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Abstract Objective Acute 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. Methods In 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. Results We 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. Significance This 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.

Abstract This review aims to highlight the historical hallmarks in the development of the concepts of seizures and epilepsy. It begins with a discussion of seizure semiology and terminology, followed by the pathophysiology of seizures. We then discuss the definition of epilepsy, its etiologies, and ultimately classification schemes. Each section starts with our current views and subsequently transports the reader back in time to understand how these views evolved and came to be what they are today. People living as early as in the prehistoric times may have been aware of the existence of seizures, and descriptions and terminology have been provided as early as 2500 BC. While names have been revised and updated through time, the meanings are seemingly unchanged. However, it is clearly evident that we have come a long way in understanding the pathophysiology and etiology of seizures and epilepsy, thus leading to our current classification schemes. No classification scheme will be perfect yet, until our understanding is advanced enough to create one based predominantly on scientific grounds. The goal is that it is relevant to clinical practice, leading to a more precise diagnosis to guide targeted treatments.