Electroencephalographic abnormalities in COVID-19-related encephalopathies: A systematic review

Background: Acute encephalopathy is a common neurological manifestation in coronavirus disease 2019 (COVID-19) patients and presents with confusion, delirium, or poor responsiveness. Non-convulsive status epilepticus (NCSE) is an important differential diagnosis in this situation. The electroencephalography (EEG) patterns in COVID-19 patients remain largely unknown. Method: A literature search was conducted on MEDLINE, EMBASE, and Cochrane database. Eligibility criteria included case series and case reports of COVID-19 patients with neurological complication who underwent EEG. Two authors screened all resulting studies and extracted the data independently. Results: Four retrospective case control studies and eleven case reports were identified. Background diffuse slow activity were seen in most of the COVID-19 patients. Other EEG patterns reported included status epilepticus, focal slow activity, rhythmic periodic discharges, and interictal epileptiform discharges. Imaging and CSF studies were available in only a few patients. Conclusions: Acute encephalopathy is common in the context of COVID-19. There is no specific EEG pattern found in these patients. Keywords: COVID-19, coronavirus, SAR-CoV-2, electroencephalogram, EEG

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Incidence of Electrographic Seizures in Patients With COVID-19

Frontiers in Neurology ◽

10.3389/fneur.2021.614719 ◽

2021 ◽

Vol 12 ◽

Author(s):

Brandon L. Waters ◽

Andrew J. Michalak ◽

Danielle Brigham ◽

Kiran T. Thakur ◽

Amelia Boehme ◽

...

Keyword(s):

Critical Illness ◽

Case Series ◽

Nasopharyngeal Swab ◽

Convulsive Status Epilepticus ◽

Retrospective Case ◽

Predictive Values ◽

Electrographic Seizure ◽

Epileptiform Discharges ◽

Interictal Epileptiform Discharges ◽

Electrographic Seizures

Critical illness and sepsis are commonly associated with subclinical seizures. COVID-19 frequently causes severe critical illness, but the incidence of electrographic seizures in patients with COVID-19 has been reported to be low. This retrospective case series assessed the incidence of and risks for electrographic seizures in patients hospitalized with COVID-19 who underwent continuous video electroencephalography monitoring (cvEEG) between March 1st, 2020 and June 30th, 2020. One hundred and twenty-two patients were initially identified who resulted SARS-CoV-2 nasopharyngeal RT-PCR swab positivity with any electroencephalography order placed in the EMR. Seventy-nine patients met study inclusion criteria: age ≥18 years, >1 h of cvEEG monitoring, and positive SARS-CoV-2 nasopharyngeal swab PCR. Six (8%) of the 79 patients suffered electrographic seizures (ES), three of whom suffered non-convulsive status epilepticus. Acute hyperkinetic movements were the most common reason for cvEEG in patients with ES (84%). None of the patients undergoing cvEEG for persistent coma (29% of all patients) had ES. Focal slowing (67 vs. 10%), sporadic interictal epileptiform discharges (EDs; 33 vs. 6%), and periodic/rhythmic EDs (67 vs. 1%) were proportionally more frequent among patients with electrographic seizures than those without these seizures. While 15% of patients without ES had generalized periodic discharges (GPDs) with triphasic morphology on EEG, none of the patients with ES had this pattern. Further study is required to assess the predictive values of these risk factors on electrographic seizure incidence and subsequent outcomes.

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P.013 Convulsive status epilepticus due to intracranial hypotension

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.115 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S19-S19

Author(s):

GS Gilmour ◽

J Scott ◽

P Couillard

Keyword(s):

