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León-Ruiz M, Benito-León J, Castañeda-Cabrero C. Triphasic waves in COVID-19 patients: Going further. Seizure 2024; 117:75-76. [PMID: 38342043 DOI: 10.1016/j.seizure.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/13/2024] Open
Affiliation(s)
- Moisés León-Ruiz
- Section of Clinical Neurophysiology, Department of Neurology, La Paz University Hospital, Paseo de la Castellana, 261, Madrid 28046, Spain.
| | - Julián Benito-León
- Department of Neurology, 12 de Octubre University Hospital, Madrid, Spain; Research Institute (i+12), 12 de Octubre University Hospital, Madrid, Spain; Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Carlos Castañeda-Cabrero
- Section of Clinical Neurophysiology, Department of Neurology, La Paz University Hospital, Paseo de la Castellana, 261, Madrid 28046, Spain
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Kopańska M, Rydzik Ł, Błajda J, Sarzyńska I, Jachymek K, Pałka T, Ambroży T, Szczygielski J. The Use of Quantitative Electroencephalography (QEEG) to Assess Post-COVID-19 Concentration Disorders in Professional Pilots: An Initial Concept. Brain Sci 2023; 13:1264. [PMID: 37759865 PMCID: PMC10526237 DOI: 10.3390/brainsci13091264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Announced by WHO in 2020, the global COVID-19 pandemic caused by SARS-CoV-2 has affected many people, leading to serious health consequences. These consequences are observed in the daily lives of infected patients as various dysfunctions and limitations. More and more people are suffering post-COVID-19 complications that interfere with or completely prevent them from working or even functioning independently on a daily basis. The aim of our study was to demonstrate that innovative quantitative electroencephalography (QEEG) can be used to assess cognitive function disorders reported after the COVID-19 pandemic. It is worth noting that no similar study has been conducted to date in a group of pilots. The QEEG method we used is currently one of the basic neurological examinations, enabling easy observation of post-COVID-19 changes in the nervous system. With the innovativeness of this technique, our study shows that the use of quantitative electroencephalography can be a precursor in identifying complications associated with cognitive function disorders after COVID-19. Our study was conducted on twelve 26-year-old pilots. All participants had attended the same flight academy and had contracted SARS-CoV-2 infection. The pilots began to suspect COVID-19 infection when they developed typical symptoms such as loss of smell and taste, respiratory problems, and rapid fatigue. Quantitative electroencephalography (QEEG), which is one of the most innovative forms of diagnostics, was used to diagnose the patients. Comparison of the results between the study and control groups showed significantly higher values of all measurements of alpha, theta, and beta2 waves in the study group. In the case of the sensorimotor rhythm (SMR), the measurement results were significantly higher in the control group compared to the study group. Our study, conducted on pilots who had recovered from COVID-19, showed changes in the amplitudes of brain waves associated with relaxation and concentration. The results confirmed the issues reported by pilots as evidenced by the increased amplitudes of alfa, theta, and beta2 waves. It should be emphasized that the modern diagnostic method (QEEG) presented here has significant importance in the medical diagnosis of various symptoms and observation of treatment effects in individuals who have contracted the SARS-CoV-2 virus. The present study demonstrated an innovative approach to the diagnosis of neurological complications after COVID-19.
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Affiliation(s)
- Marta Kopańska
- Department of Pathophysiology, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Łukasz Rydzik
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland (T.A.)
| | - Joanna Błajda
- Institute of Health Sciences, Medical College, University of Rzeszow, Kopisto 2a, 35-959 Rzeszow, Poland;
| | - Izabela Sarzyńska
- Students Science Club “Reh-Tech”, Institute of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Katarzyna Jachymek
- Students Science Club “Reh-Tech”, Institute of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Tomasz Pałka
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education, 31-571 Kraków, Poland
| | - Tadeusz Ambroży
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland (T.A.)
| | - Jacek Szczygielski
- Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland
- Department of Neurosurgery, Faculty of Medicine, Saarland University, 66421 Homburg, Germany
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Zafar SF, Khozein RJ, LaRoche S, Westover MB, Gilmore EJ. Impact of the COVID-19 Pandemic on Continuous EEG Utilization. J Clin Neurophysiol 2022; 39:567-574. [PMID: 33394823 PMCID: PMC8217411 DOI: 10.1097/wnp.0000000000000802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) has significantly impacted healthcare delivery and utilization. The aim of this article was to assess the impact of the COVID-19 pandemic on in-hospital continuous electroencephalography (cEEG) utilization and identify areas for process improvement. METHODS A 38-question web-based survey was distributed to site principal investigators of the Critical Care EEG Monitoring Research Consortium, and institutional contacts for the Neurodiagnostic Credentialing and Accreditation Board. The survey addressed the following aspects of cEEG utilization: (1) general center characteristics, (2) cEEG utilization and review, (3) staffing and workflow, and (4) health impact on EEG technologists. RESULTS The survey was open from June 12, 2020 to June 30, 2020 and distributed to 174 centers with 79 responses (45.4%). Forty centers were located in COVID-19 hotspots. Fifty-seven centers (72.1%) reported cEEG volume reduction. Centers in the Northeast were most likely to report cEEG volume reduction (odds ratio [OR] 7.19 [1.53-33.83]; P = 0.012). Additionally, centers reporting decrease in outside hospital transfers reported cEEG volume reduction; OR 21.67 [4.57-102.81]; P ≤ 0.0001. Twenty-six centers (32.91%) reported reduction in EEG technologist coverage. Eighteen centers had personal protective equipment shortages for EEG technologists. Technologists at these centers were more likely to quarantine for suspected or confirmed COVID-19; OR 3.14 [1.01-9.63]; P = 0.058. CONCLUSIONS There has been a widespread reduction in cEEG volume during the pandemic. Given the anticipated duration of the pandemic and the importance of cEEG in managing hospitalized patients, methods to optimize use need to be prioritized to provide optimal care. Because the survey provides a cross-sectional assessment, follow-up studies can determine the long-term impact of the pandemic on cEEG utilization.
