COVID-19–associated seizures may be common, linked to higher risk of death

BOSTON – COVID-19 can have damaging effects on multiple organs in the body, including the brain. A new study led by investigators at Massachusetts General Hospital and Beth Israel Deaconess Medical Center (BIDMC) indicates that some hospitalized patients with COVID-19 experience nonconvulsive seizures, which may put them at a higher risk of dying. The findings are published in the Annals of Neurology.

“Seizures are a very common complication of severe critical illness. Most of these seizures are not obvious: Unlike seizures that make a person fall down and shake, or convulse, seizures in critically ill patients are usually nonconvulsive,” explains co–senior author M. Brandon Westover, MD, PhD, an investigator in the Department of Neurology at Mass General and director of Data Science at the Mass General McCance Center for Brain Health. “There is increasing evidence that non-convulsive seizures can damage the brain and make outcomes worse, similar to convulsions.”

Westover notes that there have been only a few small reports of seizures in patients with severe COVID-19 illness, and it was previously unclear whether such seizures primarily occur in patients who already have a seizure disorder or whether they can arise for the first time because of COVID-19. The effects of such seizures on patients’ health was also unknown.

To provide insights, Westover and his colleagues analyzed medical information for 197 hospitalized patients with COVID-19 who underwent electroencephalogram (EEG) monitoring—tests that detect electrical activity of the brain using small metal discs attached to the scalp—for various reasons at nine institutions in North America and Europe.

The EEG tests detected nonconvulsive seizures in 9.6% of patients, some of whom had no prior neurological problems. Patients who had seizures needed to be hospitalized for a longer time, and they were four times more likely to die while in the hospital than patients without seizures—suggesting that neurological complications may be an important contributor to the morbidity and mortality associated with COVID-19.

“We found that seizures indeed can happen in patients with COVID-19 critical illness, even those without any prior neurologic history, and that they are associated with worse outcomes: higher rates of death and longer hospital stay, even after adjusting for other factors,” says co-senior author Mouhsin Shafi, MD, PhD, an investigator in the Department of Neurology at BIDMC, medical director of the BIDMC EEG laboratory, and director of the Berenson-Allen Center for Noninvasive Brain Stimulation. “Our results suggest that patients with COVID-19 should be monitored closely for nonconvulsive seizures. Treatments are available and warranted in patients at high risk; however, further research is needed to clarify how aggressively to treat seizures in COVID-19.”

Westover is an associate professor of Neurology at Harvard Medical School (HMS) and Shafi is an assistant professor of Neurology at HMS.

This work was supported by the National Institutes of Health, the Football Players Health Study at Harvard University, the Glenn Foundation for Medical Research and the American Federation for Aging Research, the American Academy of Sleep Medicine, the Department of Defense, and the Eleanor and Miles Shore Fellowship.

About the Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2020, Mass General was named #6 in the U.S. News & World Report list of "America’s Best Hospitals."