PMID- 33704826 OWN - NLM STAT- MEDLINE DCOM- 20210426 LR - 20240402 IS - 1531-8249 (Electronic) IS - 0364-5134 (Print) IS - 0364-5134 (Linking) VI - 89 IP - 5 DP - 2021 May TI - Electroencephalographic Abnormalities are Common in COVID-19 and are Associated with Outcomes. PG - 872-883 LID - 10.1002/ana.26060 [doi] AB - OBJECTIVE: The aim was to determine the prevalence and risk factors for electrographic seizures and other electroencephalographic (EEG) patterns in patients with Coronavirus disease 2019 (COVID-19) undergoing clinically indicated continuous electroencephalogram (cEEG) monitoring and to assess whether EEG findings are associated with outcomes. METHODS: We identified 197 patients with COVID-19 referred for cEEG at 9 participating centers. Medical records and EEG reports were reviewed retrospectively to determine the incidence of and clinical risk factors for seizures and other epileptiform patterns. Multivariate Cox proportional hazards analysis assessed the relationship between EEG patterns and clinical outcomes. RESULTS: Electrographic seizures were detected in 19 (9.6%) patients, including nonconvulsive status epilepticus (NCSE) in 11 (5.6%). Epileptiform abnormalities (either ictal or interictal) were present in 96 (48.7%). Preceding clinical seizures during hospitalization were associated with both electrographic seizures (36.4% in those with vs 8.1% in those without prior clinical seizures, odds ratio [OR] 6.51, p = 0.01) and NCSE (27.3% vs 4.3%, OR 8.34, p = 0.01). A pre-existing intracranial lesion on neuroimaging was associated with NCSE (14.3% vs 3.7%; OR 4.33, p = 0.02). In multivariate analysis of outcomes, electrographic seizures were an independent predictor of in-hospital mortality (hazard ratio [HR] 4.07 [1.44-11.51], p < 0.01). In competing risks analysis, hospital length of stay increased in the presence of NCSE (30 day proportion discharged with vs without NCSE: HR 0.21 [0.03-0.33] vs 0.43 [0.36-0.49]). INTERPRETATION: This multicenter retrospective cohort study demonstrates that seizures and other epileptiform abnormalities are common in patients with COVID-19 undergoing clinically indicated cEEG and are associated with adverse clinical outcomes. ANN NEUROL 2021;89:872-883. CI - (c) 2021 American Neurological Association. FAU - Lin, Lu AU - Lin L AUID- ORCID: 0000-0002-6724-8911 AD - Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Al-Faraj, Abrar AU - Al-Faraj A AD - Boston Medical Center, Department of Neurology, Boston, MA. FAU - Ayub, Neishay AU - Ayub N AD - Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Bravo, Pablo AU - Bravo P AD - Department of Neurology, Yale University, New Haven, CT. FAU - Das, Sudeshna AU - Das S AD - Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Ferlini, Lorenzo AU - Ferlini L AUID- ORCID: 0000-0002-6461-8796 AD - Hospital Erasme, Departement de Neurologie, Universite Libre de Bruxelles, Bruxelles, Belgium. FAU - Karakis, Ioannis AU - Karakis I AD - Department of Neurology, Emory University, Atlanta, GA. FAU - Lee, Jong Woo AU - Lee JW AUID- ORCID: 0000-0001-5283-7476 AD - Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, , MA. FAU - Mukerji, Shibani S AU - Mukerji SS AUID- ORCID: 0000-0002-5677-6954 AD - Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Newey, Christopher R AU - Newey CR AD - Department of Neurology, Cleveland Clinic, Cleveland, OH. FAU - Pathmanathan, Jay AU - Pathmanathan J AD - Department of Neurology, University of Pennsylvania, Philadelphia, PA. FAU - Abdennadher, Myriam AU - Abdennadher M AD - Boston Medical