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EEG Abnormalities Common in Hospitalized COVID-19 Patients

THURSDAY, April 1, 2021 -- Seizures and other epileptiform abnormalities are common in patients with COVID-19 undergoing clinically indicated continuous electroencephalogram (cEEG) monitoring and are associated with adverse clinical outcomes, according to a study published online March 11 in Annals of Neurology.

Lu Lin, M.D., Ph.D., from the Beth Israel Deaconess Medical Center in Boston, and colleagues assessed 197 patients with COVID-19 referred for cEEG at nine participating centers to characterize the incidence of and clinical risk factors for seizures.

The researchers found that 9.6 percent of patients had electrographic seizures, including nonconvulsive status epilepticus (NCSE) in 5.6 percent of patients. Nearly half (48.7 percent) had epileptiform abnormalities (either ictal or interictal) present. There was an association noted between clinical seizures during hospitalization prior to initiation of EEG monitoring and both electrographic seizures (odds ratio, 6.51) and NCSE (odds ratio, 8.34). NCSE was also associated with a preexisting intracranial lesion on neuroimaging (odds ratio, 4.33). Electrographic seizures were found to be an independent predictor of in-hospital mortality (hazard ratio, 4.07).

"We found that seizures indeed can happen in patients with COVID-19 critical illness, even those without any prior neurologic history, and that they are associated with worse outcomes: higher rates of death and longer hospital stay, even after adjusting for other factors," a coauthor said in a statement. "Our results suggest that patients with COVID-19 should be monitored closely for nonconvulsive seizures. 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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