Sucheta Kundu, MD
North Alabama Medical Center
Florence, Alabama
Disclosure information not submitted.
Ishita Mehra, MD, MBBS, MD
Resident Physician
North Alabama Medical Center
Florence, Alabama
Disclosure information not submitted.
Sindhoora Adyanthaya
North Alabama Medical Center
Florence, Alabama
Disclosure information not submitted.
Aksiniya Stevasarova, Resident Physician Internal Medicine PGY3
MD
n/a, United States
Disclosure information not submitted.
Karishma Kadariya, MD
Resident Physician
North Alabama Medical Center, United States
Disclosure information not submitted.
Khushdeep Chahal, MD
Program Director
North Alabama Medical Center, United States
Disclosure information not submitted.
Title: Rare Post COVID-19 Sequalae – A Case Series On New Onset Temporal Lobe Seizures In Healthy Adults
Introduction: The COVID-19 pandemic though associated predominantly with respiratory complications has also been associated with neurological effects. Seizures in the acute phase of the illness has been noted in 1-2% of patients. However, new onset temporal lobe seizures as manifestation of post COVID sequelae are extremely rare. Here we aim to describe two such cases encountered in our clinical practice.
Description: Ms. V, 61-year-old female presented with first episode of acute onset aphasia, confusion & staring spells lasting for 2 hours. She was having small staring spells with intermittent confusion & memory lapses since she contracted COVID-19 two months ago. On examination, she was confused, aphasic with no sensorimotor deficits. EEG showed status epilepticus in left temporal lobe which resolved with anti-epileptics. Mr. B, 54-year-old male presented with first episode of seizure characterized by lip-smacking sequentially followed by what was described as tonic-clonic seizure for 10 mins & then post-ictal confusion. He had intermittent episodes of disorientation & memory loss for last 6 months after he was diagnosed with COVID-19. He was afebrile, confused with no neurological deficits. Both the patients were monitored in the ICU with neuro checks. They were hemodynamically stable with labs showing normal electrolytes, glucose & renal function. Urine toxicology & brain imaging- MRI & CTA were unremarkable. They were given lorazepam & loading dose of levetiracetam. Gradually the patients improved with no recurrences of seizure activity, & were discharged on levetiracetam for post-COVID temporal lobe epilepsy. They remained seizure free at 2 months follow-up.
Discussion: These cases serve to highlight new onset epilepsy as a possible manifestation of post-COVID syndrome. Temporal lobe epilepsy can present as focal onset non-motor seizures and later evolve into status epilepticus or tonic-clonic seizures. Clinical features include staring spells, ictal automatisms, aphasia, memory lapses & confusion. Underlying mechanisms for COVID-19 related seizures include neurotropism, entry of inflammatory cytokines into the nervous system & post-infectious immune mediated cerebritis. Hence long-term follow-up is needed to investigate the increased risk of developing epilepsy as a delayed manifestation of COVID-19.