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Affiliation(s)
- Sahar F. Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Emily J. Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
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Sáez-Landete I, Gómez-Domínguez A, Estrella-León B, Díaz-Cid A, Fedirchyk O, Escribano-Muñoz M, Pedrera-Mazarro A, Martín-Palomeque G, Garcia-Ribas G, Rodríguez-Jorge F, Santos-Pérez G, Lourido-García D, Regidor-BaillyBailliere I. Retrospective Analysis of EEG in Patients With COVID-19: EEG Recording in Acute and Follow-up Phases. Clin EEG Neurosci 2022; 53:215-228. [PMID: 34319186 PMCID: PMC8958306 DOI: 10.1177/15500594211035923] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background. Interest in electroencephalographic (EEG) coronavirus disease 2019 (COVID-19) findings has been growing, especially in the search for a specific-features EEG of encephalopathy. Methods. We made a retrospective analysis of 29 EEGs recorded in 15 patients with COVID-19 and neurological symptoms. We classified the EEGs as "Acute EEG" and "follow-up EEG." We did a statistical analysis between voltage and respiratory status of the patient, stay or not in the intensive care unit (ICU), days of stay in the ICU, sedative drugs, pharmacological treatment, type of symptoms predominating, and outcome. Results. We found EEG abnormalities in all patients studied. We observed the amplitude of background <20 µV at 93% of "acute EEG," versus only 21.4% of "follow-up EEG." The average voltage went from 12.33 ± 5.09 µV in the acute EEGs to 32.8 ± 20.13 µV in the follow-up EEGs. A total of 60% of acute EEGs showed an intermittent focal rhythmic. We have not found a statistically significant association between voltage of acute EEG and nonneurological clinical status (including respiratory) that may interfere with the EEG findings. Conclusions. Nonspecific diffuse slowing EEG pattern in COVID-19 is the most common finding reported, but we found in addition to that, as a distinctive finding, low voltage EEG, that could explain the low prevalence of epileptic activity published in these patients. A metabolic/hypoxic mechanism seems unlikely on the basis of our EEG findings. This pattern in other etiologies is reminiscent of severe encephalopathy states associated with poor prognosis. However, an unreactive low voltage pattern in COVID-19 patients is not necessarily related to poor prognosis.
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Affiliation(s)
- Isabel Sáez-Landete
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Adriana Gómez-Domínguez
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Beatriz Estrella-León
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alba Díaz-Cid
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Olga Fedirchyk
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Escribano-Muñoz
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Antonio Pedrera-Mazarro
- 16507Department of Clinical Neurophysiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Gloria Santos-Pérez
- 16507Departament of Anesthesiology. Hospital Universitario Ramón y Cajal, Madrid
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Tantillo GB, Jetté N, Gururangan K, Agarwal P, Marcuse L, Singh A, Goldstein J, Kwon CS, Dhamoon MS, Navis A, Nadkarni GN, Charney AW, Young JJ, Blank LJ, Fields M, Yoo JY. Electroencephalography at the height of a pandemic: EEG findings in patients with COVID-19. Clin Neurophysiol 2022; 137:102-112. [PMID: 35305494 PMCID: PMC8901228 DOI: 10.1016/j.clinph.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To characterize continuous video electroencephalogram (VEEG) findings of hospitalized COVID-19 patients. METHODS We performed a retrospective chart review of patients admitted at three New York City hospitals who underwent VEEG at the peak of the COVID-19 pandemic. Demographics, comorbidities, neuroimaging, VEEG indications and findings, treatment, and outcomes were collected. RESULTS Of 93 patients monitored, 77% had severe COVID-19 and 40% died. Acute ischemic or hemorrhagic stroke was present in 26% and 15%, respectively. Most common VEEG indications were encephalopathy/coma (60%) and seizure-like movements (38%). Most common VEEG findings were generalized slowing (97%), generalized attenuation (31%), generalized periodic discharges (17%) and generalized sharp waves (15%). Epileptiform abnormalities were present in 43% and seizures in 8% of patients, all of whom had seizure risk factors. Factors associated with an epileptiform VEEG included increasing age (OR 1.07, p = 0.001) and hepatic/renal failure (OR 2.99, p = 0.03). CONCLUSIONS Most COVID-19 patients who underwent VEEG monitoring had severe COVID-19 and over one-third had acute cerebral injury (e.g., stroke, anoxia). Seizures were uncommon. VEEG findings were nonspecific. SIGNIFICANCE VEEG findings in this cohort of hospitalized COVID-19 patients were those often seen in critical illness. Seizures were uncommon and occurred in the setting of common seizure risk factors.
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Affiliation(s)
- Gabriela B Tantillo
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA
| | - Kapil Gururangan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parul Agarwal
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA
| | - Lara Marcuse
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA
| | - Anuradha Singh
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA
| | | | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA
| | - Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA
| | - Girish N Nadkarni
- Icahn School of Medicine at Mount Sinai, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, USA; Mount Sinai COVID-19 Informatics Center, USA
| | - Alexander W Charney
- Icahn School of Medicine at Mount Sinai, USA; Mount Sinai COVID-19 Informatics Center, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, USA
| | - James J Young
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA
| | - Leah J Blank
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA
| | - Madeline Fields
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA
| | - Ji Yeoun Yoo
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, USA.
