Continuous EEG findings in patients with COVID-19 infection admitted to a New York academic hospital system

Authors

Jacob Pellinen, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
Elizabeth Carroll, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
Daniel Friedman, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
Michael Boffa, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
Patricia Dugan, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
David E. Friedman, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
Deana Gazzola, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
Amy Jongeling, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
Alcibiades J. Rodriguez, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
Manisha Holmes, Department of Neurology, New York University Grossman School of Medicine and NYU Langone Health, New York, NY, USA.

Document Type

Article

Abstract

OBJECTIVE: There is evidence for central nervous system complications of coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Encephalopathy caused by or arising from seizures, especially nonconvulsive seizures (NCS), often requires electroencephalography (EEG) monitoring for diagnosis. The prevalence of seizures and other EEG abnormalities among COVID-19-infected patients is unknown. METHODS: Medical records and EEG studies of patients hospitalized with confirmed COVID-19 infections over a 2-month period at a single US academic health system (four hospitals) were reviewed to describe the distribution of EEG findings including epileptiform abnormalities (seizures, periodic discharges, or nonperiodic epileptiform discharges). Factors including demographics, remote and acute brain injury, prior history of epilepsy, preceding seizures, critical illness severity scores, and interleukin 6 (IL-6) levels were compared to EEG findings to identify predictors of epileptiform EEG abnormalities. RESULTS: Of 111 patients monitored, most were male (71%), middle-aged or older (median age 64 years), admitted to an intensive care unit (ICU; 77%), and comatose (70%). Excluding 11 patients monitored after cardiac arrest, the most frequent EEG finding was moderate generalized slowing (57%), but epileptiform findings were observed in 30% and seizures in 7% (4% with NCS). Three patients with EEG seizures did not have epilepsy or evidence of acute or remote brain injury, although all had clinical seizures prior to EEG. Only having epilepsy (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.4-21) or seizure(s) prior to EEG (OR 4.8, 95% CI 1.7-13) was independently associated with epileptiform EEG findings. SIGNIFICANCE: Our study supports growing evidence that COVID-19 can affect the central nervous system, although seizures are unlikely a common cause of encephalopathy. Seizures and epileptiform activity on EEG occurred infrequently, and having a history of epilepsy or seizure(s) prior to EEG testing was predictive of epileptiform findings. This has important implications for triaging EEG testing in this population.

Medical Subject Headings

Aged; Brain Diseases (physiopathology, virology); COVID-19 (complications, physiopathology); Electroencephalography; Humans; Male; Middle Aged; Neurophysiological Monitoring; New York; SARS-CoV-2

Publication Date

10-1-2020

Publication Title

Epilepsia

E-ISSN

1528-1167

Volume

61

Issue

10

First Page

2097

Last Page

2105

PubMed ID

32875578

Digital Object Identifier (DOI)

10.1111/epi.16667

Recommended Citation

Pellinen, Jacob; Carroll, Elizabeth; Friedman, Daniel; Boffa, Michael; Dugan, Patricia; Friedman, David E.; Gazzola, Deana; Jongeling, Amy; Rodriguez, Alcibiades J.; and Holmes, Manisha, "Continuous EEG findings in patients with COVID-19 infection admitted to a New York academic hospital system" (2020). Neurology. 1689.
https://scholar.barrowneuro.org/neurology/1689