Continuous EEG findings in patients with COVID-19 infection admitted to a New York academic hospital system
Authors Jacob Pellinen and Elizabeth Carroll contributed equally to this work.
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.
CONFLICTS OF INTEREST
Dr D. Friedman receives salary support for consulting and clinical trial–related activities performed on behalf of The Epilepsy Study Consortium, a nonprofit organization. Dr Friedman receives no personal income for these activities. NYU receives a fixed amount from the Epilepsy Study Consortium toward Dr Friedman's salary. Within the past 2 years, The Epilepsy Study Consortium received payments for research services performed by Dr Friedman from the following: Axcella, Biogen, Cerevel, Crossject, Engage Pharmaceuticals, Eisai, Pfizer, SK Life Science, Xenon, and Zynerba. He has also served as a paid consultant for Eisai and Neurelis Pharmaceuticals. He has received travel support from Medtronics, Eisai, and the Epilepsy Foundation. He receives research support from the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Epilepsy Foundation, Empatica, Epitel, UCB, Inc, and NeuroPace. He serves on the scientific advisory board for Receptor Life Sciences. He holds equity interests in Neuroview Technology and Receptor Life Sciences. Dr Dugan receives research support from the NIH and NeuroPace. She has received honoraria for educational materials from NeuroPace and travel reimbursement from Medtronic and NeuroPace. The remaining authors have no conflicts of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Open Research
DATA AVAILABILITY
Access to deidentified data can be granted upon request to any qualified researcher upon request.
