EEG findings in acutely ill patients investigated for SARS-CoV-2/COVID-19: A small case series preliminary report
EEG findings in acutely ill patients investigated for SARS-CoV-2/COVID-19: A small case series preliminary report
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DOI：
10.1002/epi4.12399
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发表时间：
2020-06-01
期刊：
影响因子：
3
通讯作者：
Boro, Alexis
中科院分区：
文献类型：
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作者：
Galanopoulou, Aristea S.;Ferastraoaru, Victor;Boro, Alexis
目的COVID-19感染患者可能发生急性脑病。我们调查了在接受医学检查的 COVID-19 急性病患者 (PUI) 中进行的具有医学指征的脑电图是否报告癫痫样异常，以及这些异常在 COVID-19 阳性患者中是否比阴性患者更常见。方法在这个回顾性病例系列中，成人 COVID-19 住院患者 PUI 因急性脑病和/或癫痫样事件接受了脑电图检查。 PUI 具有 8 通道头带 EEG（Ceribell；20 例 COVID-19 阳性，6 例 COVID-19 阴性）；另外 2 名 COVID-19 患者进行了常规脑电图检查。总体而言，对 26 项 Ceribell 脑电图、4 项常规脑电图和 7 项连续脑电图研究进行了审查。脑电图由委员会认证的临床神经生理学家 (n = 16) 进行解释。脑电图结果与人口统计数据、临床表现和病史以及药物使用相关。使用 Fisher 精确检验。结果我们纳入了 28 名 COVID-19 PUI（30-83 岁），其中 22 名检测呈阳性（63.6% 男性），6 名检测呈阴性（33.3% 男性）。在 COVID-19 阳性和 COVID-19 阴性患者中，脑电图最常见的指征分别是新发脑病（68.2% vs 33.3%）和癫痫样事件（14/22, 63.6%; 2/6, 33.3%），甚至在没有癫痫病史的患者中也是如此（11/17, 64.7%; 2/6, 33.3%）。 40.9% 的 COVID-19 阳性患者和 16.7% 的 COVID-19 阴性患者存在散发性癫痫样放电 (ED)；据报道，8/9 (88.9%) 的患有 ED 的 COVID-19 阳性患者和 1/1 的患有 ED 的 COVID-19 阴性患者出现额尖波。没有捕获到电图癫痫发作，但 19/22 名 COVID-19 阳性和 6/6 名 COVID-19 阴性患者在脑电图检查前接受了抗癫痫药物和/或镇静剂。意义这是患有脑病或疑似临床癫痫发作的急性 COVID-19 阳性患者脑电图上出现 ED 的第一份初步报告。 ED 在这一群体中相对常见，通常表现为额部锐波。需要进一步的研究来证实这些发现，并评估 COVID-19 对激活癫痫活动的潜在直接或间接影响。
ObjectiveAcute encephalopathy may occur in COVID-19-infected patients. We investigated whether medically indicated EEGs performed in acutely ill patients under investigation (PUIs) for COVID-19 report epileptiform abnormalities and whether these are more prevalent in COVID-19 positive than negative patients.MethodsIn this retrospective case series, adult COVID-19 inpatient PUIs underwent EEGs for acute encephalopathy and/or seizure-like events. PUIs had 8-channel headband EEGs (Ceribell; 20 COVID-19 positive, 6 COVID-19 negative); 2 more COVID-19 patients had routine EEGs. Overall, 26 Ceribell EEGs, 4 routine and 7 continuous EEG studies were reviewed. EEGs were interpreted by board-certified clinical neurophysiologists (n = 16). EEG findings were correlated with demographic data, clinical presentation and history, and medication usage. Fisher's exact test was used.ResultsWe included 28 COVID-19 PUIs (30-83 years old), of whom 22 tested positive (63.6% males) and 6 tested negative (33.3% male). The most common indications for EEG, among COVID-19-positive vs COVID-19-negative patients, respectively, were new onset encephalopathy (68.2% vs 33.3%) and seizure-like events (14/22, 63.6%; 2/6, 33.3%), even among patients without prior history of seizures (11/17, 64.7%; 2/6, 33.3%). Sporadic epileptiform discharges (EDs) were present in 40.9% of COVID-19-positive and 16.7% of COVID-19-negative patients; frontal sharp waves were reported in 8/9 (88.9%) of COVID-19-positive patients with EDs and in 1/1 of COVID-19-negative patient with EDs. No electrographic seizures were captured, but 19/22 COVID-19-positive and 6/6 COVID-19-negative patients were given antiseizure medications and/or sedatives before the EEG.SignificanceThis is the first preliminary report of EDs in the EEG of acutely ill COVID-19-positive patients with encephalopathy or suspected clinical seizures. EDs are relatively common in this cohort and typically appear as frontal sharp waves. Further studies are needed to confirm these findings and evaluate the potential direct or indirect effects of COVID-19 on activating epileptic activity.