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Orendáčová M, Kvašňák E. Possible Mechanisms Underlying Neurological Post-COVID Symptoms and Neurofeedback as a Potential Therapy. Front Hum Neurosci 2022; 16:837972. [PMID: 35431842 PMCID: PMC9010738 DOI: 10.3389/fnhum.2022.837972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
Theoretical considerations related to neurological post-COVID complications have become a serious issue in the COVID pandemic. We propose 3 theoretical hypotheses related to neurological post-COVID complications. First, pathophysiological processes responsible for long-term neurological complications caused by COVID-19 might have 2 phases: (1) Phase of acute Sars-CoV-2 infection linked with the pathogenesis responsible for the onset of COVID-19-related neurological complications and (2) the phase of post-acute Sars-CoV-2 infection linked with the pathogenesis responsible for long-lasting persistence of post-COVID neurological problems and/or exacerbation of another neurological pathologies. Second, post-COVID symptoms can be described and investigated from the perspective of dynamical system theory exploiting its fundamental concepts such as system parameters, attractors and criticality. Thirdly, neurofeedback may represent a promising therapy for neurological post-COVID complications. Based on the current knowledge related to neurofeedback and what is already known about neurological complications linked to acute COVID-19 and post-acute COVID-19 conditions, we propose that neurofeedback modalities, such as functional magnetic resonance-based neurofeedback, quantitative EEG-based neurofeedback, Othmer's method of rewarding individual optimal EEG frequency and heart rate variability-based biofeedback, represent a potential therapy for improvement of post-COVID symptoms.
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Affiliation(s)
- Mária Orendáčová
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Eugen Kvašňák
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
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Khair A. Intermittent Frontal Rhythmic Discharges as an Electroencephalogram Biomarker of Acute SARS-CoV-2 Infection-Associated Encephalopathy in Children. Cureus 2021; 13:e19149. [PMID: 34868783 PMCID: PMC8628864 DOI: 10.7759/cureus.19149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/05/2022] Open
Abstract
Data on neurological sequelae of COVID-19 infection in children are sparse. Neurotropic and neuroinvasive potentials of the SARS-CoV-2 virus are a matter of ongoing scientific debate and not yet well understood. Most of the reported symptoms are nonspecific including headache, encephalopathy, weakness, and as a part of multisystem inflammatory response syndrome. Few observational studies have reported acute encephalopathy to be one of the neurological manifestations of COVID-19 infection, mostly in adults. A little is known about epileptogenesis or electroencephalogram (EEG) findings in this limited cohort of pediatric patients. We report a 17-year-old female with type 1 diabetes mellitus (DM), who presented with two weeks history of intermittent headaches, followed by a one-day history of acute change in behavior in the form of prolonged staring, decreased speech, confusion, and alternating periods of agitation and sleepiness. No fever or respiratory symptoms. Her blood glucose was normal. Brain MRI was unremarkable. Cerebrospinal fluid (CSF) studies showed 1000 RBCs, no WBCs, normal glucose/protein, negative culture, and negative infectious PCR, and autoimmune panels. She was found to be positive for SARS-CoV-2 PCR with negative IgG. Her EEG showed remarkable background slowing and frequent frontal intermittent rhythmic discharges. She was managed with high-dose steroids with the full clinical recovery of all symptoms at discharge, as well as normalization of subsequent EEG studies. We hypothesize there may be some specific seizure characteristics or EEG patterns in patients with pediatric COVID-19 infection and concomitant acute encephalopathy. It is perhaps reasonable to obtain EEG studies in children who test positive for SARS-CoV-2 and report central neurological symptoms. Long-term follow-up of this cohort of patients will be helpful to understand the clinical significance and implications of such neurophysiological studies.
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Affiliation(s)
- Abdulhafeez Khair
- Neurology, Nemours Children's Health, Thomas Jefferson University, Wilmington, USA
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8
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Corazza LA, Tatsch JFS, Barros MP, Queiroz APD, Batista LLR, Aidar MB, Baldocchi MA, Rocha MSG, Brucki SMD. Electroencephalographic findings among inpatients with COVID-19 in a tertiary hospital from a middle-income country. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:315-320. [PMID: 34133512 DOI: 10.1590/0004-282x-anp-2020-0555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/16/2021] [Indexed: 03/25/2023]
Abstract
BACKGROUND In 2019, the world witnessed the emergence of a new type of coronavirus - the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The spectrum of coronavirus disease 2019 (COVID-19) is variable, and amongst its manifestations are neurological implications. OBJECTIVE This report aimed to describe electroencephalographic findings in COVID-19 patients from a general tertiary hospital in São Paulo, Brazil. METHODS It was a retrospective, observational, and non-interventional study. Data were collected anonymously, comprising inpatients from Mar 1 to Jun 30, 2020, either confirmed (positive RT-PCR) or probable cases (CO-RADS 4/5) who had performed EEG during hospitalization. RESULTS Twenty-eight patients were enrolled, 17 (60.7%) women and 11 men, with a median age of 58 (minimum and maximum: 18-86; IQR 23.5). COVID-19 diagnosis was confirmed in 22 (78.5%). Twenty-one patients (75%) had severe disease, requiring mechanical ventilation due to acute respiratory distress syndrome (ARDS); 16 (57.1%) patients developed adjunct sepsis throughout hospitalization. There was no specific pattern found for COVID-19 in EEG. No patients presented with status epilepticus or electrographic events; most patients developed an encephalopathic pattern, as seen in most studies, with a high prevalence of altered mental status as an indication for EEG. Adjunct sepsis was associated with higher mortality. CONCLUSIONS EEG presents as a useful tool in the context of COVID-19, as in other conditions, to differentiate nonconvulsive status epilepticus (NCSE) from encephalopathy and other causes of mental status alterations. Further studies are required to analyze whether there might be a specific EEG pattern to the disease.
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Dono F, Nucera B, Lanzone J, Evangelista G, Rinaldi F, Speranza R, Troisi S, Tinti L, Russo M, Di Pietro M, Onofrj M, Bonanni L, Assenza G, Vollono C, Anzellotti F, Brigo F. Status epilepticus and COVID-19: A systematic review. Epilepsy Behav 2021; 118:107887. [PMID: 33743344 PMCID: PMC7968345 DOI: 10.1016/j.yebeh.2021.107887] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/28/2021] [Accepted: 02/21/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE In March 2020, the World Health Organization declared the SARS-CoV-2 infection-related coronavirus Disease (COVID-19) a pandemic. During the first and second waves of the pandemic spread, there have been several reports of COVID-19-associated neurological manifestations, including acute seizures and status epilepticus (SE). In this systematic review, we summarized the available data on clinical features, diagnosis, and therapy of COVID-19-related SE. METHODS We performed a systematic search of the literature to identify data on demographics, clinical, neurophysiological, and neuroradiological data of patients with COVID-19-related SE. We used regression models (linear or logistic) with a stepwise forward method to identify features associated with mortality or severity of SE. RESULTS Thirty-nine articles were included with a total of 47 cases of SE associated with COVID-19. Age, time between the acute respiratory phase of SARS-CoV-2 infection and SE onset, and hospitalization correlated with a higher SE severity as assessed by quantitative validated scales. CONCLUSIONS SE can be a neurological manifestation of SARS-CoV-2 infection. Although a possible association between SE and COVID-19 has been reported, the exact mechanisms are still not fully understood. Systemic inflammatory syndrome due to cytokine release could play a role in COVID-19-related SE.
