Authors :
Ganesh Murthy, MD - University of Arizona- Phoenix Campus; Steve Chung, MD - Chairman of Neurology, Department of Neurology, University of Arizona-Phoenix Campus; Daniel Fayard, MD - Department of Neurology - University of Arizona-Phoenix Campus; Ryan Chung, - - Washington University
Rationale: The COVID-19 epidemic has revealed significant neurological manifestations including de novo seizures in patients who do not have a prior history of epilepsy or clear epilepsy risk factors. Our center is located in Arizona, which in the early part of January 2021 had more cases per capita than any other place in the world (1). We performed a retrospective review to observe the EEG patterns of hospitalized adult patients with COVID-19 between March 2020 and February 2021. We were able to establish the incidence of epileptiform discharges, seizures, and background findings, and found it comparable to values outlined in prior meta-analyses.
Methods: We performed a retrospective chart review on patients who tested positive for COVID-19 RNA and had inpatient routine or continuous video EEGs between March 2020 and February 2021. The demographic data collected included the patient's age, indication for EEG, type of EEG (trend versus routine EEG), history of prior seizures, findings of acute stroke on imaging, presenting history of cardiac arrest, as well as the incidence and location of EEG findings in respect to the background, epileptiform discharges, and seizures.
Results: The most common background finding was diffuse background slowing, which was seen in 63.6% of patients (n=63/99), followed by focal slowing with or without concurrent diffuse background slowing, seen in 15.1% of patients (n=15/99). Epileptiform discharges were seen in 11.1% of patients (n=11/99). Focal epileptiform findings were seen more frequently than generalized epileptiform discharges (9.1%, n=8/99 vs 2.0%, n=2/99). Focal interictal epileptiform findings occurred most frequently in the frontal region (44.4%, n=9/99). Seizures were seen in 5.1% of patients (n=5/99). Only 1 of these patients had a documented prior history of seizures (20%, n=1/5). When combining seizures, epileptiform discharges, and focal background slowing, the most common location for these abnormalities was in the frontal regions 36.4% (n=8/22).
Conclusions: Our findings are similar to those seen in other meta analyses looking at EEG patterns in hospitalized patients who had COVID-19 (2,3). Interestingly, as noted by Antony et Al, epileptiform discharges as well as focal slowing were seen most frequently in the frontal regions (2). This correlates with a hypothesis that the possible route of entry of the virus into the central nervous system is via the olfactory bulb in the orbitofrontal region which is possibly why frontal abnormalities are most commonly seen (4).
References:
- Archer, G. (2021, January 04). Arizona has highest rate of COVID-19 in the world, latest data shows. Retrieved May 13, 2021, from https://www.abc15.com/news/coronavirus/arizona-has-highest-rate-of-covid-19-in-the-world-latest-data-showshttps://www.abc15.com/news/coronavirus/arizona-has-highest-rate-of-covid-19-in-the-world-latest-data-shows
- Antony AR, Haneef Z. Systematic review of EEG findings in 617 patients diagnosed with COVID-19. Seizure. 2020 Dec;83:234-241. doi: 10.1016/j.seizure.2020.10.014. Epub 2020 Oct 19. PMID: 33121875; PMCID: PMC7569418.
- Kubota T, Gajera PK, Kuroda N. Meta-analysis of EEG findings in patients with COVID-19. Epilepsy Behav. 2021 Feb;115:107682. doi: 10.1016/j.yebeh.2020.107682. Epub 2020 Dec 4. PMID: 33342709; PMCID: PMC7833461.
- Zubair AS, McAlpine LS, Gardin T, Farhadian S, Kuruvilla DE, Spudich S. Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review. JAMA Neurol. 2020;77(8):1018–1027. doi:10.1001/jamaneurol.2020.2065
Funding: Please list any funding that was received in support of this abstract.: No additional funding was received.