Status Epilepticus ◽

Intracranial Hypotension ◽

Chronic Back Pain ◽

Case Reports ◽

Convulsive Status Epilepticus ◽

Scoliosis Surgery ◽

Cortical Vein ◽

Vein Thrombosis ◽

Epileptiform Discharges ◽

Cortical Vein Thrombosis

Background: Intracranial hypotension (IH) is typically characterized by an orthostatic headache. There have been limited case reports describing iatrogenic IH presenting with seizures. Methods: Case report. Results: A 71-year-old woman with chronic back pain developed convulsive status epilepticus (SE), characterized by generalized clonic seizures, immediately following scoliosis surgery. She had no history of seizures or seizure risk factors. Despite treatment with Midazolam, Phenytoin and Lacosamide, seizures recurred five times over three hours. Thus, Propofol and Midazolam infusions were initiated. An electroencephalogram revealed burst suppression and bilateral hemispheric epileptiform discharges. MRI brain was consistent with IH without cortical vein thrombosis. Fluid from the surgical drains was positive for Beta-2 transferrin, indicating cerebral spinal fluid. Her intracranial hypotension was likely due to an -intraoperative dural tear causing SE. Over two weeks, she remained on bedrest, sedation was weaned, and Phenytoin and Lacosamide were tapered and discontinued. She had no further seizures. Conclusions: IH is an under recognized cause of seizure following spinal or cranial surgery, lumbar puncture, or spinal anaesthesia. Proposed mechanisms include traction on cortical structures, increased cerebral blood flow and cortical irritation secondary to subdural hygromas.

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Advances in the management of generalized convulsive status epilepticus: what have we learned?

Brain ◽

10.1093/brain/awab049 ◽

2021 ◽

Author(s):

Aidan Neligan ◽

Sanjeev Rajakulendran ◽

Matthew C. Walker

Keyword(s):

Status Epilepticus ◽

Case Reports ◽

Meta Analysis ◽

Treatment Strategies ◽

Case Series ◽

Refractory Status Epilepticus ◽

Convulsive Status Epilepticus ◽

The Past ◽

Class A ◽

Adults And Children

Abstract Convulsive status epilepticus is the most serious manifestation of an epileptic diathesis. In the early stages (5–30 min), there exists class A evidence to support the efficacy of benzodiazepines as first-line treatment. As status epilepticus progresses into the later stages, the evidence for treatment becomes less robust until we are depending upon short case series and case reports for the treatment of refractory status epilepticus. However, the past year saw the publication of three randomized controlled trials in the setting of benzodiazepine-resistant established convulsive status epilepticus: the EcLiPSE and ConSEPT studies, compared levetiracetam to phenytoin in children; and the ESETT study compared fosphenytoin, levetiracetam and sodium valproate in adults and children. In addition, the emergence of data from the SENSE study, a multicentre multinational prospective cohort study and the publication of a systematic review and meta-analysis of the mortality of status epilepticus over the past 30 years, has brought the treatment of status epilepticus into sharp focus. In this update we provide a detailed analysis of these studies and their impact on clinical practice. We review contentious areas of management in status epilepticus where a consensus is lacking and advance the case for more research on existing and alternative treatment strategies.

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Management of Refractory Intracranial Hypotension Using Percutaneous Fibrin Sealant Patch – A Case Series and Review of the Literature

Pain Management Case Reports ◽

10.36076/pmcr.2018/3/13 ◽

2019 ◽

pp. 13-31

Author(s):

Kevin Wong

Keyword(s):

Literature Review ◽

Fibrin Sealant ◽

Intracranial Hypotension ◽

Case Reports ◽

Case Series ◽

Retrospective Case ◽

Percutaneous Injection ◽

Retrospective Case Series ◽

Blood Patch

Background: Intracranial hypotension (IH) among patients with persistent cerebrospinal fluid (CSF) leakage remains a challenging problem. The majority of these cases resolve spontaneously with conservative measures. The customary treatment for IH is epidural blood patch (EBP). In some cases, CSF leaks can persist for months or even years despite multiple trials of EBP. To date, there are only a limited number of published studies documenting the percutaneous injection of fibrin sealant for treatment of IH refractory to conservative measures and EBP. Objective: Our objective was to perform a literature review and retrospective case series regarding patients who underwent percutaneous injection of fibrin sealant for treatment of refractory IH at our institution. Study Design: This case series used a singlecentered retrospective observational study design and literature review. Setting: Patients in this case series were treated at a community-based tertiary care medical center. Methods: Five consecutive patients with the diagnosis of IH refractory to conservative measures and EBP who underwent percutaneous patching with fibrin sealant were identified at our institution between January 1, 2000 and January 1, 2016. A retrospective chart review was performed and data including demographics, characteristics, interventions, clinical outcomes, and complications were collected. A critical review of the current literature regarding the percutaneous use of fibrin sealant for treatment of IH was conducted. Results: Four of the 5 patients (80%) experienced no further symptoms of IH and no adverse events were noted. One patient (20%) ultimately required surgical duroplasty. Review of the current literature showed a total of 2 prospective case series, 4 retrospective case series, and 11 case reports. Our present case series and literature review demonstrated that fibrin sealants were well-tolerated by most patients and associated with low incidences of complications and recurrence. Limitations: This study is limited by the small retrospective case series of 5 patients. Conclusions: Percutaneous injection of fibrin sealant may be considered in refractory cases of IH when repeated trials of EBP have persistently failed. It appears to be a highly effective, safe, and easy-touse alternative therapy for patients with refractory IH in an ambulatory setting. Our review of the literature revealed only studies with low quality of evidence, including case series and case reports. There is a substantial need for high-quality studies and clinical evidence to corroborate the efficacy and safety of this percutaneous technique. However, this ideal is very challenging because of the relative rarity and heterogeneous etiologies of cases. Keywords: Fibrin sealant, intracranial hypotension, CSF leak, epidural blood patch, orthostatic headache, refractory, quality of life, percutaneous

