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Epileptiform activity and seizures in patients with COVID-19
  1. Fabiane Santos de Lima,
  2. Naoum Issa,
  3. Kaitlin Seibert,
  4. Jared Davis,
  5. Richard Wlodarski,
  6. Sara Klein,
  7. Faten El Ammar,
  8. Shasha Wu,
  9. Sandra Rose,
  10. Peter Warnke,
  11. James Tao
  1. Department of Neurology, University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr James Tao, Division of Biological Sciences, University of Chicago, Chicago, IL 60637-5418, USA; jtao{at}

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Acute symptomatic seizures have been reported in sporadic cases in patients with COVID-19.1 2 However, a recent large retrospective cohort study suggested that there was no increased risk of acute symptomatic seizures in these patients.3 As such, the association of seizures with COVID-19 has not been established. Admittedly, EEG studies have been significantly underused due to exposure concerns, and epileptiform activity has seldom been identified in this patient population. The aims of this study were to determine the prevalence of epileptiform activity and to assess the risk of seizures in patients with COVID-19.


We retrospectively reviewed consecutive patients with COVID-19 from 1 March to 27 May 2020 in a single institution. Patients were included if they were (1) ≥18 years of age, (2) positive for nasal swab SARS-CoV-2 RNA qualitative PCR test and (3) underwent EEG monitoring. Patients with a prior active diagnosis of epilepsy were excluded. Patient data regarding demographics, medical history, neuroimaging, laboratory tests, complications, mortality, metabolic profiles and treatment were extracted from electronic medical records. COVID-19 disease severity was categorised according to WHO guideline into (1) non-severe: absence of viral pneumonia or hypoxia, or clinical signs of pneumonia but SpO2 of >90% on room air; (2) severe: clinical pneumonia, respiratory rate of >30 and SpO2 of <90% on room air; (3) critical: sepsis with organ dysfunction or requiring mechanical ventilation.

EEG studies were performed using standard international 10–20 …

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  • Contributors FSdL, JT, NI and KS conceived the study, interpreted the data and wrote the manuscript. RW, JD, SK, FEA, SW and SR collected the data and reviewed the literature and the manuscript for intellectual context. PW critically reviewed the manuscript for intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.