IMR Press / JIN / Volume 21 / Issue 4 / DOI: 10.31083/j.jin2104115
Open Access Review
SARS-CoV-2 infection and seizures: the perfect storm
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1 Department of Neurology, University of North Carolina, Chapel Hill, NC 27599-7025, USA
*Correspondence: (Clio Rubinos)
Academic Editor: Rafael Franco
J. Integr. Neurosci. 2022, 21(4), 115;
Submitted: 1 December 2021 | Revised: 17 January 2022 | Accepted: 18 January 2022 | Published: 20 June 2022
(This article belongs to the Special Issue COVID-19 and its neurological implications)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Seizures have been increasingly identified as a neurologic manifestation of coronavirus disease 2019 (COVID-19) infection. They may be symptomatic due to systemic infections, as a result of direct central nervous system (CNS) invasion, or occur in response to inflammatory reactions to the virus. It is possible that proinflammatory molecules released in response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to hyperexcitability and epileptogenesis, similar to infections caused by other neurotrophic viruses. Cerebral spinal fluid (CSF) in patients with COVID-19 and seizures is negative for SARS-CoV-2 (PCR) in the majority of patients, but has been found to be positive for proinflammatory molecules like IL-6, IL-8, and anti-neuronal autoantibodies. Electroencephalogram (EEG) in COVID-19 patients are nonspecific. However, in the encephalopathic and critically ill subpopulation, EEG is essential in detecting nonconvulsive seizures and status epilepticus which is associated with increased overall mortality in COVID-19 patients. Thus, as encephalopathy is often the only CNS symptom evidenced in patients with nonconvulsive seizures, more judicious use of continuous EEG in encephalopathic COVID-19 patients should be considered. This would facilitate earlier detection and treatment of seizures in this population, which would ultimately improve outcomes. Further research into the onset and potential for development of seizures and epilepsy in patients with COVID-19 is needed.

Status epilepticus
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