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De novo convulsive status epilepticus in patients with multiple sclerosis treated with dalfampridine

Multiple Sclerosis Journal ◽

10.1177/1352458518790379 ◽

2018 ◽

Vol 25 (4) ◽

pp. 618-621 ◽

Cited By ~ 3

Author(s):

Emilie Panicucci ◽

Mikael Cohen ◽

Veronique Bourg ◽

Fanny Rocher ◽

Pierre Thomas ◽

...

Keyword(s):

Multiple Sclerosis ◽

Status Epilepticus ◽

De Novo ◽

Case Reports ◽

Brain Magnetic Resonance Imaging ◽

Convulsive Status Epilepticus ◽

Biological Tests ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

History Of Epilepsy

Background: Dalfampridine extended release (DAL) is a broad-spectrum voltage-gated potassium channel blocker that is indicated in multiple sclerosis to improve the nerve conduction of demyelinated axons. Seizures are a known side effect of DAL, which is contraindicated in patients with a history of epilepsy. Objective: Three cases of multiple sclerosis (MS) with de novo convulsive status epilepticus (CSE) probably related to dalfampridine administration are described. Methods: No patients had a history of seizures or renal impairment. Biological tests were normal. A brain magnetic resonance imaging (MRI) showed diffuse cortical and subcortical atrophy without active inflammatory lesions. Results: All three patients presented with CSE that was attributed to DAL and so was discontinued. Conclusion: These case reports illustrate that, aside from seizures, de novo CSE is a potential complication of MS patients treated with DAL.

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Probable Neuropsychological & Cognitive Complications due to Cytokine Storm in Patients With COVID-19

Basic and Clinical Neuroscience Journal ◽

10.32598/bcn.2022.3202.1 ◽

2021 ◽

Vol 0 (0) ◽

pp. 1-37

Author(s):

Zahra Keshtgar ◽

◽

GH. Reza Chalabianloo ◽

Niloofar Esmaeili ◽

◽

...

Keyword(s):

Nervous System ◽

Case Reports ◽

Case Series ◽

Executive Dysfunction ◽

Inflammatory Factors ◽

Cytokine Storm ◽

Case Control Studies ◽

Necrosis Factor Alpha ◽

Cross Sectional ◽

Tnf Α

Introduction: COVID-19 (coronavirus disease 2019) was identified in China in December 2019 for the first time and is rapidly spreading throughout the world as a pandemic. As COVID-19 causes mild to severe acute respiratory syndrome, most studies in this context have focused on pathogenesis primarily in the respiratory system. However, evidence shows that the central nervous system (CNS) may also be affected by COVID-19. Since COVID-19 is spreading, it is imperative to study its possible cognitive effects in patients suffering and recovering from COVID-19. Methods: The articles used in this study were searched by keywords such as Cytokine storm and covid-19, covid-19 and executive dysfunction, cognitive disorder and covid-19, CNS and covid 19, Coronavirus, Neuroinvasion in science direct, Scopus, PubMed, Embase, and Web of Science databases based on Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. The study will assess all observational studies published between December 2019 and April 2021 in peer-reviewed journals, including cross-sectional, cohort, case-control studies, case reports and case series. The search result was 106 articles, of which 73 articles related to Covid-19, the stages of infection by this virus, its effect on the nervous system and neurological symptoms, the cytokine storm caused by this infection, and the possible cognitive consequences caused by this virus in patients, has been reviewed. Other articles were not checked due to their limited relevance to the topic under discussion. Results: Studies show that neurons may be directly affected by SARS-CoV-1 and SARS-CoV-2. Furthermore, various studies indicate that systemic inflammation (so-called "cytokine storm") is also responsible for brain damage induced by infection with SARS-CoV-1 and SARS-CoV-2. Such a way that this patients showed elevated levels of interleukin (IL-), 6, 8, and 10 and of tumor necrosis factor-alpha (TNF- α) in their blood. Conclusion: Various cognitive defects following an increase level of cytokines such as TNF-α and IL-6,8 have been observed. Therefore, due to the increase level of these pro-inflammatory factors in the brains of these patients, cognitive deficits can be expected, which need further investigation.

