EEG Abnormalities and Their Radiographic Correlates in a COVID-19 Inpatient Cohort

ABSTRACT: Objective: To identify the prevalence of EEG abnormalities in patients with COVID-19 with neurologic changes, their associated neuroimaging abnormalities and rates of mortality. Methods: A retrospective case series of 192 adult COVID-19 positive inpatients with EEG performed between March and June 2020 at 4 hospitals: 161 undergoing continuous, 24 routine, and 7 reduced- montage EEG. Study indication, epilepsy history, intubation status, administration of sedatives or antiseizure medications, metabolic abnormalities, neuroimaging pathology associated with epileptiform abnormalities, and in-hospital mortality were analyzed. Results: EEG indications included encephalopathy (54.7%), seizure (18.2%), coma (17.2%), focal deficit (5.2%), and abnormal movements (4.6%). Epileptiform abnormalities occurred in 39.6% of patients: focal intermittent epileptiform discharges in 25.0%, lateralized periodic discharges in 6.3%, and generalized periodic discharges in 19.3%. Seizures were recorded in 8 patients, 3 with status epilepticus. Antiseizure medication administration, epilepsy history, and older age were associated with epileptiform abnormalities. Only 26.3% of patients with any epileptiform abnormality, 37.5% with electrographic seizures, and 25.7% patients with clinical seizures had known epilepsy. Background findings included generalized slowing (88.5%), focal slowing (15.6%), burst suppression (3.6%), attenuation (3.1%), and normal EEG (3.1%). Neuroimaging pathology was identified in 67.1% of patients with epileptiform abnormalities, over two-thirds acute. In-hospital mortality was 39.5% for patients with epileptiform abnormalities, 36.2% for those without. Risk factors for mortality were coma and ventilator support at time of EEG. Significance: This article highlights the range of EEG abnormalities frequently associated with acute neuroimaging abnormalities in COVID-19. Mortality rates were high, particularly for patients in coma requiring mechanical ventilation. These findings may guide the prognosis and management of patients with COVID-19 and neurologic changes.