COVID-19-associated seizure: Difference between revisions

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{{SI}}
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{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{Mandana.Sa}} [[User:Tayebah Chaudhry|Tayebah Chaudhry]][mailto:dr.thch@yahoo.com], {{Fs}}, {{sali}}


{{SK}}  
{{SK}}  
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==Overview==
==Overview==


While headache, nausea and vomiting are the main neurological symptoms of '''Covid -19''', up to '''40%''' of these patients are experiencing '''seizure''', '''loss of smell sensation''' and '''[[ataxia]]'''.<ref>{{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244399/}}</ref>
[[Seizure]] refers to an episode of [[symptom]]s due to abnormally excessive or synchronous [[neuronal]] activity in the [[brain]] followed by return to normal state. [[Seizures]] manifest as abnormal uncontrolled shaking movements that involve much of the [[body]] with loss of [[consciousness]], shaking movements of part of the [[body]] with variable level of [[consciousness]] or a subtle momentary loss of [[consciousness]]. As [[COVID-19]] (caused by [[SARS-CoV-2|SARS-Cov2]]) is now known to have several [[neurological]] [[complications]], [[seizure]] is one of the [[complications]] seen in a few cases so far. [[Brain]] waive activity can be seen on [[EEG]] to confirm diagnosis since structural changes are very rarely seen on [[brain]] [[imaging]]. Anti-[[seizure]] [[medications]] are used for symptomatic treatment of [[seizure]] along with [[treatment]] of [[COVID-19]].
 
various neurological manifestations arising with [[covid 19 pandemic]] have not been studying adequately. However, there are some slim evidences demonstrating  how the '''[[covid 19]]''' could lead to several neurological complications such as '''[[seizure]]''',''cranial deficits''','''[[meningitis]]''' ,[[delirium]] and '''[[encephalopathy]]'''. This chapter focuses on '''[[covid 19]]''' and '''[[seizure]]'''.


==Historical Perspective==
==Historical Perspective==


*A women with the past medical history of seizure following herpetic encephalitis ,presented with a sudden focal [[myoclonus]] and positive test for '''covid 19''' in Italy, 23rd of april 2020.<ref>{{https://www.seizure-journal.com/article/S1059-1311(20)30115-1/fulltext}}</ref>
*First case of seizure in [[COVID-19]] patient was a result of [[meningitis]]/[[encephalitis]] caused by [[SARS-CoV-2|SARS-CoV2]] and documented by Moriguchi et al in late February 2020 <ref name="pmid32251791">{{cite journal |vauthors=Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, Ueno M, Sakata H, Kondo K, Myose N, Nakao A, Takeda M, Haro H, Inoue O, Suzuki-Inoue K, Kubokawa K, Ogihara S, Sasaki T, Kinouchi H, Kojin H, Ito M, Onishi H, Shimizu T, Sasaki Y, Enomoto N, Ishihara H, Furuya S, Yamamoto T, Shimada S |title=A first case of meningitis/encephalitis associated with SARS-Coronavirus-2 |journal=Int. J. Infect. Dis. |volume=94 |issue= |pages=55–58 |date=May 2020 |pmid=32251791 |pmc=7195378 |doi=10.1016/j.ijid.2020.03.062 |url=}}</ref>.
 
*After that, more cases were reported with acute [[Seizure|seizures]] as a complication of COVID-19.<ref name="HepburnMullaguri2020">{{citejournal|last1=Hepburn|first1=Madihah|last2=Mullaguri|first2=Naresh|last3=George|first3=Pravin|last4=Hantus|first4=Stephen|last5=Punia|first5=Vineet|last6=Bhimraj|first6=Adarsh|last7=Newey|first7=Christopher R.|title=Acute Symptomatic Seizures in Critically Ill Patients with COVID-19: Is There an Association?|journal=Neurocritical Care|year=2020|issn=1541-6933|doi=10.1007/s12028-020-01006-1}}</ref><ref><nowiki>{{</nowiki>https://www.sciencedirect.com/science/article/pii/S1059131120301151<nowiki>}}</nowiki></ref>
*Also, a cohort multicentre study was done in china, April 2020 , demonstrating that covid 19 doesn't increase the risk of symptomatic seizure in patients hospitalized with acute respiratory phase of covid 19.Althogh ,some seizure like reactions were seen because of acute reaction to stress or hypocalcemia .<ref>{{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}</ref>
*In early February 2020, seizurelike activity was reported in two COVID-19 patients but the cause was acute [[anxiety]] disorder and [[electrolyte imbalance]] instead of viral damage by [[SARS-Cov-2]]<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>
*To view the historical perspective of COVID-19, [[COVID-19 historical perspective|click here]].


