Clinical characteristics and long-term treatment outcomes of patients with new-onset epileptic seizures associated with COVID-19 infection

TL;DR

This study examines the clinical features and long-term outcomes of patients who experienced new epileptic seizures during acute COVID-19 infection.

Contribution

The study provides new insights into the prognosis and treatment outcomes of new-onset seizures in the context of acute COVID-19.

Findings

Patients without acute encephalopathy were younger and more likely to develop epilepsy.

New-onset seizures associated with COVID-19 generally have a favorable prognosis with low rates of drug-resistant epilepsy.

EEG findings and seizure characteristics differed significantly between patients with and without acute encephalopathy.

Abstract

This study investigates the clinical characteristics and approximately two-year treatment outcomes of patients with new-onset epileptic seizures during the acute phase of COVID-19 infection.

A retrospective, single-center cohort study was conducted from December 2022 to June 2023. The patients were categorized into two groups: those with acute encephalopathy (Group 1) and those without (Group 2).

This study enrolled a total of 34 patients (15 male and 19 female), with 18 assigned to Group 1 and 16 to Group 2. Patients in Group 2 (median: 32.5 years) were significantly younger than those in Group 1 (median: 60 years; p < 0.05). Status epilepticus was more frequent in Group 1 (66.7%, 12/18) compared to Group 2 (6.3%, 1/16; p < 0.001). Seizure latency was significantly shorter in Group 1 (median: 2 days) than in Group 2 (median: 9 days; p < 0.001). Abnormal posterior background activity on EEG was observed in 57.1% of Group 1 patients (4/7, p < 0.05), but in none of the Group 2 patients. However, a higher proportion of Group 2 patients showed interictal epileptiform discharges (72.7%, 8/11) compared to Group 1 (28.6%, 2/7). Epilepsy-related MRI abnormalities appeared in 22.2% (4/18) of Group 1 and 31.3% (5/16) of Group 2 patients. The proportion diagnosed with epilepsy was significantly higher in Group 2 compared to Group 1 (87.5% vs. 22.2%, p < 0.05). After 25 months of follow-up, one patient from each group developed drug-resistant epilepsy.

New-onset epileptic seizures associated with COVID-19 generally have a favorable prognosis. A lower proportion of patients developed drug-resistant epilepsy.

Figures