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Affiliation(s)
- Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Bruna Nucera
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Jacopo Lanzone
- Fondazione Europea per la Ricerca Biomedica Onlus, Trescore Balneario, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Fabrizio Rinaldi
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Rino Speranza
- Department of Neuroscience, Imaging and Clinical Science, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Serena Troisi
- Pediatric Neurology, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lorenzo Tinti
- Department of Neurology, San Gerardo Hospital, Monza, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Science, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Catello Vollono
- Dipartimento Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Unit of Neurophysiopathology and Sleep Medicine, Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
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Schultz B, Krauß T, Schmidt M, Schultz M, Schneider A, Wiesner O, Schmidt JJ, Stahl K, David S, Hoeper MM, Busch M. High Incidence of Epileptiform Potentials During Continuous EEG Monitoring in Critically Ill COVID-19 Patients. Front Med (Lausanne) 2021; 8:613951. [PMID: 33842496 PMCID: PMC8032936 DOI: 10.3389/fmed.2021.613951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To analyze continuous 1- or 2-channel electroencephalograms (EEGs) of mechanically ventilated patients with coronavirus disease 2019 (COVID-19) with regard to occurrence of epileptiform potentials. Design: Single-center retrospective analysis. Setting: Intensive care unit of Hannover Medical School, Hannover, Germany. Patients: Critically ill COVID-19 patients who underwent continuous routine EEG monitoring (EEG monitor: Narcotrend-Compact M) during sedation. Measurements and Main Results: Data from 15 COVID-19 patients (11 men, four women; age: 19-75 years) were evaluated. Epileptiform potentials occurred in 10 of 15 patients (66.7%). Conclusions: The results of the evaluation regarding the occurrence of epileptiform potentials show that there is an unusually high percentage of cerebral involvement in patients with severe COVID-19. EEG monitoring can be used in COVID-19 patients to detect epileptiform potentials.
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Affiliation(s)
- Barbara Schultz
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Terence Krauß
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Maren Schmidt
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | | | - Andrea Schneider
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Olaf Wiesner
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Julius J Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Klaus Stahl
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Sascha David
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marius M Hoeper
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Markus Busch
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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11
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Kopańska M, Banaś-Ząbczyk A, Łagowska A, Kuduk B, Szczygielski J. Changes in EEG Recordings in COVID-19 Patients as a Basis for More Accurate QEEG Diagnostics and EEG Neurofeedback Therapy: A Systematic Review. J Clin Med 2021; 10:jcm10061300. [PMID: 33809957 PMCID: PMC8004106 DOI: 10.3390/jcm10061300] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION AND PURPOSE The SARS-CoV-2 virus is able to cause abnormalities in the functioning of the nervous system and induce neurological symptoms with the features of encephalopathy, disturbances of consciousness and concentration and a reduced ability to sense taste and smell as well as headaches. One of the methods of detecting these types of changes in COVID-19 patients is an electroencephalogram (EEG) test, which allows information to be obtained about the functioning of the brain as well as diagnosing diseases and predicting their consequences. The aim of the study was to review the latest research on changes in EEG in patients with COVID-19 as a basis for further quantitative electroencephalogram (QEEG) diagnostics and EEG neurofeedback training. Description of the state of knowledge: Based on the available scientific literature using the PubMed database from 2020 and early 2021 regarding changes in the EEG records in patients with COVID-19, 17 publications were included in the analysis. In patients who underwent an EEG test, changes in the frontal area were observed. A few patients were not found to be responsive to external stimuli. Additionally, a previously non-emerging, uncommon pattern in the form of continuous, slightly asymmetric, monomorphic, biphasic and slow delta waves occurred. CONCLUSION The results of this analysis clearly indicate that the SARS-CoV-2 virus causes changes in the nervous system that can be manifested and detected in the EEG record. The small number of available articles, the small number of research groups and the lack of control groups suggest the need for further research regarding the short and long term neurological effects of the SARS-CoV-2 virus and the need for unquestionable confirmation that observed changes were caused by the virus per se and did not occur before. The presented studies described non-specific patterns appearing in encephalograms in patients with COVID-19. These observations are the basis for more accurate QEEG diagnostics and EEG neurofeedback training.
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Affiliation(s)
- Marta Kopańska
- Department of Pathophysiology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
- Correspondence:
| | - Agnieszka Banaś-Ząbczyk
- Department of Biology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland;
| | - Anna Łagowska
- Student Research Club “Reh-Tech”, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.Ł.); (B.K.)
| | - Barbara Kuduk
- Student Research Club “Reh-Tech”, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.Ł.); (B.K.)
| | - Jacek Szczygielski
- Department of Neurosurgery, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
- Department of Neurosurgery, Faculty of Medicine, Saarland University, 06841 Saarbrücken, Germany;
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12
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Lambrecq V, Hanin A, Munoz-Musat E, Chougar L, Gassama S, Delorme C, Cousyn L, Borden A, Damiano M, Frazzini V, Huberfeld G, Landgraf F, Nguyen-Michel VH, Pichit P, Sangare A, Chavez M, Morélot-Panzini C, Morawiec E, Raux M, Luyt CE, Rufat P, Galanaud D, Corvol JC, Lubetzki C, Rohaut B, Demeret S, Pyatigorskaya N, Naccache L, Navarro V. Association of Clinical, Biological, and Brain Magnetic Resonance Imaging Findings With Electroencephalographic Findings for Patients With COVID-19. JAMA Netw Open 2021; 4:e211489. [PMID: 33720371 PMCID: PMC7961310 DOI: 10.1001/jamanetworkopen.2021.1489] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022] Open
Abstract
Importance There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management. Objectives To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy. Design, Setting, and Participants This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020. Exposures Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest. Main Outcomes and Measures Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records. Results Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter-enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19-related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter-enhancing lesions. Conclusions and Relevance The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19-related encephalopathy and guide treatment strategy.