==Classification==
==Classification==
There isn't any established classification for '''covid-19 associated seizure'''.


 
*There is no established classification for [[COVID-19]] associated [[seizure]].
.


==Pathophysiology==
==Pathophysiology==
Although there are some evidences suggesting SARS-COV-2 may affect '''[[CNS]]''' through two direct ways:[[haematogenous]] and '''neuronal retrograde dissemination ''',the exact neurotropic mechanisms  of this virus are yet to be known.<ref>{{https://pubmed.ncbi.nlm.nih.gov/32458193/}}</ref>


*[[Neurological]] complications caused by [[COVID-19]] are through direct or indirect pathways.
*This includes [[hematogenous]] pathway, [[neuronal]] [[retrograde]] dissemination through [[olfactory bulb]], entry into to [[glial]] cells and [[neurons]] via [[ACE2]] receptor and impairment of [[gas]] exchange in [[lung]]s leading to [[anemia]], hence increasing [[anaerobic]] metabolites in [[brain]] resulting in [[cellular]] and interstitial [[edema]] <ref><nowiki>{{</nowiki>https://pubmed.ncbi.nlm.nih.gov/32458193/<nowiki>}}</nowiki></ref>
*[[Seizures]] in a patient with [[COVID-19]] may be due to primary [[virus]] [[infection]] or due to reactivation of the latent [[virus]].
*Infiltration of the [[brain]] [[tissue]] by the [[virus]] and subsequent production of [[toxins]] by the [[virus]] is one of the several mechanisms that can cause [[seizures]] in a [[COVID-19]] [[patient]]. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>
*Production of [[inflammatory]] mediators by the brain may also trigger [[seizures]].
*[[Inflammatory]] [[cytokines]] that are released as a result of [[inflammatory cascade]] provoked by [[COVID-19]] include [[interleukin]] 2,6,7, and 10, [[TNF-α]] and [[granulocyte colony-stimulating factor]]. Consequently, activation of [[glutamate receptors]] by the cytokines causes [[neuronal]] [[hyperexcitability]] and development of [[seizures]]. <ref name="KarimiSharifi Razavi2020">{{cite journal|last1=Karimi|first1=Narges|last2=Sharifi Razavi|first2=Athena|last3=Rouhani|first3=Nima|title=Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report|journal=Iranian Red Crescent Medical Journal|volume=22|issue=3|year=2020|issn=2074-1804|doi=10.5812/ircmj.102828}}</ref>




.
[[Image:covid 19 seizure.jpeg|500px|thumb|center|Pathophysiology <ref name="AbboudAbboud2020">{{cite journal|last1=Abboud|first1=Hilal|last2=Abboud|first2=Fatima Zahra|last3=Kharbouch|first3=Hanane|last4=Arkha|first4=Yasser|last5=El Abbadi|first5=Najia|last6=El Ouahabi|first6=Abdessamad|title=COVID-19 and SARS-Cov-2 Infection: Pathophysiology and Clinical Effects on the Nervous System|journal=World Neurosurgery|volume=140|year=2020|pages=49–53|issn=18788750|doi=10.1016/j.wneu.2020.05.193}}</ref>]]


