Meta-analysis of 175 patients with COVID-19 and seizures, status epilepticus, or cortical myoclonus: An individual patient data analysis

Authors

Aditi Kappagantu BS, Wayne State University School of MedicineFollow
Helena A. Brantz MS, Wayne State University School of MedicineFollow
Amman Bhasin BA, Wayne State University School of MedicineFollow
Cristina Jageka BS, Wayne State University School of MedicineFollow
Rooqash Ali MD, Wayne State UniversityFollow
Izzy Saef MD, Dept. of Neurology, Division of Neurointensive care and Cerebrovascular diseases, Brigham and Women’s Hospital, Boston, MAFollow
Brittany M. Stopa MPH, Virginia Tech Carilion School of Medicine, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women’s HospitalFollow
Ayaz Khawaja MD, Dept. of Neurology, Division of Neurointensive care and Cerebrovascular diseases, Wayne State UniversityFollow

Research Mentor Name

Ayaz Khawaja, MD

Research Mentor Email Address

akhawaja@wayne.edu

Institution / Department

Wayne State University/Department of Neurology

Document Type

Research Abstract

Research Type

clinicalresearch

Level of Research

no

Abstract

Objective

To characterize management and outcomes of seizures, status epilepticus, and cortical myoclonus in COVID-19, with individual patient data analysis of published literature.

Methods

Systematic literature review was conducted in accordance with PRISMA guidelines. Criteria included new-onset seizures, status epilepticus, and/or cortical myoclonus with concomitant COVID-19. COVID-19 severity was dichotomized into mild and severe cases. Good outcome was defined as discharge without severe deficits, and/or return to baseline.

Results

A total of 105 studies reporting 176 patients (male 56.3%;mean age 47.8,SD 25.6) were included. Status epilepticus occurred in 47 patients (26.7%) and myoclonus in 41 (23.3%). Severe COVID-19 occurred in 90 (53.6%) patients. Seizure-like activity on electroencephalography (EEG) was noted in 52/103 patients (50.5%). The most common underlying diagnosis was encephalitis in 47/91 patients (51.6%), followed by infarct (n=18; 19.8%) and intracranial hemorrhage (n=14;15.4%). The most common antiepileptic was levetiracetam (93/130; 71.5%). Pulse-dose steroids were used in 32 (19.3%) patients, whereas IVIg was used in 22 (13.4%). Overall, 101 patients (63.9%) had good outcomes while 24 (14.6%) died. In multi-variate regression, severe COVID-19 (OR=0.116), age (OR=0.980), and intubation (OR=0.303) were associated with worse outcomes. In a separate regression model, encephalitis was associated with good outcomes (OR=6.07), while severe COVID-19 predicted worse outcomes (OR=0.17).

Conclusion

Severe COVID-19 strongly determines outcomes, whereas status and myoclonus do not. Most patients responded to standard seizure treatments and achieved good outcomes. Aggressive seizure treatment and identification of etiology are strongly recommended to direct targeted treatments. Further research should focus on long-term seizure and neurocognitive outcomes.

Disciplines

Infectious Disease | Medical Neurobiology | Medicine and Health Sciences | Nervous System Diseases | Neurology | Neurosciences | Other Public Health

Recommended Citation

Kappagantu, Aditi BS; Brantz, Helena A. MS; Bhasin, Amman BA; Jageka, Cristina BS; Ali, Rooqash MD; Saef, Izzy MD; Stopa, Brittany M. MPH; and Khawaja, Ayaz MD, "Meta-analysis of 175 patients with COVID-19 and seizures, status epilepticus, or cortical myoclonus: An individual patient data analysis" (2022). Medical Student Research Symposium. 180.
https://digitalcommons.wayne.edu/som_srs/180