EEG Characteristics in Hospitalized Patients With Acute COVID-19 Symptoms

ABSTRACT

Objective Our objective was to evaluate the incidence of seizures, pattern of EEG abnormalities, and localization of abnormal discharges in hospitalized patients with COVID-19. Background The COVID-19 epidemic has revealed significant neurological manifestations including de novo seizures in patients who do not have a prior history of epilepsy or clear epilepsy risk factors. Our center is located in Arizona, which in the early part of January 2021 had more cases per capita than any other place in the world. Design/Methods We performed a retrospective review to observe the electroencephalogram (EEG) patterns of hospitalized adult patients with COVID-19 between March 2020 and February 2021. Results We identified 99 patients who were COVID-19 positive and had EEG testing during the same hospitalization. The most common EEG abnormality was diffuse background slowing, which was seen in 63.6% of patients (n = 63/99), compare to 15.1% of focal background slowing. Epileptiform discharges were seen in 11.1% of patients and seizures were found in 5.1% of patients, as newly diagnosed seizures. When combining all focal abnormalities, the most common location for these abnormalities was in the frontal regions 36.4% (n = 8/22). Even though 21 patients had acute focal neuroradiologic findings, only 5 had correlated EEG abnormalities within the same region. When EEG was obtained with suspected seizures (n = 33), 4 cases (12.1%, n = 4/33) indeed showed ictal pattern compared to 1.6% when seizures was not suspected (p = 0.087). Conclusions Abnormal EEG findings are most commonly found in the frontal lobe among hospitalized patients with acute COVID-19 symptoms. De novo seizures may be seen with COVID-19 infection. Suspicion of seizures should be raised in patients with COVID-19 encephalopathy. The utility of an EEG may help allow us better insight into how and where the COVID infection affects our central nervous system.