Seizures, including status epilepticus may be the first symptom of Covid-19 in children, suggests a new study published in the journal Seizure.^1,2

The retrospective study from Israel analysed data from 175 children who presented with seizures to the emergency departments of a tertiary hospital between March 1st and December 31st 2020. These children also had a confirmed diagnosis of Covid-19 based on a positive nasopharyngeal RT PCR test for SARS-CoV-2.

Out of the 175 children diagnosed with Covid-19 in the emergency department, 11 children, aged 6 months to 17 years, came to the emergency with seizures. Six of these 11 children had fever. None of them had severe COVID-19, which necessitated intensive care with either ventilatory or hemodynamic support. SpO2 remained above 92% at all time

Clinically, the types of seizures were generalized tonic-clonic seizures in nine children, focal tonic seizure in one child with a past history of uncontrolled epilepsy with multiple seizure types and bilateral asymmetrical tonic-clonic seizure in a 5-month-old infant. Three of the children had uncontrolled seizures despite appropriate treatment with antiseizure medication.

Five children had a past history of epilepsy, one child reported a single unprovoked seizure 3 years prior to this admission, while one child had  an intellectual disability. Four children were on anti-epileptic drugs prior to their current hospitalization: one was on valproic acid, two were on levetiracetam, while one child had been taking (both levetiracetam and lamotrigine.

A finding of note was convulsive status epilepticus in five children. None of these had a previous history of status epilepticus, so this was the first episode and one child had no history of seizures.

All these children recovered well during their hospital stay and were discharged within a week of admission.

Till a year and half back, Covid-19 was an unknown disease. Since then, diverse clinical presentations of Covid-19 have been recognized. And, now it is well-established that Covid-19 is not just a respiratory disease.

The observations of this study indicate that in children, Covid-19 may manifest as seizures, including status epilepticus, even in those who did not have a prior history of epilepsy or any other neurological disorder and in the absence of fever or severe Covid-19.

Seizures therefore could be a sign of acute Covid-19. Any child presenting with seizures should also be tested for Covid-19, especially during the ongoing pandemic. A high index of suspicion would facilitate early diagnosis of Covid-19, including an asymptomatic infection and prevent spread of the virus.

References

1. Kurd M, et al. Seizures as the main presenting manifestation of acute SARS-CoV-2 infection in children. Seizure. 2021;92:89-93.
2. Seizure a first sign of COVID in kids? - Medscape - Sep 10, 2021.