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Affiliation(s)
- Virginie Lambrecq
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Department, Sorbonne Université, Paris, France
| | - Aurélie Hanin
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
| | - Esteban Munoz-Musat
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Department, Sorbonne Université, Paris, France
| | - Lydia Chougar
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Neuroradiology Department, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Salimata Gassama
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Cécile Delorme
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Louis Cousyn
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurology Department, Sorbonne Université, Paris, France
| | - Alaina Borden
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Maria Damiano
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Valerio Frazzini
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Gilles Huberfeld
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Department, Sorbonne Université, Paris, France
| | - Frank Landgraf
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Vi-Huong Nguyen-Michel
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Phintip Pichit
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Aude Sangare
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Mario Chavez
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
| | - Capucine Morélot-Panzini
- Service de Pneumologie, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Service de Pneumologie, Médecine Intensive et Réanimation, Pitié-Salpêtrière Hospital, Paris, France
| | - Elise Morawiec
- Service de Pneumologie, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Service de Pneumologie, Médecine Intensive et Réanimation, Pitié-Salpêtrière Hospital, Paris, France
| | - Mathieu Raux
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Department of Anesthesia, Critical Care and Peri-Operative Medicine, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Department of Anesthesia, Critical Care and Peri-Operative Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - Charles-Edouard Luyt
- Institut de Cardiologie, Sorbonne Université, Paris, France
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche, 1166–Institute of Cardiometabolism and Nutrition, Paris, France
- Assistance Publique des Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Institut de Cardiologie, Pitié-Salpêtrière Hospital, Paris, France
| | - Pierre Rufat
- Assistance Publique des Hôpitaux de Paris, Biostatistic Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Damien Galanaud
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Neuroradiology Department, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Catherine Lubetzki
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurology Department, Sorbonne Université, Paris, France
| | - Benjamin Rohaut
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurology Department, Sorbonne Université, Paris, France
| | - Sophie Demeret
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Nadya Pyatigorskaya
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Neuroradiology Department, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Lionel Naccache
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Department, Sorbonne Université, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurology Department, Sorbonne Université, Paris, France
- Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France
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13
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Niguet JP, Tortuyaux R, Garcia B, Jourdain M, Chaton L, Préau S, Poissy J, Favory R, Nseir S, Mathieu D, Kazali Alidjinou E, Delval A, Derambure P. Neurophysiological findings and their prognostic value in critical COVID-19 patients: An observational study. Clin Neurophysiol 2021; 132:1009-1017. [PMID: 33743295 PMCID: PMC7906512 DOI: 10.1016/j.clinph.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe EEG patterns of critical Coronavirus Disease 2019 (COVID-19) patients with suspicion of encephalopathy and test their association with clinical outcome. METHODS EEG after discontinuation of sedation in all patients, and somesthesic evoked potentials and brainstem auditive evoked potentials when EEG did not show reactivity, were performed. Clinical outcome was assessed at day 7 and 14 after neurophysiological explorations. RESULTS 33 patients were included for analysis. We found slowed background activity in 85% of cases, unreactive activity in 42% of cases, low-voltage activity in 21% of cases and rhythmic or periodic delta waves in 61% of cases. EEG epileptic events were never recorded. Clinical outcome at day 14 was associated with unreactive background activity and tended to be associated with rhythmic or periodic delta waves and with low-voltage activity. Results of multimodal evoked potentials were in favor of a preservation of central nervous system somatosensory and auditory functions. CONCLUSIONS Among critical COVID-19 patients with abnormal arousal at discontinuation of sedation, EEG patterns consistent with encephalopathy are found and are predictive for short term clinical outcome. SIGNIFICANCE The abnormal EEG with presence of periodic discharges and lack of reactivity could be related to encephalopathy linked to COVID-19.
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Affiliation(s)
- Jean-Paul Niguet
- CHU Lille, Department of Clinical Neurophysiology, F-59000 Lille, France
| | - Romain Tortuyaux
- CHU Lille, Department of Clinical Neurophysiology, F-59000 Lille, France; CHU Lille, Department of Intensive Care, F-59000 Lille, France
| | - Bruno Garcia
- CHU Lille, Department of Intensive Care, F-59000 Lille, France
| | - Mercè Jourdain
- CHU Lille, Department of Intensive Care, F-59000 Lille, France; Inserm, Univ Lille, CHU Lille, Lille Pasteur Institute, EGID, U1190, F-59000 Lille, France
| | - Laurence Chaton
- CHU Lille, Department of Clinical Neurophysiology, F-59000 Lille, France
| | - Sébastien Préau
- CHU Lille, Department of Intensive Care, F-59000 Lille, France; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France
| | - Julien Poissy
- CHU Lille, Department of Intensive Care, F-59000 Lille, France
| | - Raphael Favory
- CHU Lille, Department of Intensive Care, F-59000 Lille, France; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France
| | - Saad Nseir
- CHU Lille, Department of Intensive Care, F-59000 Lille, France
| | - Daniel Mathieu
- CHU Lille, Department of Intensive Care, F-59000 Lille, France
| | | | - Arnaud Delval
- CHU Lille, Department of Clinical Neurophysiology, F-59000 Lille, France; Inserm, Univ Lille, CHU Lille, U1172, F-59000 Lille, France
| | - Philippe Derambure
- CHU Lille, Department of Clinical Neurophysiology, F-59000 Lille, France; Inserm, Univ Lille, CHU Lille, U1172, F-59000 Lille, France.
