September 21, 2020

COVID-19 and Seizures: Is There a Link?

Abstract, published in Epilepsia

The rapid spread of the COVID-19 pandemic poses unique challenges to the management of people with chronic diseases. Reports of the possible ability of the of SARS-CoV-2 to infect the brain and indirect consequences in severe COVID-19 cases raise the question of whether the infection can be associated with an increased risk of seizure recurrence or the development of new onset and acute symptomatic seizures.

Although the literature does not provide relevant evidence for seizure worsening in persons with epilepsy during a SARS-CoV-2 infection, there are theoretical risks, for example, seizures triggered by fever. Moreover, a severe disease course and advanced disease stages can, for instance, result in cerebrovascular events, brain dysfunction resulting from insufficient oxygen reaching the brain, and overreaction of the body’s immune system, all of which may trigger the development of acute seizures. These theoretical risks are supported  by reports of occasional seizures in COVID-19 patients.

Although the low number of reports so far suggests that the risk may be relatively low, the reports indicate that an early neurological manifestation with seizures should not be ruled out. In the context of these cases, we discuss possible pathophysiological mechanisms that may trigger seizures in patients with SARS-CoV-2 infection.

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