==Causes==
==Causes==


The aetiology of [[seizure]] regardless whether it is '''covid-19''' or not ,is divided into two categories:
*Cause of COVID-19-associated seizure is viral infection by [[SARS-CoV-2]] and its consequences which include:<ref name="pmid32416567">{{cite journal |vauthors=Asadi-Pooya AA |title=Seizures associated with coronavirus infections |journal=Seizure |volume=79 |issue= |pages=49–52 |date=July 2020 |pmid=32416567 |pmc=7212943 |doi=10.1016/j.seizure.2020.05.005 |url=}}</ref>
*'''Provoked seizures''' : these seizures usually have a temporary trigger such as '''[[CNS infection]]''','''electrolytes disturbance''', '''[[withdrawal syndrome]]''','''[[ sepsis]] '','''fever''', '''sleep deprivation''' and '''[[stroke]]'''.
**[[Hypoxia]]
*'''Unprovoked  seizures''': In this catrgory ,there isn't any obvious cause or precipitating factor  .<ref>{{ https://www.ncbi.nlm.nih.gov/books/NBK430765/}}</ref>
**[[Metabolic]] derangement
**[[Organ failure]]
**[[Cerebral]] damage.<ref><nowiki>{{</nowiki>https://www.ncbi.nlm.nih.gov/books/NBK430765/<nowiki>}}</nowiki></ref>
**To view causes of COVID-19, [[COVID-19 causes|click here]].


==Differentiating COVID-19-associated seizure from other Diseases==
==Differentiating COVID-19-associated seizure from other Diseases==
Apart from the viral cause of seizure, differential diagnosis for this disease is usually based on the presenting symptoms as below:
*Loss of awareness :[[syncope]]-[[Epilepsy]]-cardiac disorder


*Generalized convulsive movements:[[Epilepsy]]-'''syncope with secondary jerking movement'''-Involuntary movement disorders and other neurological conditions
 
*'''Drop attack''':[[Epilepsy]]-Cardiac-[[Brainstem abnormalities]]-[[vertebrobasilar ischemia]]-'''Idiopathic
*For further information about the differential diagnosis, [[COVID-19-associated seizure differential diagnosis|click here]].
*Transient focal motor and sensory attack:'''[[tics]]'''-'''tonic spasms of [[multiple
*To view the differential diagnosis of COVID-19, [[COVID-19 differential diagnosis|click here]].
*Facial muscles and eye movement:[[partial seizures]]-movement disorder-Other neurological conditions.<ref>{{ https://www.nice.org.uk/guidance/CG20/documents/appendix-a-a-differential-diagnosis-first-consultation2}}</ref>


==Epidemiology and Demographics==
==Epidemiology and Demographics==
*More data is required to comment on [[epidemiology]] and [[demographics]] of [[COVID-19]]-associated [[seizure]].
*One study, specifically investigated the neurological manifestations of [[COVID-19]] and documented [[CNS]] manifestations in 25% of the patients ([[headache]] (13%), [[dizziness]] (17%), impaired [[consciousness]] (8%), acute [[cerebrovascular]] problems (3%), [[ataxia]] (0.5), and [[seizures]] (0.5%)]<ref name="MaoJin2020">{{cite journal|last1=Mao|first1=Ling|last2=Jin|first2=Huijuan|last3=Wang|first3=Mengdie|last4=Hu|first4=Yu|last5=Chen|first5=Shengcai|last6=He|first6=Quanwei|last7=Chang|first7=Jiang|last8=Hong|first8=Candong|last9=Zhou|first9=Yifan|last10=Wang|first10=David|last11=Miao|first11=Xiaoping|last12=Li|first12=Yanan|last13=Hu|first13=Bo|title=Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China|journal=JAMA Neurology|volume=77|issue=6|year=2020|pages=683|issn=2168-6149|doi=10.1001/jamaneurol.2020.1127}}</ref>


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].
OR
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].


