Status epilepticus in covid-19: a systematic review of case reports and short case series

SESSION TITLE: Chest Infections Posters 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: There is a wide range of central nervous system manifestations related to Coronavirus disease 2019 (COVID-19), and in this systematic review, we aim to evaluate status epilepticus in COVID-19 patients in terms of etiology, diagnosis, and hospital course by studying the reported cases of status epilepticus in COVID-19 patients. METHODS: The authors conducted a systematic review of studies on COVID-19 patients with status epilepticus (SE) published in English from the start of the COVID-19 era till December 2020, with subsequent surveillance till August 2021. We searched PubMed, Cochrane Central, EBSCO, and Scopus and utilized the snowball technique to identify eligible studies. Two pairs of authors independently extracted relevant data from each included study, including demographics, medical history, diagnostic and laboratory findings, treatment, prognosis, and hospital stay. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports and series. The statistical analysis included various tests such as Kruskal-Wallis, Dwass-Steel-Critchlow-Fligner, chi-square/Fisher exact test, and multinomial logistic regression. These tests helped to assess differences in ages of patients, test differences in outcomes and categorical variables, and confirm the relationship between age and outcomes. The authors adjusted for potential confounders and performed subgroup analyses based on age, gender, and comorbidities to identify factors affecting prognosis. RESULTS: The study reviewed 400 articles and selected 34 studies (14 case reports, 12 case series, eight letters to the editor, and one editorial) that met their inclusion criteria, yielding a patient sample of 35 individuals. The patients’ mean age was 48.68 years, with 65.8% males and 34.3% females. The patients had either late-onset COVID-19-related status epilepticus (SE) or presented with SE at admission for other COVID-19-related reasons. Fever was the most common symptom reported in 15 patients, and hypotension and hypoxia were seen in two patients each. Diagnostic evaluation included CT scans, MRI, chest imaging, and laboratory tests, with all patients testing positive for COVID-19, except one pediatric patient. Brain CT scans and MRI revealed intracranial hemorrhage in nine patients, CVT in three, white matter disease in four, and vasogenic edema in three patients. EEG findings were reported for 26 patients, 19 of them were abnormal (73.1%). Generalized or focal slowing was the most common abnormality, seen in 13 patients (50%). Additionally, laboratory and CSF findings varied based on the patient's disease process. Age has correlated significantly with worse outcomes which were confirmed using a multinomial logistic regression test showing older patients had a higher probability of death as an outcome compared with being discharged (OR = 1.092, 95% CI, 1.004 – 1.190, P=0.039) CONCLUSIONS: Brain imaging with CT brain and MRI might be necessary to rule out life-threatening causes. EEG monitoring might be helpful. Additionally, older age showed to be significantly associated with worse outcomes in these patients. CLINICAL IMPLICATIONS: COVID-19 can lead to seizures and status epilepticus, and clinicians should consider the possibility of hemorrhage, CVT, and white matter disease in these patients. EEG monitoring and brain imaging should be considered in COVID-19 patients with seizures. DISCLOSURES: No relevant relationships by Rami Abd-Rabu No relevant relationships by Saeed Abughazaleh No relevant relationships by Ahmed Aljabali No relevant relationships by Lean Alkhatib No relevant relationships by Anas Alrwashdeh No relevant relationships by Saqr Alsakarneh No relevant relationships by Hamza Alzghoul No relevant relationships by Farah Bawa'neh No relevant relationships by Omar Obeidat