Center, Department of Neurology, Boston, MA. FAU - Casassa, Charles AU - Casassa C AD - Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Gaspard, Nicolas AU - Gaspard N AD - Department of Neurology, Yale University, New Haven, CT. AD - Hospital Erasme, Departement de Neurologie, Universite Libre de Bruxelles, Bruxelles, Belgium. FAU - Goldenholz, Daniel M AU - Goldenholz DM AUID- ORCID: 0000-0002-8370-2758 AD - Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Gilmore, Emily J AU - Gilmore EJ AD - Department of Neurology, Yale University, New Haven, CT. FAU - Jing, Jin AU - Jing J AD - Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Kim, Jennifer A AU - Kim JA AD - Department of Neurology, Yale University, New Haven, CT. FAU - Kimchi, Eyal Y AU - Kimchi EY AD - Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Ladha, Harshad S AU - Ladha HS AD - Department of Neurology, Emory University, Atlanta, GA. FAU - Tobochnik, Steven AU - Tobochnik S AUID- ORCID: 0000-0001-9071-8398 AD - Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, , MA. FAU - Zafar, Sahar AU - Zafar S AUID- ORCID: 0000-0001-5252-5376 AD - Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Hirsch, Lawrence J AU - Hirsch LJ AD - Department of Neurology, Yale University, New Haven, CT. FAU - Westover, M Brandon AU - Westover MB AUID- ORCID: 0000-0003-4803-312X AD - Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA. FAU - Shafi, Mouhsin M AU - Shafi MM AUID- ORCID: 0000-0002-4531-1967 AD - Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA. LA - eng GR - R01 NS102190/NS/NINDS NIH HHS/United States GR - KL2 TR002542/TR/NCATS NIH HHS/United States GR - UL1 TR001863/TR/NCATS NIH HHS/United States GR - P01 AG031720-06A1/NH/NIH HHS/United States GR - 1R01NS107291/NH/NIH HHS/United States GR - K23 MH115812/MH/NIMH NIH HHS/United States GR - R01 MH115949/MH/NIMH NIH HHS/United States GR - R01 AG060987/AG/NIA NIH HHS/United States GR - K08 MH116135/NH/NIH HHS/United States GR - RF1 AG064312/AG/NIA NIH HHS/United States GR - P01 AG031720/AG/NIA NIH HHS/United States GR - Gerontology Grant/ GR - Glenn Foundation for Medical Research/ GR - Football Players Health Study (FPHS)/ GR - K23 MH115812/NH/NIH HHS/United States GR - R01 AG060987/NH/NIH HHS/United States GR - R01 MH115949/NH/NIH HHS/United States GR - M.M.S./NH/NIH HHS/United States GR - K08 MH116135/MH/NIMH NIH HHS/United States GR - AASM Foundation Strategic Research Award/ GR - 1R01NS102574/NH/NIH HHS/United States GR - R01 NS102574/NS/NINDS NIH HHS/United States GR - 1R01NS102190/NH/NIH HHS/United States GR - 1RF1AG064312/NH/NIH HHS/United States GR - R01 NS107291/NS/NINDS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20210324 PL - United States TA - Ann Neurol JT - Annals of neurology JID - 7707449 SB - IM MH - Aged MH - COVID-19/diagnosis/*epidemiology/*physiopathology MH - Electroencephalography/*trends MH - Female MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Risk Factors MH - Seizures/diagnosis/*epidemiology/*physiopathology MH - Treatment Outcome PMC - PMC8104061 MID - NIHMS1696464 COIS- Nothing to report. EDAT- 2021/03/12 06:00 MHDA- 2021/04/27 06:00 PMCR- 2021/06/16 CRDT- 2021/03/11 13:01 PHST- 2021/03/08 00:00 [revised] PHST- 2020/07/30 00:00 [received] PHST- 2021/03/08 00:00 [accepted] PHST- 2021/03/12 06:00 [pubmed] PHST- 2021/04/27 06:00 [medline] PHST- 2021/03/11 13:01 [entrez] PHST- 2021/06/16 00:00 [pmc-release] AID - ANA26060 [pii] AID - 10.1002/ana.26060 [doi] PST - ppublish SO - Ann Neurol. 2021 May;89(5):872-883. doi: 10.1002/ana.26060. Epub 2021 Mar 24.