Seizures As The Main Manifestation of Acute COVID-19 in Pediatrics

A systematic retrospective study was performed on 175 children of age 0 to 18 years who were presented to the emergency department and diagnosed with acute SARS-CoV-2 infection. Prior neurological disorder was reported in 12% of the patients. It was observed that 6% of the patients were presented with seizures. Nine patients presented with generalized tonic-clonic seizures. One patient with prior history of uncontrolled epilepsy with multiple seizure types had a focal tonic seizure. A 5-month-old patient presented with bilateral asymmetrical tonic-clonic seizure.

Fever was recorded only in 54% of the patients with seizures. It was noted that the patients had seizures as the presenting sign of infection and none had severe COVID-19. Furthermore, five children presented with convulsive status epilepticus (SE) with no prior history SE.  SE cases were treated with appropriate doses of midazolam and anti-seizure medications like phenobarbital, valproic acid and levetiracetam as per requirement. The cerebrospinal fluid (CSF) bacterial culture and PCR for common encephalitis pathogens including Herpes 1 and 2 and enteroviruses were negative. Brain imaging and electroencephalography did not yield any significant results.

Unlike in adults, seizures occur early and maybe the main manifestation of acute COVID-19 in children. Seizures, including status epilepticus, may occur without fever even in children with no history of epilepsy and are not associated with severe disease. Early diagnosis of COVID-19 is vital for infection control. Thus, children who present with new-onset seizures or exacerbation of prior epilepsy, with or without fever, regardless of other typical signs of acute COVID-19 must be tested immediately for COVID-19.

Source : Seizure