Incidence of Electrographic Seizures in Patients With COVID-19

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.

Download Full-text

EEG Abnormalities and Their Radiographic Correlates in a COVID-19 Inpatient Cohort

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001136 ◽

2021 ◽

pp. 10.1212/CPJ.0000000000001136

Author(s):

Sean T. Hwang ◽

Ahmad A. Ballout ◽

Anup N. Sonti ◽

Amitha Kapyur ◽

Claudia Kirsch ◽

...

Keyword(s):

Hospital Mortality ◽

Case Series ◽

Medication Administration ◽

Retrospective Case ◽

Ventilator Support ◽

Periodic Discharges ◽

Epileptiform Discharges ◽

Abnormal Movements ◽

Eeg Abnormalities ◽

Electrographic Seizures

ABSTRACT:Objective:To identify the prevalence of EEG abnormalities in patients with COVID-19 with neurologic changes, their associated neuroimaging abnormalities and rates of mortality.Methods:A retrospective case series of 192 adult COVID-19 positive inpatients with EEG performed between March and June 2020 at 4 hospitals: 161 undergoing continuous, 24 routine, and 7 reduced- montage EEG. Study indication, epilepsy history, intubation status, administration of sedatives or antiseizure medications, metabolic abnormalities, neuroimaging pathology associated with epileptiform abnormalities, and in-hospital mortality were analyzed.Results:EEG indications included encephalopathy (54.7%), seizure (18.2%), coma (17.2%), focal deficit (5.2%), and abnormal movements (4.6%). Epileptiform abnormalities occurred in 39.6% of patients: focal intermittent epileptiform discharges in 25.0%, lateralized periodic discharges in 6.3%, and generalized periodic discharges in 19.3%. Seizures were recorded in 8 patients, 3 with status epilepticus. Antiseizure medication administration, epilepsy history, and older age were associated with epileptiform abnormalities. Only 26.3% of patients with any epileptiform abnormality, 37.5% with electrographic seizures, and 25.7% patients with clinical seizures had known epilepsy. Background findings included generalized slowing (88.5%), focal slowing (15.6%), burst suppression (3.6%), attenuation (3.1%), and normal EEG (3.1%). Neuroimaging pathology was identified in 67.1% of patients with epileptiform abnormalities, over two-thirds acute. In-hospital mortality was 39.5% for patients with epileptiform abnormalities, 36.2% for those without. Risk factors for mortality were coma and ventilator support at time of EEG.Significance:This article highlights the range of EEG abnormalities frequently associated with acute neuroimaging abnormalities in COVID-19. Mortality rates were high, particularly for patients in coma requiring mechanical ventilation. These findings may guide the prognosis and management of patients with COVID-19 and neurologic changes.

Download Full-text

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

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v8i35.741 ◽

2020 ◽

Vol 8 (35) ◽

pp. 36-41

Author(s):

Jie Pan ◽

Shazma Khan ◽

Smathorn Thakolwiboon ◽

Dargelis Chi

Keyword(s):

Status Epilepticus ◽

Case Reports ◽

Neurological Complication ◽

Case Series ◽

Convulsive Status Epilepticus ◽

Acute Encephalopathy ◽

Case Control Studies ◽

Retrospective Case ◽

Epileptiform Discharges ◽

Slow Activity

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

Download Full-text

Tocilizumab in the treatment of rapidly evolving COVID-19 pneumonia and multifaceted critical illness: A retrospective case series

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2020.10.061 ◽

2020 ◽

Vol 60 ◽

pp. 417-424 ◽

Cited By ~ 1

Author(s):

Ahmed Mady ◽

Waleed Aletreby ◽

Basheer Abdulrahman ◽

Mohammed Lhmdi ◽

Alfateh M. Noor ◽

...

Keyword(s):

Critical Illness ◽

Case Series ◽

Retrospective Case ◽

Retrospective Case Series

Download Full-text

Utility of Intraoperative Frozen Sections during Thyroid Surgery

International Journal of Otolaryngology ◽

10.1155/2013/496138 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 19

Author(s):

Russel Kahmke ◽

Walter T. Lee ◽

Liana Puscas ◽

Richard L. Scher ◽

Michael J. Shealy ◽

...

Keyword(s):

Predictive Value ◽

Frozen Section ◽

Case Series ◽

Follicular Neoplasm ◽

Frozen Sections ◽

Fine Needle Aspirate ◽

Retrospective Case ◽

Predictive Values ◽

Fine Needle ◽

Intraoperative Frozen Section

Objective. To describe the usefulness of intraoperative frozen section in the diagnosis and treatment of thyroid nodules where fine needle aspirate biopsies have evidence of follicular neoplasm.Study Design. Retrospective case series.Methods. All patients have a fine needle aspirate biopsy, an intraoperative frozen section, and final pathology performed on a thyroid nodule after initiation of the Bethesda System for Reporting Thyroid Cytopathology in 2009 at a single tertiary referral center. Sensitivity, specificity, positive predictive value, and negative predictive value are calculated in order to determine added benefit of frozen section to original fine needle aspirate data.Results. The sensitivity and specificity of the frozen section were 76.9% and 67.9%, respectively, while for the fine needle aspirate were 53.8% and 74.1%, respectively. The positive and negative predictive values for the fine needle aspirates were 25% and 90.9%, respectively, while for the frozen sections were 27.8% and 94.8%, respectively. There were no changes in the operative course as a consequence of the frozen sections.Conclusion. Our data does not support the clinical usefulness of intraoperative frozen section when the fine needle aspirate yields a Bethesda Criteria diagnosis of follicular neoplasm, suspicious for follicular neoplasm, or suspicious for malignancy at our institution.

