New-Onset Non-convulsive Status Epilepticus in Previously Healthy COVID-19 Patient

Abstract

The novel severe acute respiratory syndrome (SARS-CoV-2) virus has spread rapidly worldwide in the last several year. COVID-19 presentation ranges widely from asymptomatic to acute respiratory failure. Interestingly, although neurological manifestations of COVID-19 have often been described in the literature, only a few cases reports describe status epilepticus associated with COVID-19 patients. This is a case of a 52-year-old previously healthy woman who presented to the emergency department with fever, worsening cough, shortness of breath, and hypoxia. She was found to be COVID-19-positive. She developed a bilateral tonic-clonic seizure 16 days after her first symptoms appeared. Continuous video encephalogram (CEEG) showed a generalized periodic pattern with triphasic morphology. This finding is suggestive of non-convulsive status epilepticus which resolved after valproic acid loading as given. The patient is fully recovered at 6 months follow-up and seizure-free on levetiracetam 750 mg twice daily. This case demonstrates a new onset of bilateral tonic-clonic seizure followed by non-convulsive status epilepticus associated with COVID-19 infection. As the spectrum of COVID-19 neurological manifestation has yet to be established, healthcare providers should be cognizant of the possibility of non-convulsive status epilepticus in COVID-19 patients in order to provide timely workup and management.