EEG Patterns in Pediatric Patients with Multisystem Inflammatory Syndrome in Children or COVID-19 Co-infection

Background Children with recent or acute COVID-19 infections are susceptible to a number of neurological complications, including encephalopathy and seizures. Within the phenomenon of multisystem inflammatory syndrome in children (MIS-C), patients may be encephalopathic or have other nervous system sequelae. The EEG patterns accompanying neurologic complications of COVID-19 infection have been reported, but primarily in case reports or small case series. Methods In this study, we reviewed all reports of EEG patterns seen in pediatric patients with presentations attributed to COVID-19 infection. Results Fifty patient reports were identified, drawn from 27 articles. We separately analyzed patients whose primary neurologic concern was (1) encephalopathy, (2) seizures, or (3) other neurologic abnormalities. Patients with acute encephalopathy tend to have EEG showing diffusely slow background, often in the delta range; however, the pattern of slowing is sometimes anterior or posterior predominant and may evolve over the course of illness. Conclusions Patients with COVID-19 infection presenting with seizures with may have focal or bilateral semiologies, but post-ictal EEG rarely shows interictal epileptiform discharges, and is more likely to also show diffuse slowing. However, subclinical seizures and non-convulsive status epilepticus have been reported, so prolonged EEG monitoring may still be indicated.