Can COVID-19 give rise to epilepsy?
COVID-19 affects the lungs first and foremost, but it can also affect other organs, including the brain. In cases of cerebral involvement, the effects seen most frequently are altered sense of taste and smell, headache and stroke. The risk of COVID-19 infection causing epilepsy or exacerbating pre-existing epilepsy is very low. Like other neurotropic viral infections, COVID-19 can cause epileptic seizures. The infection gives rise to a massive increase in proinflammatory cytokines. This cytokine storm can cause leakage through the blood-brain barrier, enabling the virus to penetrate the brain and bind to angiotensin-converting enzyme 2 (ACE2) receptors. These receptors are found on both neurons and various glial cells. The result is an increase in glutamate and aspartate concentration and reduced gamma aminobutyric acid (GABA) concentration. In addition, a number of ion channels are affected, which may cause increased excitability and hence epileptic seizures (1).
During the first phase of the pandemic, Chinese researchers conducted a retrospective multi-centre study in which 304 hospitalised COVID-19 patients were included, 108 of them with a severe disease course. No cases of new-onset epilepsy were recorded, including amongst persons with cerebral involvement (2).
A meta-analysis based on 39 studies and 68 362 COVID-19 patients showed that around 21 % had neurological symptoms. Most common were headache (4.6 %) and stroke (4.0 %). Epileptic seizures occurred in 0.7 % (3).
For many patients with epilepsy the lockdown of society, with a high threshold for visiting hospitals and less contact with health professionals, has been very negative
Several case reports have been published describing refractory status epilepticus as part of a COVID-19 infection. Two of them responded to intravenous immunoglobulin therapy and one was associated with anti-NMDA-receptor encephalitis (4–6). In some, the seizures and status epilepticus were linked to the infection itself, while in others they were a consequence of stroke, for instance.