OR
*Several risk factors of [[seizure]] in [[COVID-19]] patients were considered in a multicenter [[restrospective]] study from Jan 18th to FEb 18th, 2020 in China.<ref><nowiki>{{</nowiki>https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524<nowiki>}}</nowiki></ref>
 
*[[Risk factor]]s that were studied include acute [[cerebrovascular disease]], [[traumatic brain injury]] (TBI), [[central nervous system]] (CNS) [[infection]], [[shock]], [[hypoxia]], severe [[metabolic disturbance]], [[multiple‐organ dysfunction syndrome]], [[sepsis]], and exposure to drugs or [[toxic]] substances.
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
*According to the study, [[hypoxia]] and [[imipenem]] were shown to be important risk factors, among several others, for [[seizure]] in a [[COVID-19]] patient.
 
*To view the risk factors of COVID-19, [[COVID-19 risk factors|click here]].
OR
 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].


OR
*There is insufficient evidence to recommend routine screening for [[COVID-19]] associated [[seizure]].


According to the [guideline name], screening for [disease name] is not recommended.
==Natural History, Complications, and Prognosis==


OR
'''Natural History'''


According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
*[[Seizure]] activity in a patient with or without [[COVID-19]] usually lasts for a few seconds to less than 5 minutes with return to normal after the [[seizure]] episode.
*If [[seizure]] episode lasts for more than 5 minutes it is called [[status epilepticus]].
*This is followed by a period of [[confusion]], called [[Postictal state|postictal period]] that can last 3-15 minutes and sometimes hours.


==Natural History, Complications, and Prognosis==
'''Complications'''
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].


OR
*Complications of COVID-19-associated seizure include:
**[[Headache]]
**[[Tiredness]]
**Difficulty [[speaking]]
**[[Difficulty breathing]] (due to blockage of airway)
**Abnormal behavior
**[[Psychosis]]
**Injury to [[tongue]] due to [[bite]] during [[seizure]] activity
**[[Trauma]] due to sudden [[fall]] and/or [[loss of consciousness]]


Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
'''Prognosis'''


OR
*In general, after the first [[seizure]], subsequent [[seizure]] episodes can be predicted using [[EEG]] and [[brain imaging]].<ref name="pmid22963022">{{cite journal |vauthors=Wilden JA, Cohen-Gadol AA |title=Evaluation of first nonfebrile seizures |journal=Am Fam Physician |volume=86 |issue=4 |pages=334–40 |date=August 2012 |pmid=22963022 |doi= |url=}}</ref>
 
*[[Prognosis]] of seizure in a [[COVID-19]] patient is not known.
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
*However, if left untreated, [[seizure]] caused by acute brain event is known to have low risk of recurrence but higher risk of death compared to those with [[epilepsy]]. <ref name="pmid8965090">{{cite journal |vauthors=Sander JW, Shorvon SD |title=Epidemiology of the epilepsies |journal=J. Neurol. Neurosurg. Psychiatry |volume=61 |issue=5 |pages=433–43 |date=November 1996 |pmid=8965090 |pmc=1074036 |doi=10.1136/jnnp.61.5.433 |url=}}</ref>


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].


OR
*The diagnosis of COVID-19-associated seizure is made through [[Electroencephalography|electroencephalogram]] ([[EEG]], brain waive activity).<ref name="pmid32374647">{{cite journal| author=Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK| title=Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases. | journal=Neurodiagn J | year= 2020 | volume= 60 | issue= 2 | pages= 78-95 | pmid=32374647 | doi=10.1080/21646821.2020.1756132 | pmc=7212538 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32374647  }} </ref>


The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*Other diagnostic tests include:
**[[CT scan]] brain
**[[MRI]] brain
**Blood test
**[[Lumbar puncture]]
**[[Toxicology]] screening


OR
===Symptoms===


The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
'''Common symptoms:'''


OR
*[[Staring]]
*[[Jerking]] movements of the [[Arm|arms]] and [[legs]]
*Stiffening of the [[body]]
*Loss of [[consciousness]]
*[[Breathing]] problems


There are no established criteria for the diagnosis of [disease name].
===== Loss of [[bowel]] or [[bladder]] control =====


===History and Symptoms===
*Falling suddenly for no apparent reason, especially when associated with [[loss of consciousness]]
The majority of patients with [disease name] are asymptomatic.
*Not responding to [[noise]] or words for brief periods
*Appearing confused or in a haze


OR
'''Less common symptoms:'''


The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
*Nodding of [[head]] rhythmically, associated with lack of awareness
*Periods of rapid [[eye]] [[blinking]]


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].