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14
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Vellieux G, Sonneville R, Vledouts S, Jaquet P, Rouvel-Tallec A, d’Ortho MP. COVID-19-Associated Neurological Manifestations: An Emerging Electroencephalographic Literature. Front Physiol 2021; 11:622466. [PMID: 33679425 PMCID: PMC7933549 DOI: 10.3389/fphys.2020.622466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide since the end of year 2019 and is currently responsive for coronavirus infectious disease 2019 (COVID-19). The first reports considered COVID-19 as a respiratory tract disease responsible for pneumonia, but numerous studies rapidly emerged to warn the medical community of COVID-19-associated neurological manifestations, including encephalopathy at the acute phase and other postinfectious manifestations. Using standard visual analysis or spectral analysis, recent studies reported electroencephalographic (EEG) findings of COVID-19 patients with various neurological symptoms. Most EEG recordings were normal or revealed non-specific abnormalities, such as focal or generalized slowing, interictal epileptic figures, seizures, or status epilepticus. Interestingly, novel EEG abnormalities over frontal areas were also described at the acute phase. Underlying mechanisms leading to brain injury in COVID-19 are still unknown and matters of debate. These frontal EEG abnormalities could emphasize the hypothesis whereby SARS-CoV-2 enters the central nervous system (CNS) through olfactory structures and then spreads in CNS via frontal lobes. This hypothesis is reinforced by the presence of anosmia in a significant proportion of COVID-19 patients and by neuroimaging studies confirming orbitofrontal abnormalities. COVID-19 represents a new viral disease characterized by not only respiratory symptoms but also a systemic invasion associated with extra-respiratory signs. Neurological symptoms must be the focus of our attention, and functional brain evaluation with EEG is crucial, in combination with anatomical and functional brain imaging, to better understand its pathophysiology. Evolution of symptoms together with EEG patterns at the distance of the acute episode should also be scrutinized.
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Affiliation(s)
- Geoffroy Vellieux
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Romain Sonneville
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Sérafima Vledouts
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Pierre Jaquet
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Anny Rouvel-Tallec
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Marie-Pia d’Ortho
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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15
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Koutroumanidis M, Gratwicke J, Sharma S, Whelan A, Tan SV, Glover G. Alpha coma EEG pattern in patients with severe COVID-19 related encephalopathy. Clin Neurophysiol 2021; 132:218-225. [PMID: 33060058 PMCID: PMC7527310 DOI: 10.1016/j.clinph.2020.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Encephalopathy is a major neurological complication of severe Coronavirus Disease 2019 (COVID-19), but has not been fully defined yet. Further, it remains unclear whether neurological manifestations are primarily due to neurotropism of the virus, or indirect effects, like cerebral hypoxia. METHODS We analysed the electroencephalograms (EEGs) of 19 consecutive patients with laboratory-confirmed COVID-19, performed at peak disease severity as part of their clinical management. Disease severity, respiratory failure, immune and metabolic dysfunction, sedation status, and neurological examination on the day of the EEG were noted. RESULTS Severe encephalopathy was confirmed in 13 patients, all with severe COVID-19; 10 remained comatose off sedation, and five of them had alpha coma (AC). Disease severity, sedation, immune and metabolic dysfunction were not different between those with AC and those without. CONCLUSIONS Severe COVID-19 encephalopathy is a principal cause of persisting coma after sedation withdrawal. The relatively high incidence of the rare AC pattern may reflect direct SARS-CoV-2 neurotropism with a predilection for the brainstem ascending reticular system. SIGNIFICANCE Systematic early EEG detection of encephalopathy related to severe COVID-19 is important for the acute care and the management of long-term neurological and cognitive sequelae, and may help our better understanding of its pathophysiology.
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Affiliation(s)
| | - James Gratwicke
- Department of Neurology and Clinical Neurophysiology, St. Thomas' Hospital, London, UK
| | - Simeran Sharma
- Department of Neurology and Clinical Neurophysiology, St. Thomas' Hospital, London, UK
| | - Aoife Whelan
- Department of Neurology and Clinical Neurophysiology, St. Thomas' Hospital, London, UK
| | - S Veronica Tan
- Department of Neurology and Clinical Neurophysiology, St. Thomas' Hospital, London, UK
| | - Guy Glover
- Intensive Care Unit, St Thomas' Hospital, London, UK
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16
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Adamczyk-Sowa M, Mado H, Kubicka-Bączyk K, Jaroszewicz J, Sobala-Szczygieł B, Bartman W, Sowa P. SARS-CoV-2/COVID-19 in multiple sclerosis patients receiving disease-modifying therapy. Clin Neurol Neurosurg 2020; 201:106451. [PMID: 33388661 PMCID: PMC7831713 DOI: 10.1016/j.clineuro.2020.106451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023]
Abstract
MS-related disability is an independent risk factor for COVID-19 severity. Most likely, disease-modifying therapy does not affect the severity of COVID-19. Special caution should be applied when administering DMT causing lymphopenia in patients with MS and COVID-19.
At the end of 2019, the COVID-19 pandemic began, which at the time of writing continues to be a serious problem for many areas of medicine, including neurology. Since patients with multiple sclerosis (MS) often exhibit motor disability and receive disease-modifying therapy (DMT), which has an immunosuppressive effect, it is plausible that this will affect the susceptibility of MS patients to COVID-19, as well as the course of this disease. However, current data indicate that the use of DMT does not cause negative prognosis in COVID-19 sufferers, but the motor disability progression associated with MS does. In this study, we present the case reports of 4 patients with relapsing-remitting MS, who developed COVID-19, and despite the use of DMT the course of the disease was mild. Two patients were treated with dimethyl fumarate, one with Interferon β1b and one with glatiramer acetate. One of the patients using dimethyl fumarate had lymphopenia. All patients had symptoms of COVID-19 from the nervous system, the most frequent being headache, which occurred in all patients. The aim of this article is to present a case series of four patients with MS and COVID-19, and to discuss the available literature on COVID-19 in patients with MS, with particular consideration of the impact of DMT.
