EEG findings in COVID-19 positive patients: A case series

Objective: Limited information is available regarding EEG findings in hospitalized COVID-19 patients. Background: Neurological involvement with COVID-19 is now increasingly recognized and include encephalopathy, strokes, headache, etc., all of which can predispose to seizures. Design/Methods: EEGs were performed at Ochsner Medical Center over the time period of 3/13/2020 - 6/4/2020 on all patients with a positive COVID-19 test. Studies were reviewed independently by US board certified epileptologists and interpretations conformed to the ACNS (American Clinical Neurophysiology Society) terminology. Findings were summarized by type of abnormality, gender, age and mortality. Results: 102 patients (51 males, 51 females) were identified in age ranges of 32-50 (14), 50-69 (52) and 70-92 (36). Study duration was 30-40 minutes (25) and 12 hours or more (77). During EEG, anesthetic sedation was present in 15 and sedation absent or discontinued more than 24 hours prior recording in all others. Multiple co-morbidities (hypertension, diabetes, obesity) were present in 92 patients. Hypertension only in 8, and no co-morbidities in 2, including one female at 29 weeks gestation. 18 deaths occurred with 10 patients aged 70-77 years (5 males;5 females) and 8 patients aged 50-68 years (5 males;3 females) Most (76) studies showed moderate to severe (delta > theta) slowing;mild (theta) slowing was seen in 12 patients. Epileptic activity found in 11 patients included non-convulsive status epilepticus (NCSE) (5 patients), ictal-interictal continuum (1 patient) and non-sustained short epileptiform discharges (5 patients). Normal EEG was found in 3. Conclusions: Reports are emerging of the impact of COVID-19 on the brain. In our cohort, most patients had EEG findings consistent with moderate to severe cerebral dysfunction that may be seen with severe illnesses in the ICU. However, NCSE and other epileptiform patterns may also be seen on EEG.