Seizures may indicate COVID-19 infection, study finds

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The novel coronavirus (COVID-19) could trigger seizures, according to a new study published in the journal Seizure.

The study describes the first patient to develop a focal status epilepticus as a presenting symptom of COVID-19. The patient was a 78-year-old woman who had a previous episode of herpes encephalitis with seizures that had been well managed for two years. She was admitted for ongoing myoclonic jerks of the right face and right limbs, treated with intravenous valproic acid, followed by intravenous midazolam for the persistence of subintrant focal seizures. Twelve hours later, the patient developed a fever and tested positive for SARS-CoV-2, the virus that causes COVID-19 infection.

COVID-19 is of critical concern in the medical community not only for its fast spread, but its variability of presentation. Since some patients with COVID-19 do not show fever or radiologic abnormalities on initial clinical picture, the diagnosis of the infection is challenging.

This patient developed a focal status epilepticus as the initial presentation of COVID-19 in the context of a predisposing but well-controlled post-encephalitic epilepsy. Further, the patient did not develop pneumonia or require oxygen therapy. Though there are limitations, the authors said it is possible to hypothesize that SARS-CoV-2 could trigger seizures through a neurotropic pathogenic mechanism.

Even in the absence of fever or respiratory symptoms, the recurrence or worsening of paroxysmal neurological events should raise the diagnostic hypothesis of COVID-19 infection, the authors said. Further data is needed to understand and assess the real burden of neurological symptoms in COVID-19 and how those contribute to morbidity and mortality, especially in time-dependent pathologies.

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