotics & antiseizure medications (ASMs) (p=0.029 and 0.014, respectively). PRES, present in several patients with seizures, did not reach statistical significance. There was no association between seizures and primary indication for cEEG or prior history of epilepsy.

cEEG duration was longer for patients with seizures (p=0.029). There was significant association between prevalence of sporadic EDs and having a seizure while on cEEG (p=0.029), with 71% of patients having frequent or abundant EDs at some and 29% of cases not having any interictal Eds. After correction for multiple comparisons, the binary variable for presence or absence of sporadic EDs did not remain significantly associated with seizures.

The relationship between seizures and marked changes in background EEG characteristics (frequency, continuity, reactivity, and/or sleep architecture) was also statistically significant (p=0.014). The generalized background slowing was the most common cEEG finding overall. The worst background frequency in patients with seizures tended to be slower than in those without, although frequency content did not remain significant after correction for multiple comparisons.

Conclusions: Infection and antibiotics were the only two clinical variables associated with seizures in COVID-19 patients, which may be attributed to their lowering of seizure threshold. Not surprisingly, patients with seizures on cEEG were more likely to be given ASMs and remain on cEEG longer than those without recorded seizures. The most common overall EEG finding (generalized background slowing) and most common interictal abnormality (GPD-TM) were not associated with seizures, suggesting these finding were more likely a marker of toxic-metabolic encephalopathy in COVID-19 patients. Association of sporadic EDs with seizures, may help guide clinical decision-making, with the caveat that the absence of sporadic EDs does not exclude seizures.

Data to be presented in table format.

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