OR
*Physical examination of a patient with COVID-19-associated seizure include:
 
==== Vital Signs ====


Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[Vital signs]]: [[Tachycardia]] may be present.


OR
===== HEENT =====


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
* Finding a [[bite]] to the side of the [[tongue]] (when present, is helpful in making the diagnosis).


OR
===== Neuromuscular =====


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
*[[Postictal state|Postictal]] [[drowsiness]] or [[confusion]].


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].


OR
*[[Postictal state|Postictal]] levels of the following may be elevated in a patient with [[seizures]]:
 
**[[Prolactin]] (within 20 minutes after a convulsive event)
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
**[[Lactate]] (within 1 to 2 hours)
 
**[[Ammonia]] (within several hours)
OR
**[[Creatine kinase]] (especially 24 to 48 hours postictally)
 
**To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].
There are no diagnostic laboratory findings associated with [disease name].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].


OR
*There are no typical [[ECG]] findings associated with seizures in a [[COVID-19]] patient.
 
*To view the [[electrocardiogram]] findings on COVID-19, [[COVID-19 electrocardiogram|click here]].<br />
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR


There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*There are no [[X-rays|x-ray]] findings associated with [[COVID-19]] associated [[seizure]].
*To view the [[X-rays|x-ray]] finidings on COVID-19, [[COVID-19 x ray|click here]].<br />


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
OR
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR


There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*There are no typical [[Echocardiography|echocardiographic]] findings for [[seizure]] related to [[COVID-19]].
*To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]].<br />


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
OR


[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[CT]] [[brain]] may show structural lesions but majority of patients will show nothing.
 
*To view the [[CT scan]] findings on COVID-19, [[COVID-19 CT scan|click here]].
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].


OR
*[[MRI]] brain may show structural lesions but majority of patients will show nothing.
 
*To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]].<br />
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].


OR
*There are no other imaging findings associated with [[seizure]] related to [[COVID-19]].
 
*To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]].<br />
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


OR
*To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]].<br />
 
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].


OR
*Development of [[seizures]] in a [[COVID-19]] patient requires urgent treatment.<ref name="pmid25174548">{{cite journal |vauthors=Ueda R, Saito Y, Ohno K, Maruta K, Matsunami K, Saiki Y, Sokota T, Sugihara S, Nishimura Y, Tamasaki A, Narita A, Imamura A, Maegaki Y |title=Effect of levetiracetam in acute encephalitis with refractory, repetitive partial seizures during acute and chronic phase |journal=Brain Dev. |volume=37 |issue=5 |pages=471–7 |date=May 2015 |pmid=25174548 |doi=10.1016/j.braindev.2014.08.003 |url=}}</ref><ref name="pmid32283294">{{cite journal |vauthors=Ye M, Ren Y, Lv T |title=Encephalitis as a clinical manifestation of COVID-19 |journal=Brain Behav. Immun. |volume= |issue= |pages= |date=April 2020 |pmid=32283294 |pmc=7146652 |doi=10.1016/j.bbi.2020.04.017 |url=}}</ref><ref name="pmid32416567" />
 
*After the cause of [[seizure]] is determined, medical therapy should be aimed at treating the cause immediately (for example, [[hypoxia]], [[fever]], metabolic imbalance).
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Anti-seizure medication ([[levetiracetam]] 50-60 mg/kg/day) is often necessary.
 
*Anti-epileptics therapy with [[mannitol]] has been documented in decreasing [[cerebral edema]].
OR
*For a single [[seizure]] less than 5 min rescue treatment with [[benzodiazepine]] is not needed.
 
