Characteristics of epileptic seizures in COVID-19 patients during the first year of the pandemic: a systematic review

In March 2020, the World Health Organization declared COVID-19 a pandemic. Epileptic seizures were described in different cohorts as being associated both with the acute phase and with long COVID-19. The objective of this review was to identify the incidence and characteristics of seizures in patients infected with SARS-CoV-2 in cohort studies published between December 2019 and December 2020. According to the PRISMA statement, a search in nine databases was conducted. One hundred and twenty-two articles were included in the final analysis. Of 9,285 patients, 328 (3.53%) adults and 22 (0.24%) pediatric patients had seizures during and/or after COVID-19. Of these, 71/328 (21.65%) adults and 5/22 (22.73%) pediatric patients had been diagnosed with epilepsy or had had an episode of seizure before infection. Among the classified seizures in adults, 14.33% (n = 47) were myoclonic, 14.02% (n = 46) generalized tonic-clonic seizures (GTCS) and 10.67% (n = 35) focal motor seizures. Of the pediatric patients, 10 (45.45%) had GTCS and 6 (27.27%) had status epilepticus with predominant motor symptoms. In 98.48% of the adults and in all 22 pediatric patients, the seizure occurred during the acute phase. The incidence of seizures was 3.6% in adults and 13.58% in pediatric patients. In adults, de novo seizures were approximately 3.1 times more incident than recrudescences; in pediatric patients, seizures in those without prior history were exactly three times more incident. Among the classified seizures, the most common was myoclonic in adults and GTCS in pediatric patients.