Seizure and COVID-19: Association and review of potential mechanism

Highlights • Neurological Symptoms are being reported commonly in COVID-19 patients. • Mechanism of Seizure manifestation is still Unclear. • It is important to maintain control of epilepsy with AEDs in Patients with Epilepsy (PWE) infected with COVID-19 as mortality associated with epilepsy is higher in patients with uncontrollable seizures. • Consider possible interactions between epilepsy medications and the agents currently being used for symptomatic management in patients with COVID-19.
Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, this highly transmissible virus has since spread rapidly around the world. Though respiratory complication is the primarily reported manifestation though rare, yet serious neurological complications are being frequently reported in the literature. In selected coronavirus disease-2019 (COVID-19) cases neurologic complications may manifest as seizures. In this paper, we have reviewed current literature on seizures linked with SARS- COV 2 infection including published or pre-print original articles, review articles, and case reports. We have discussed the electroencephalogram (EEG), imaging, and Cerebrospinal fluid (CSF) findings in COVID-19 patients presenting with seizure. We will be concluding the paper by briefly discussing the three possible seizure development mechanisms in patients infected with SARS- COV 2, which includes - (a) Direct Mechanism (b) Indirect Mechanism and (c) Exacerbation of Seizure in Patients with Epilepsy (PWE). Our aim is to update the physicians working with COVID-19 patients about this potential complication and hope that understanding of these proposed mechanisms can provide an opportunity for the physicians for early diagnosis or even better, help prevent this complication.