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Affiliation(s)
- Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Hubert Mado
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland.
| | - Katarzyna Kubicka-Bączyk
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Barbara Sobala-Szczygieł
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Bartman
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Paweł Sowa
- Department of Otorhinolaryngology and Oncological Laryngology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
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17
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Ayub N, Cohen J, Jing J, Jain A, Tesh R, Mukerji SS, Zafar SF, Westover MB, Kimchi EY. Clinical Electroencephalography Findings and Considerations in Hospitalized Patients With Coronavirus SARS-CoV-2. Neurohospitalist 2020; 11:204-213. [PMID: 34163546 DOI: 10.1177/1941874420972237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background and Purpose Reports have suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes neurologic manifestations including encephalopathy and seizures. However, there has been relatively limited electrophysiology data to contextualize these specific concerns and to understand their associated clinical factors. Our objective was to identify EEG abnormalities present in patients with SARS-CoV-2, and to determine whether they reflect new or preexisting brain pathology. Methods We studied a consecutive series of hospitalized patients with SARS-CoV-2 who received an EEG, obtained using tailored safety protocols. Data from EEG reports and clinical records were analyzed to identify EEG abnormalities and possible clinical associations, including neurologic symptoms, new or preexisting brain pathology, and sedation practices. Results We identified 37 patients with SARS-CoV-2 who underwent EEG, of whom 14 had epileptiform findings (38%). Patients with epileptiform findings were more likely to have preexisting brain pathology (6/14, 43%) than patients without epileptiform findings (2/23, 9%; p = 0.042). There were no clear differences in rates of acute brain pathology. One case of nonconvulsive status epilepticus was captured, but was not clearly a direct consequence of SARS-CoV-2. Abnormalities of background rhythms were common, as may be seen in systemic illness, and in part associated with recent sedation (p = 0.022). Conclusions Epileptiform abnormalities were common in patients with SARS-CoV-2 referred for EEG, but particularly in the context of preexisting brain pathology and sedation. These findings suggest that neurologic manifestations during SARS-CoV-2 infection may not solely relate to the infection itself, but rather may also reflect patients' broader, preexisting neurologic vulnerabilities.
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Affiliation(s)
- Neishay Ayub
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Cohen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jin Jing
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Clinical Data Animation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Aayushee Jain
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Clinical Data Animation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan Tesh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Clinical Data Animation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shibani S Mukerji
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sahar F Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Clinical Data Animation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Eyal Y Kimchi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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18
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Systematic review of EEG findings in 617 patients diagnosed with COVID-19. Seizure 2020; 83:234-241. [PMID: 33121875 PMCID: PMC7569418 DOI: 10.1016/j.seizure.2020.10.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 02/06/2023] Open
Abstract
Objective We performed a systematic review of the literature to synthesize the data on EEG findings in COVID-19. Frontal EEG patterns are reported to be a characteristic finding in COVID-19 encephalopathy. Although several reports of EEG abnormalities are available, there is lack of clarity about typical findings. Methods Research databases were queried with the terms “COVID” OR “coronavirus” OR “SARS” AND “EEG”. Available data was analyzed from 617 patients with EEG findings reported in 84 studies. Results The median age was 61.3 years (IQR 45−69, 33.3 % female). Common EEG indications were altered mental status (61.7 %), seizure-like events (31.2 %), and cardiac arrest (3.5 %). Abnormal EEG findings (n = 543, 88.0 %) were sub-classified into three groups: (1) Background abnormalities: diffuse slowing (n = 423, 68.6 %), focal slowing (n = 105, 17.0 %), and absent posterior dominant rhythm (n = 63, 10.2 %). (2) Periodic and rhythmic EEG patterns: generalized periodic discharges (n = 35, 5.7 %), lateralized/multifocal periodic discharges (n = 24, 3.9 %), generalized rhythmic activity (n = 32, 5.2 %). (3) Epileptiform changes: focal (n = 35, 5.7 %), generalized (n = 27, 4.4 %), seizures/status epilepticus (n = 34, 5.5 %). Frontal EEG patterns comprised of approximately a third of all findings. In studies that utilized continuous EEG, 96.8 % (n = 243) of the 251 patients were reported to have abnormalities compared to 85.0 % (n = 311) patients who did not undergo continuous EEG monitoring (χ2 = 22.8, p =< 0.001). Significance EEG abnormalities are common in COVID-19 related encephalopathy and correlates with disease severity, preexisting neurological conditions including epilepsy and prolonged EEG monitoring. Frontal findings are frequent and have been proposed as a biomarker for COVID-19 encephalopathy.
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19
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Orrù G, Conversano C, Malloggi E, Francesconi F, Ciacchini R, Gemignani A. Neurological Complications of COVID-19 and Possible Neuroinvasion Pathways: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6688. [PMID: 32937949 PMCID: PMC7558767 DOI: 10.3390/ijerph17186688] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/23/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) outbreak has shocked the whole world with its unexpected rapid spread. The virus responsible for the disease, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), enters host cells by means of the envelope spike protein, which binds to angiotensin-converting enzyme 2 receptors. These receptors are highly expressed in heart, lungs, respiratory tract epithelium, endothelial cells and brain. Since an increasing body of significant evidence is highlighting a possible neuroinvasion related to SARS-CoV-2, a state of the art on the neurological complications is needed. To identify suitable publications, our systematic review was carried out by searching relevant studies on PubMed and Scopus databases. We included studies investigating neurologic manifestations of SARS-CoV-2 in patients over 18. According to the analyzed studies, the most frequent disorders affecting central nervous system (CNS) seem to be the following: olfactory and taste disorders, ischemic/hemorrhagic stroke, meningoencephalitis and encephalopathy, including acute necrotizing encephalopathy, a rare type of encephalopathy. As regards the peripheral nervous system (PNS), Guillain-Barré and Miller Fisher syndromes are the most frequent manifestations reported in the literature. Important clinical information on the neurological manifestations of SARS-CoV-2 would help clinicians raise awareness and simultaneously improve the prognosis of critically ill patients.
