by Juliette Dufour
For December 2022, we have selected: Incidence of Epilepsy and Seizures Over the First 6 Months After a COVID-19 Diagnosis: A Retrospective Cohort Study, Neurology, 2022. DOI: 10.1212/WNL.0000000000201595
People who contract COVID-19 show an increased risk of many neurological and psychiatric sequelae in the subsequent six months, with incidence highest in those admitted to an intensive care setting. Any severe infection can cause cortical hyperexcitability through metabolic disturbances. Acute symptomatic seizures and status epilepticus are, however, rare with COVID-19. Given the heterogeneous literature, it remains uncertain if COVID-19 infection predisposes patients to develop seizures or epilepsy. Most investigations of COVID 19 and seizures have focused on the acute setting while assessments of medium-term neurological outcomes have not included epilepsy or had low case numbers. Therefore, our authors of the month studied the potential association between COVID-19 and seizures or epilepsy in the six months after infection.
The authors conducted a retrospective study using an electronic health records network (TriNetXAnalytics) of 81 million people. They analyzed 860,934 electronic health records and matched each person with COVID-19 to those with influenza.
Our authors of the month found that COVID-19 was associated with an increased risk of seizures and epilepsy compared to influenza. The incidence of seizures within six months of COVID-19 was 0.81% (95% CI, 0.75-0.88; HR compared to influenza 1.55 (1.39-1.74)). The incidence of epilepsy was 0.30% (0.26-0.34; HR compared to influenza 1.87 (1.54-2.28)). The HR of epilepsy after COVID-19 compared to influenza was greater in people who had not been hospitalised and in individuals aged under 16 years.
The authors concluded that the incidence of new seizures or epilepsy diagnoses in the six months following COVID-19 was low overall, but higher than in matched patients with influenza. This difference was more marked in people who were not hospitalised, highlighting the risk of epilepsy and seizures even in those with less severe infection.