Download Full-text

Progression, recovery and fatality in patients with SARS-CoV-2 related pneumonia in Wuhan, China: a single-centered, retrospective, observational study

10.1101/2020.05.12.20099739 ◽

2020 ◽

Author(s):

Hua Wang ◽

Yirong Lu ◽

Qingquan Lv ◽

Xiping Wu ◽

Tian Hu ◽

...

Keyword(s):

Critical Illness ◽

False Negative ◽

Case Series ◽

Case Fatality ◽

Detection Methods ◽

Close Monitoring ◽

Diagnostic Efficiency ◽

Rt Pcr ◽

Retrospective Case ◽

Increased Risk

Objectives To determine the case fatality rates and death risk factors. Design Retrospective case series. Setting A COVID-19 ward of a secondary Hospital in Wuhan, China. Participants Consecutively hospitalized COVID-19 patients between Jan 3, 2020 and Feb 27, 2020. Outcomes were followed up to discharge or death. Results Of 121 patients included, 66 (54.6%) were males. The median age was 59 (IQR: 46 to 67) years, and hypertension (33 patients; 27.3%) the leading comorbidity. Lymphopenia (83 of 115 patients; 72.2%) frequently occurred and then normalized on day 4 (IQR: 3 to 6) after admission in the survivors, with lung lesion absorbed gradually on day 8 (IQR: 6 to10) after onset (33 of 57 patients; 57.9%). The real-time polymerase chain reaction (RT-PCR) assays for SARS-CoV-2 were positive in 78 (78/108; 72.2%) patients, and a false-negative RT-PCR occurred in 15 (13.9%) patients. Hypoxemia occurred in 94 (94/117; 80.3%) patients, and supplemental oxygen was given in 88 (72.7%) patients, and mon-invasive or invasive ventilation in 20 (16.5%) cases. Corticosteroid use might link to death. The case fatality rates were 4.4% (one of 23 patients), 29.3% (12/41), 22.8% (13/57) or 45% (9/20) for patients with moderate, severe, critical illness or on ventilator. The length of hospital stay was 14 (IQR: 10 to 20) days, and selfcare ability worsened in 21 patients (21/66; 31.8%) cases. Patients over 60 years were most likely to have poorer outcomes, and increasing in age by one-year increased risk for death by 18% (CI: 1.04-1.32). Conclusions In management of patients with SARS-CoV-2 pneumonia, especially the elderly with hypertension, close monitoring and appropriate supportive treatment should be taken earlier and aggressively to prevent from developing severe or critical illness. Corticosteroid use might link to death. Repeated RT-PCR tests or novel detection methods for SARS-CoV-2 should be adopted to improve diagnostic efficiency.

Download Full-text

Use of electrographic seizures and interictal epileptiform discharges for improving performance in seizure prediction

2015 IEEE Recent Advances in Intelligent Computational Systems (RAICS) ◽

10.1109/raics.2015.7488419 ◽

2015 ◽

Cited By ~ 3

Author(s):

C Sudalaimani ◽

S A Asha ◽

K Parvathy ◽

T Elizabeth Thomas ◽

P Devanand ◽

...

Keyword(s):

Seizure Prediction ◽

Epileptiform Discharges ◽

Interictal Epileptiform Discharges ◽

Electrographic Seizures

Download Full-text

Prospective evaluation of interrater agreement between EEG technologists and neurophysiologists

Scientific Reports ◽

10.1038/s41598-021-92827-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Isabelle Beuchat ◽

Senubia Alloussi ◽

Philipp S. Reif ◽

Nora Sterlepper ◽

Felix Rosenow ◽

...