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Affiliation(s)
- Graziella Orrù
- Department of Surgical, Medical and Molecular & Critical Area Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy; (C.C.); (E.M.); (F.F.); (R.C.); (A.G.)
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20
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Pellinen J, Carroll E, Friedman D, Boffa M, Dugan P, Friedman DE, Gazzola D, Jongeling A, Rodriguez AJ, Holmes M. Continuous EEG findings in patients with COVID-19 infection admitted to a New York academic hospital system. Epilepsia 2020; 61:2097-2105. [PMID: 32875578 DOI: 10.1111/epi.16667] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
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.
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Affiliation(s)
- 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
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21
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Chen W, Toprani S, Werbaneth K, Falco-Walter J. Status epilepticus and other EEG findings in patients with COVID-19: A case series. Seizure 2020; 81:198-200. [PMID: 32861152 PMCID: PMC7441944 DOI: 10.1016/j.seizure.2020.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Neurological manifestations of COVID-19 infection include impaired consciousness, strokes, and seizures. Limited reports describing EEG abnormalities in patients with COVID-19 have been published. These articles reported nonspecific encephalopathic patterns, epileptiform discharges, and rarely seizures. Our primary aim was to assess EEG abnormalities in patients with COVID-19 and evaluate for epileptiform activity or seizures. METHODS We identified five critically ill adult patients with COVID-19 who underwent EEG monitoring. All patients had Ceribell™ rapid response EEG initially and two continued with conventional long-term video EEG. RESULTS All 5 patients had encephalopathy and 3 also had seizure-like movements, thus prompting EEG monitoring. EEGs all showed nonspecific markers of encephalopathy including diffuse slowing and generalized rhythmic delta activity. Two also had epileptiform discharges reaching 2-3 Hz at times, with one patient in nonconvulsive status epilepticus and the other developing clinical status epilepticus with myoclonic movements. EEG and clinical symptoms improved with anti-seizure medications. CONCLUSION Status epilepticus was present in 2 out of our cohort of 5 critically ill patients who underwent EEG monitoring. These findings highlight the importance of EEG monitoring in high-risk patients with COVID-19 and encephalopathy. EEG recordings in such patients can identify pathological patterns that will benefit from treatment with anti-seizure medications.
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Affiliation(s)
- Wendy Chen
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Sheela Toprani
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Katherine Werbaneth
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Jessica Falco-Walter
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
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22
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Pasini E, Bisulli F, Volpi L, Minardi I, Tappatà M, Muccioli L, Pensato U, Riguzzi P, Tinuper P, Michelucci R. EEG findings in COVID-19 related encephalopathy. Clin Neurophysiol 2020; 131:2265-2267. [PMID: 32736327 PMCID: PMC7367805 DOI: 10.1016/j.clinph.2020.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Elena Pasini
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Francesca Bisulli
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lilia Volpi
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Irene Minardi
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Maria Tappatà
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lorenzo Muccioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Umberto Pensato
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Patrizia Riguzzi
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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23
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Ayub N, Cohen J, Jing J, Jain A, Tesh R, Mukerji SS, Zafar SF, Westover MB, Kimchi EY. Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32699855 DOI: 10.1101/2020.07.13.20152207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background and Purpose Reports have suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes neurologic manifestations including encephalopathy and seizures. However, there has been relatively limited electrophysiology data to contextualize these specific concerns and to understand their associated clinical factors. Our objective was to identify EEG abnormalities present in patients with SARS-CoV-2, and to determine whether they reflect new or preexisting brain pathology. Methods We studied a consecutive series of hospitalized patients with SARS-CoV-2 who received an EEG, obtained using tailored safety protocols. Data from EEG reports and clinical records were analyzed to identify EEG abnormalities and possible clinical associations, including neurologic symptoms, new or preexisting brain pathology, and sedation practices. Results We identified 37 patients with SARS-CoV-2 who underwent EEG, of whom 14 had epileptiform findings (38%). Patients with epileptiform findings were more likely to have preexisting brain pathology (6/14, 43%) than patients without epileptiform findings (2/23, 9%; p=0.042). There were no clear differences in rates of acute brain pathology. One case of nonconvulsive status epilepticus was captured, but was not clearly a direct consequence of SARS-CoV-2. Abnormalities of background rhythms were common, and patients recently sedated were more likely to lack a posterior dominant rhythm (p=0.022). Conclusions Epileptiform abnormalities were common in patients with SARS-CoV-2 referred for EEG, but particularly in the context of preexisting brain pathology and sedation. These findings suggest that neurologic manifestations during SARS-CoV-2 infection may not solely relate to the infection itself, but rather may also reflect patients' broader, preexisting neurologic vulnerabilities.
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24
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Vellieux G, Rouvel-Tallec A, Jaquet P, Grinea A, Sonneville R, d'Ortho MP. COVID-19 associated encephalopathy: Is there a specific EEG pattern? Clin Neurophysiol 2020; 131:1928-1930. [PMID: 32615526 PMCID: PMC7311351 DOI: 10.1016/j.clinph.2020.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Geoffroy Vellieux
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Neurophysiologie clinique, Service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France.
| | - Anny Rouvel-Tallec
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Neurophysiologie clinique, Service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Pierre Jaquet
- Médecine intensive-réanimation, AP-HP, Bichat-Claude Bernard Hospital, F-75018 Paris, France
| | - Alexandra Grinea
- Médecine intensive-réanimation, AP-HP, Bichat-Claude Bernard Hospital, F-75018 Paris, France
| | - Romain Sonneville
- Médecine intensive-réanimation, AP-HP, Bichat-Claude Bernard Hospital, F-75018 Paris, France; Université de Paris, INSERM UMR1148, Team 6, F-75018 Paris, France
| | - Marie-Pia d'Ortho
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Neurophysiologie clinique, Service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
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