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Immunosuppressive therapy of systemic lupus erythematosus associated peripheral neuropathy: A systematic review

Lupus ◽

10.1177/0961203320948181 ◽

2020 ◽

Vol 29 (12) ◽

pp. 1509-1519

Author(s):

Alexandru Constantin ◽

Daniela Năstase ◽

Delia Tulbă ◽

Paul Bălănescu ◽

Cristian Băicuș

Keyword(s):

Systemic Lupus Erythematosus ◽

Peripheral Neuropathy ◽

Lupus Erythematosus ◽

Case Reports ◽

Immunosuppressive Agents ◽

Case Series ◽

Systemic Lupus ◽

Retrospective Case ◽

Randomized Controlled ◽

Neuropsychiatric Manifestations

Introduction Peripheral neurologic manifestations may be associated with most of the collagen vascular diseases including systemic lupus erythematosus (SLE), yet most of the times it is not clear what therapy should be prescribed. EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations suggest the use of glucocorticoids and immunosuppressive agents for the treatment of SLE associated peripheral neuropathy (PN) (strength of statement A, category of evidence 1), however these recommendations are based on studies that did not focus specifically on PN but rather on neuropsychiatric manifestations of SLE out of which only one was a randomized controlled clinical trial that included 7 patients with peripheral neuropathy. The objective of this systematic review is to determine whether the pathogenic treatments (corticosteroids, immunosuppressive agents, intravenous immunoglobulins, plasmapheresis) are effective for SLE associated PN. Methods We searched MEDLINE for all the studies that included the pathogenic treatment of SLE associated PN. The purpose was to identify randomized clinical trials, and in the absence of these, we included observational studies and case reports or case series. Results The search returned only retrospective case reports or case series. Only one prospective study, a randomized controlled study, was focused on neuropsychiatric SLE and included few patients with PN (7). Some studies reported cases of PN responsive to glucocorticoids (GC), cyclophosphamide (CYC), rituximab (RTX), azathioprine (AZA), plasmapheresis (PPH), intravenous immunoglobulin (IVIG), mycophenolate mofetil (MMF) or different combinations of these immunosuppressive agents, whereas others noticed effectiveness of sequential treatments (i.e. administration of a therapeutic agent after another single agent or a combination of agents had previously failed). Many studies did not mention how the outcomes were objectively measured. Conclusions There are no interventional studies dedicated to the SLE associated PN, only retrospective case reports or case series which not only did they show contradictory results, but they also represent the lowest level of evidence. There is a strong need for new analytical studies dedicated to SLE associated PN. Protocol registered with PROSPERO (number CRD42019121748).

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Insights From Practice With Use of Direct Oral Anticoagulants in Transplantation

Progress in Transplantation ◽

10.1177/1526924818800056 ◽

2018 ◽

Vol 28 (4) ◽

pp. 380-385

Author(s):

Razan Alsheikh ◽

Osamah M. Alfayez ◽

Majed S. Al Yami

Keyword(s):

Case Reports ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Organ Transplant ◽

Case Series ◽

Solid Organ ◽

Special Population ◽

Retrospective Case ◽

Transplant Patients ◽

Attractive Option

Solid organ transplant patients are at risk of developing atrial fibrillation and venous thromboembolism. Direct oral anticoagulants are considered an attractive option for anticoagulation in patients due to their convenience; however, strong evidence of their use in transplantation is lacking. We conducted a search using Pubmed, Embase, and Scopus databases, in addition to International Society of Heart and Lung transplantation and American Transplant Congress abstracts (from 2012 through December 2017). Fourteen articles were reviewed that included case reports, retrospective case series, or chart review analyses of small cohorts. Based on this review, the findings can only generate hypotheses that should be further studied in a larger randomized cohort. This review can help clinicians gain insight into the use of direct oral anticoagulant in this special population. For now, clinicians should be cautious about their use in this special population.