Keyword(s):

Interrater Agreement ◽

Prospective Evaluation ◽

False Negatives ◽

Predictive Values ◽

Epileptiform Discharges ◽

Interictal Epileptiform Discharges ◽

Eeg Recordings ◽

Taking Action ◽

Electroencephalogram Eeg ◽

Eeg Pattern

AbstractWe aim to prospectively investigate, in a large and heterogeneous population, the electroencephalogram (EEG)-reading performances of EEG technologists. A total of 8 EEG technologists and 5 certified neurophysiologists independently analyzed 20-min EEG recordings. Interrater agreement (IRA) for predefined EEG pattern identification between EEG technologists and neurophysiologits was assessed using percentage of agreement (PA) and Gwet-AC1. Among 1528 EEG recordings, the PA [95% confidence interval] and interrater agreement (IRA, AC1) values were as follows: status epilepticus (SE) and seizures, 97% [96–98%], AC1 kappa = 0.97; interictal epileptiform discharges, 78% [76–80%], AC1 = 0.63; and conclusion dichotomized as “normal” versus “pathological”, 83.6% [82–86%], AC1 = 0.71. EEG technologists identified SE and seizures with 99% [98–99%] negative predictive value, whereas the positive predictive values (PPVs) were 48% [34–62%] and 35% [20–53%], respectively. The PPV for normal EEGs was 72% [68–76%]. SE and seizure detection were impaired in poorly cooperating patients (SE and seizures; p < 0.001), intubated and older patients (SE; p < 0.001), and confirmed epilepsy patients (seizures; p = 0.004). EEG technologists identified ictal features with few false negatives but high false positives, and identified normal EEGs with good PPV. The absence of ictal features reported by EEG technologists can be reassuring; however, EEG traces should be reviewed by neurophysiologists before taking action.

Download Full-text

Interictal Epileptiform Discharge Dynamics in Peri-sylvian Polymicrogyria Using EEG-fMRI

Frontiers in Neurology ◽

10.3389/fneur.2021.658239 ◽

2021 ◽

Vol 12 ◽

Author(s):

Noa Cohen ◽

Yoram Ebrahimi ◽

Mordekhay Medvedovsky ◽

Guy Gurevitch ◽

Orna Aizenstein ◽

...

Keyword(s):

Case Series ◽

Epileptic Seizures ◽

Epileptic Activity ◽

Scalp Eeg ◽

Epileptiform Discharges ◽

Interictal Epileptiform Discharges ◽

Malformation Of Cortical Development ◽

Interictal Epileptiform Discharge ◽

Drug Resistant Epilepsy ◽

Patients With Epilepsy

Polymicrogyria (PMG) is a common malformation of cortical development associated with a higher susceptibility to epileptic seizures. Seizures secondary to PMG are characterized by difficult-to-localize cerebral sources due to the complex and widespread lesion structure. Tracing the dynamics of interictal epileptiform discharges (IEDs) in patients with epilepsy has been shown to reveal the location of epileptic activity sources, crucial for successful treatment in cases of focal drug-resistant epilepsy. In this case series IED dynamics were evaluated with simultaneous EEG-fMRI recordings in four patients with unilateral peri-sylvian polymicrogyria (PSPMG) by tracking BOLD activations over time: before, during and following IED appearance on scalp EEG. In all cases, focal BOLD activations within the lesion itself preceded the activity associated with the time of IED appearance on EEG, which showed stronger and more widespread activations. We therefore propose that early hemodynamic activity corresponding to IEDs may hold important localizing information potentially leading to the cerebral sources of epileptic activity. IEDs are suggested to develop within a small area in the PSPMG lesion with structural properties obscuring the appearance of their electric field on the scalp and only later engage widespread structures which allow the production of large currents which are recognized as IEDs on EEG.

Download Full-text

Alfentanil Mediated Activation of Epileptiform Activity in the Electrocorticogram During Resection of Epileptogenic Foci

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

10.1017/s0317167100021065 ◽

1997 ◽

Vol 24 (1) ◽

pp. 29-36 ◽

Cited By ~ 1

Author(s):

Keene Daniel L. ◽

David Roberts ◽

Splinter William M. ◽

Michael Higgin ◽

Enrique Ventureyra

Keyword(s):

Epileptiform Activity ◽

Epileptic Seizures ◽

Surgical Excision ◽

Electrographic Seizure ◽

Epileptiform Discharges ◽

Before And After ◽

Electrographic Seizures ◽

Balanced Anaesthesia ◽

Epileptogenic Foci ◽

Significant Activation

ABSTRACT:Purpose:Alfentanil is a potent, short-acting opioid agent which has been used during balanced anaesthesia in children undergoing the surgical excision of epileptic foci. After the observation that this agent had the potential to induce epileptic seizures, we questioned the frequency of this occurrence in this group of patients.Method:Twelve patients (6 males, 6 females) undergoing surgical excision of an epileptic foci were prospectively followed. For each patient an electrocorticogram was recorded for 30 minutes before and after receiving alfentanil 20 pg/kg intravenously. The frequency of epileptiform abnormalities before and after drug administration was evaluated. When the electrocorticogram no longer showed the effects of alfentanil administration, methohexital 0.5 ug/kg was given intravenously.Results:Alfentanil induced significant activation of epileptiform discharges among 83% of these patients. Twenty-five per cent had an electrographic seizure. In comparison, methohexital induced significant activation of epileptiform discharges in 50% of these patients. None experienced electrographic seizures.Conclusions:As alfentanil can induce electrographic seizures in patients known to have epilepsy, caution is advised in its use in this group of patients.

Download Full-text