COVID-19 could cause novel seizures in patients without epilepsy

Conference

AAN 2021

New research showed a higher incidence of new-onset seizures among COVID-19 patients without a known history of epilepsy, compared with patients with a known history of epilepsy. Further investigation into the pathophysiology of this phenomenon is required; the authors hypothesise it includes cytokine storm, increased permeability of the blood-brain barrier, hypoxia, and vascular events.

Anecdotal reports have indicated a possible relationship between COVID-19 infections and novel seizures. For this retrospective study, data was gathered of 917 patients who were admitted with COVID-19 and who received standard antiepileptic medication for any reason [1]. Patients were divided into 4 groups: patients with a history of epilepsy, presenting with or without breakthrough seizures, and patients without a history of epilepsy, presenting with or without new-onset seizures.

Results demonstrated that patients without a known history of epilepsy had 3 times greater odds to have a new-onset seizure than patients with a history of epilepsy: of 451 patients with a history of epilepsy, 48 (11%) had a novel seizure; of 466 patients without a history of epilepsy, 127 (27%) had a novel seizure (OR 3.15; P<0.0001). Patients with new-onset seizures had a significantly longer length of stay at the hospital: 128 patients with new-onset seizures and no history of epilepsy (22%) had an average stay of 26.9 days; 48 patients with a history of epilepsy and breakthrough seizures (8%) had an average stay of 12.8 days, and 40 patients with a history of epilepsy and no new seizures (70%) had an average stay of 10.9 days.

Mortality rates were higher among patients who had a novel seizure (29%) than among those who did not (29% vs 23%, respectively; OR 1.41; P=0.045). There was no difference in mortality rates between patients who had and did not have a history of epilepsy (OR 0.90; P=0.47).

The researchers offered multiple hypotheses for the mechanism of action for seizures during COVID-19: cytokine storm, disruption and increased permeability of the blood-brain barrier, hypoxia, and/or coagulation abnormalities resulting in strokes.

Bhaskar H, et al. Association of COVID-19 infections with novel and breakthrough epileptic seizures. ES.003, AAN 2021 Virtual Congress, 17-22 April.

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