A Review on Pathophysiology and Prognosis of Seizures in Covid-19

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) is a novel infectious disease. It has caused one of the most destructive pandemics in human history with symptoms ranging from mild to severe. In severe cases, patients can develop pneumonia, acute respiratory distress syndrome (ARDS), and multi-organ failure. Among the neurological manifestations, seizures have been most commonly reported. Different mechanisms have been proposed for the occurrence of seizures in COVID-19 patients. Hypoxia and severe metabolic and electrolyte derangements may theoretically lower seizure thresholds. Furthermore, cytokine storm and the involvement of ACE receptors are also being considered as possible etiologies for these seizures. We performed a detailed literature review and included 15 case reports of seizures in COVID patients. The majority of the patients had past conditions ranging from diabetes and hypertension to as severe as fahr syndrome, AF (Atrial Fibrillation), and MM (Multiple Myeloma). Most of the patients with fits had moderate to severe COVID-19. Most patients were treated with levetiracetam, a very effective anti-epileptic. For COVID-19 patients with seizures, a multidisciplinary approach should be considered to enhance the care of the patients. It is very important to do a long-term follow-up of these patients to fully understand if these patients tend to develop epilepsy.