• Lu Lin, Abrar Al-Faraj, Neishay Ayub, Pablo Bravo, Sudeshna Das, Lorenzo Ferlini, Ioannis Karakis, Jong Woo Lee, Shibani S Mukerji, Christopher R Newey, Jay Pathmanathan, Myriam Abdennadher, Charles Casassa, Nicolas Gaspard, Daniel M Goldenholz, Emily J Gilmore, Jin Jing, Jennifer A Kim, Eyal Y Kimchi, Harshad S Ladha, Steven Tobochnik, Sahar Zafar, Lawrence J Hirsch, M Brandon Westover, and Mouhsin M Shafi.
• Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA.
• Ann. Neurol. 2021 May 1; 89 (5): 872-883.

ObjectiveThe aim was to determine the prevalence and risk factors for electrographic seizures and other electroencephalographic (EEG) patterns in patients with Coronavirus disease 2019 (COVID-19) undergoing clinically indicated continuous electroencephalogram (cEEG) monitoring and to assess whether EEG findings are associated with outcomes.MethodsWe identified 197 patients with COVID-19 referred for cEEG at 9 participating centers. Medical records and EEG reports were reviewed retrospectively to determine the incidence of and clinical risk factors for seizures and other epileptiform patterns. Multivariate Cox proportional hazards analysis assessed the relationship between EEG patterns and clinical outcomes.ResultsElectrographic seizures were detected in 19 (9.6%) patients, including nonconvulsive status epilepticus (NCSE) in 11 (5.6%). Epileptiform abnormalities (either ictal or interictal) were present in 96 (48.7%). Preceding clinical seizures during hospitalization were associated with both electrographic seizures (36.4% in those with vs 8.1% in those without prior clinical seizures, odds ratio [OR] 6.51, p = 0.01) and NCSE (27.3% vs 4.3%, OR 8.34, p = 0.01). A pre-existing intracranial lesion on neuroimaging was associated with NCSE (14.3% vs 3.7%; OR 4.33, p = 0.02). In multivariate analysis of outcomes, electrographic seizures were an independent predictor of in-hospital mortality (hazard ratio [HR] 4.07 [1.44-11.51], p < 0.01). In competing risks analysis, hospital length of stay increased in the presence of NCSE (30 day proportion discharged with vs without NCSE: HR 0.21 [0.03-0.33] vs 0.43 [0.36-0.49]).InterpretationThis multicenter retrospective cohort study demonstrates that seizures and other epileptiform abnormalities are common in patients with COVID-19 undergoing clinically indicated cEEG and are associated with adverse clinical outcomes. ANN NEUROL 2021;89:872-883.© 2021 American Neurological Association.

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