Study examines prevalence, risk factors for nonconvulsive seizures in hospitalized COVID-19 patients

Some hospitalized patients with the novel coronavirus (COVID-19 experience non-convulsive seizures, which may put them at a higher risk of dying, according to new findings published in the Annals of Neurology.

For the study, researchers analyzed medical information for 197 hospitalized patients with COVID-19 who underwent electroencephalogram (EEG) monitoring, tests that detect electrical activity of the brain using small metal discs attached to the scalp, for various reasons at nine institutions in North America and Europe.

"Seizures are a very common complication of severe critical illness,” said M. Brandon Westover, MD, PhD, co-senior author of the study, an investigator in the Department of Neurology at Massachusetts General Hospital (MGH), and director of Data Science at the MGH McCance Center for Brain Health, in a statement. "There is increasing evidence that non-convulsive seizures can damage the brain and make outcomes worse, similar to convulsions."

The EEG tests detected nonconvulsive seizures in 9.6 percent of patients, some of whom had no prior neurological problems. Patients who had seizures needed to be hospitalized for a longer time, and they were four times more likely to die while in the hospital than patients without seizures, suggesting that neurological complications may be an important contributor to the morbidity and mortality associated with COVID-19, the researchers said.

The study found that seizures can happen in patients with COVID-19 critical illness, even those without any prior neurologic history, and are associated with worse outcomes, including higher rates of death and longer hospital stay, after adjusting for other factors, according to the study.

"Our results suggest that patients with COVID-19 should be monitored closely for nonconvulsive seizures,” said Mouhsin Shafi, MD, PhD, co-senior author of the study, an investigator in the Department of Neurology at Beth Israel Deaconess Medical Center (BIDMC), medical director of the BIDMC EEG laboratory, and director of the Berenson-Allen Center for Noninvasive Brain Stimulation, in a statement. “Treatments are available and warranted in patients at high risk; however, further research is needed to clarify how aggressively to treat seizures in COVID-19."

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