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Applications of Office-Based 445 nm Blue Laser Transnasal Flexible Laser Surgery: A Case Series and Review of Practice

Ear Nose & Throat Journal ◽

10.1177/0145561320960544 ◽

2020 ◽

Vol 100 (1_suppl) ◽

pp. 105S-112S

Author(s):

Benjamin John Miller ◽

Amr Abdelhamid ◽

Yakubu Karagama

Keyword(s):

Laser Surgery ◽

Case Reports ◽

Case Series ◽

Primary Outcome Measure ◽

Blue Laser ◽

Current Evidence ◽

Future Research ◽

Retrospective Case ◽

Laryngeal Lesions ◽

Benign Laryngeal Lesions

Background: The recent introduction of 445 nm blue laser to office-based laryngology presents potential advantages. These include a desirable combination of cutting and photoangiolytic qualities and a lightweight, shock-resistant design. Despite its increasing use, current evidence is limited to experimental data and case reports. Objectives: The authors present a case series and overview of office blue laser transnasal flexible laser surgery (TNFLS), considering indications, patient selection, safety, technique, and surgical outcomes. We also review the safety and relevance of TNFLS to the ongoing coronavirus pandemic. Methods: Retrospective case series and narrative review. Our primary outcome measure was preoperative and postoperative Voice Handicap Index (VHI-10) score. Complications were documented by nature and severity. Results: Thirty-six cases of office blue laser TNFLS were performed. A statistically significant improvement in VHI-10 score was demonstrated in cases of recurrent respiratory papillomatosis (RRP) and benign laryngeal lesions causing dysphonia ( P < 0.01 and 0.045). Blue laser also proved effective in assisting office biopsy procedures. A minor and self-limiting complication was reported. Conclusions: Office blue laser TNFLS is safe and effective in the treatment of RRP and a range of benign laryngeal lesions. Future research should compare the efficacy and safety of blue laser with potassium titanyl phosphate laser in office-based treatment of these conditions. Further assessment of the cutting qualities of blue laser, initially in the theater environment, is necessary to refine our understanding of future applications.

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Cholinesterase Inhibitors and Memantine: Best Practices

CNS Spectrums ◽

10.1017/s1092852900027048 ◽

2008 ◽

Vol 13 (S16) ◽

pp. 34-35 ◽

Cited By ~ 6

Author(s):

Rachelle S. Doody

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Best Practices ◽

Cholinesterase Inhibitors ◽

Treatment Guidelines ◽

Case Reports ◽

Case Series ◽

Added Value ◽

Case Control Studies ◽

Number Of Patients

Today’s therapies must be put in the context of both currently available treatments as well as treatment trials with exciting potential for use in the near future. Current clinical trial methodologies do not allow for clear separation of symptomatic treatments from disease-modifying therapies; it may be unproductive to maintain this distinction given the current range of treatments available. A more currently relevant focus is added value. Therapies should aim to provide added value through incremental benefits above and beyond existing treatments, as well as enduring benefits.Alzheimer’s disease (AD) treatment guidelines are not used by physicians only. Healthcare payers often make use of these guidelines to delimit coverage. Cost concerns will also impact AD treatments after generic cholinesterase inhibitors are made available; it is widely believed that a great number of patients will switch to generics. Therefore, treatment guidelines must account for the possible adverse effects of switching therapies as well as the desirability of persistent treatment. There are many AD treatment guidelines, among them the American Academy of Neurology (AAN) Management of Dementia Guidelines, which are currently being revised. The Institute for the Study on Aging (ISOA) Management of Alzheimer’s Disease in Managed Care Guideline also presents a different approach for a different audience.The first step to creating evidence-based best practices guidelines is to determine what is meant by “evidence.” A system of classification exists for examining forms of evidence: Class I evidence is provided by one or more well-designed, randomized, controlled clinical trials, including overviews or meta-analyses of such trials. Class II evidence is provided by well-designed observational studies with concurrent controls; for example, case-control studies that generate hypotheses about epidemiologic associations. Class III evidence is provided by expert opinion, case series, case reports, and studies with historical controls.

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