*[[Intravenous]] antiseizure medication are used with caution in [[COVID-19]] patients due to the adverse effects (e.g., [[Phenytoin]], [[Phenobarbital]] and [[Lacosamide]] in [[respiratory]] and [[cardiac]] problems) and [[drug]] interactions (e.g., [[Carbamazepine]], [[Phenytoin]], [[Phenobarbital]] and [[Valproic acid]]).  
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*[[Brivaracetam]] and [[Levetiracetam]] have less adverse effects and drug interactions.
 
*In patients with more than one [[seizure]] (either shorter or longer than 5 min) and in [[status epilepticus]] rescue treatment with [[benzodiazepines]] in addition to ASM is needed.  
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.


OR
* Surgical intervention is not recommended for the management of [[COVID-19]] associated [[seizure]].
 
Surgery is the mainstay of treatment for [disease or malignancy].


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].


OR
* There are no established measures for the [[primary prevention]] of [[seizures]] associated with [[COVID-19]].
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
OR


Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
* There are no established measures for the [[secondary prevention]] of [[seizures]] associated with [[COVID-19]].


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Up-To-Date]]


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Latest revision as of 23:49, 12 December 2020

WikiDoc Resources for COVID-19-associated seizure

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mandana Safakhah, MD[2] Tayebah Chaudhry[3], Fahimeh Shojaei, M.D., Syed Musadiq Ali M.B.B.S.[4]

Synonyms and keywords:

Overview

Seizure refers to an episode of symptoms due to abnormally excessive or synchronous neuronal activity in the brain followed by return to normal state. Seizures manifest as abnormal uncontrolled shaking movements that involve much of the body with loss of consciousness, shaking movements of part of the body with variable level of consciousness or a subtle momentary loss of consciousness. As COVID-19 (caused by SARS-Cov2) is now known to have several neurological complications, seizure is one of the complications seen in a few cases so far. Brain waive activity can be seen on EEG to confirm diagnosis since structural changes are very rarely seen on brain imaging. Anti-seizure medications are used for symptomatic treatment of seizure along with treatment of COVID-19.

Historical Perspective

Classification

Pathophysiology


Pathophysiology [7]

Causes

Differentiating COVID-19-associated seizure from other Diseases

  • For further information about the differential diagnosis, click here.
  • To view the differential diagnosis of COVID-19, click here.

Epidemiology and Demographics

Risk Factors

Screening

  • There is insufficient evidence to recommend routine screening for COVID-19 associated seizure.

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Study of Choice

Symptoms

Common symptoms:

Loss of bowel or bladder control
  • Falling suddenly for no apparent reason, especially when associated with loss of consciousness
  • Not responding to noise or words for brief periods
  • Appearing confused or in a haze

Less common symptoms:

  • Nodding of head rhythmically, associated with lack of awareness
  • Periods of rapid eye blinking

Physical Examination

  • Physical examination of a patient with COVID-19-associated seizure include:

Vital Signs

HEENT
  • Finding a bite to the side of the tongue (when present, is helpful in making the diagnosis).
Neuromuscular

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

  • CT brain may show structural lesions but majority of patients will show nothing.
  • To view the CT scan findings on COVID-19, click here.

MRI

  • MRI brain may show structural lesions but majority of patients will show nothing.
  • To view the MRI findings on COVID-19, click here.

Other Imaging Findings

  • There are no other imaging findings associated with seizure related to COVID-19.
  • To view other imaging findings on COVID-19, click here.

Other Diagnostic Studies

  • To view other diagnostic studies for COVID-19, click here.

Treatment

Medical Therapy

Surgery

  • Surgical intervention is not recommended for the management of COVID-19 associated seizure.

Primary Prevention

Secondary Prevention

References

  1. ↑ Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, Ueno M, Sakata H, Kondo K, Myose N, Nakao A, Takeda M, Haro H, Inoue O, Suzuki-Inoue K, Kubokawa K, Ogihara S, Sasaki T, Kinouchi H, Kojin H, Ito M, Onishi H, Shimizu T, Sasaki Y, Enomoto N, Ishihara H, Furuya S, Yamamoto T, Shimada S (May 2020). "A first case of meningitis/encephalitis associated with SARS-Coronavirus-2". Int. J. Infect. Dis. 94: 55–58. doi:10.1016/j.ijid.2020.03.062. PMC 7195378 Check |pmc= value (help). PMID 32251791 Check |pmid= value (help).
  2. ↑ Template:Citejournal
  3. ↑ {{https://www.sciencedirect.com/science/article/pii/S1059131120301151}}
  4. ↑ {{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}
  5. ↑ {{https://pubmed.ncbi.nlm.nih.gov/32458193/}}
  6. ↑ 6.0 6.1 Karimi, Narges; Sharifi Razavi, Athena; Rouhani, Nima (2020). "Frequent Convulsive Seizures in an Adult Patient with COVID-19: A Case Report". Iranian Red Crescent Medical Journal. 22 (3). doi:10.5812/ircmj.102828. ISSN 2074-1804.
  7. ↑ Abboud, Hilal; Abboud, Fatima Zahra; Kharbouch, Hanane; Arkha, Yasser; El Abbadi, Najia; El Ouahabi, Abdessamad (2020). "COVID-19 and SARS-Cov-2 Infection: Pathophysiology and Clinical Effects on the Nervous System". World Neurosurgery. 140: 49–53. doi:10.1016/j.wneu.2020.05.193. ISSN 1878-8750.
  8. ↑ 8.0 8.1 Asadi-Pooya AA (July 2020). "Seizures associated with coronavirus infections". Seizure. 79: 49–52. doi:10.1016/j.seizure.2020.05.005. PMC 7212943 Check |pmc= value (help). PMID 32416567 Check |pmid= value (help).
  9. ↑ {{https://www.ncbi.nlm.nih.gov/books/NBK430765/}}
  10. ↑ Mao, Ling; Jin, Huijuan; Wang, Mengdie; Hu, Yu; Chen, Shengcai; He, Quanwei; Chang, Jiang; Hong, Candong; Zhou, Yifan; Wang, David; Miao, Xiaoping; Li, Yanan; Hu, Bo (2020). "Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China". JAMA Neurology. 77 (6): 683. doi:10.1001/jamaneurol.2020.1127. ISSN 2168-6149.
  11. ↑ {{https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524}}
  12. ↑ Wilden JA, Cohen-Gadol AA (August 2012). "Evaluation of first nonfebrile seizures". Am Fam Physician. 86 (4): 334–40. PMID 22963022.
  13. ↑ Sander JW, Shorvon SD (November 1996). "Epidemiology of the epilepsies". J. Neurol. Neurosurg. Psychiatry. 61 (5): 433–43. doi:10.1136/jnnp.61.5.433. PMC 1074036. PMID 8965090.
  14. ↑ Haines S, Caccamo A, Chan F, Galaso G, Catinchi A, Gupta PK (2020). "Practical Considerations When Performing Neurodiagnostic Studies on Patients with COVID-19 and Other Highly Virulent Diseases". Neurodiagn J. 60 (2): 78–95. doi:10.1080/21646821.2020.1756132. PMC 7212538 Check |pmc= value (help). PMID 32374647 Check |pmid= value (help).
  15. ↑ Ueda R, Saito Y, Ohno K, Maruta K, Matsunami K, Saiki Y, Sokota T, Sugihara S, Nishimura Y, Tamasaki A, Narita A, Imamura A, Maegaki Y (May 2015). "Effect of levetiracetam in acute encephalitis with refractory, repetitive partial seizures during acute and chronic phase". Brain Dev. 37 (5): 471–7. doi:10.1016/j.braindev.2014.08.003. PMID 25174548.
  16. ↑ Ye M, Ren Y, Lv T (April 2020). "Encephalitis as a clinical manifestation of COVID-19". Brain Behav. Immun. doi:10.1016/j.bbi.2020.04.017. PMC 7146652 Check |pmc= value (help). PMID 32283294 Check |pmid= value (help).


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