A study of Electroencephalography Findings and its Prognostic Value in Severe COVID-19 Patients Admitted at Intensive Care Unit

Fawad Ahmad; Wasim Alamgir; Imran Ahmad; Saima Shafait; Anusha Pervaiz; Zahid Farooq Baig

doi:10.51253/pafmj.v74i2.7446

Authors

Fawad Ahmad Department of Neurology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Wasim Alamgir epartment of General Medicine, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Imran Ahmad Department of Neurology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Saima Shafait Department of Neurology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Anusha Pervaiz Department of Neurology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Zahid Farooq Baig Department of Medicine, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i2.7446

Keywords:

COVID-19, Electroencephalography, Encephalopathy, Electroencephalogram (EEG), Richmond Agitation-Sedation Scale

Abstract

Objective: To study electroencephalography patterns in COVID-19 patients admitted to intensive care unit and find the association of these patterns with outcome.

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2020 to Mar 2021.

Methodology: Eighteen electroencephalograms in COVID-19 patients with Encephalopathy were recorded using a 10-20 electrode system. The duration of each recording was 30 minutes. Traces were analysed by a neurologist for delta slowing, epileptiform discharges, and posterior dominant rhythm. Generalised slowing was classified as mild (background slowing), moderate (intermittent slowing) and severe (continuous slowing).

Results: A total of 18 COVID-19 patients, with a mean age of 63±16.02 years, underwent electroencephalography recording of 30 min duration. Diabetes mellitus and ischemic heart disease were the most common co-morbidity (7, 38.9%), followed by CKD. Non-specific generalised slowing was observed in all EEGs. No epileptiform discharges or focality were seen. Posterior Dominant Rhythm has been related to a good outcome. At the same time, severe Encephalopathy (Richmond Agitation-Sedation Scale of -3 to -5) was associated with poor outcomes (p-value<0.05).

Conclusion: Patients with Posterior Dominant Rhythm had more chances of having good outcomes, while patients with severe encephalopathy findings on EEG were more at risk of poor outcomes.

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Author Biographies

Imran Ahmad, Department of Neurology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Saima Shafait, Department of Neurology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Anusha Pervaiz, Department of Neurology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Zahid Farooq Baig, Department of Medicine, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan

References

Ahmad I, Rathore FA. Neurological manifestations and complications of COVID-19: A literature review. J Clin Neurosci 2020; 77: 8-12. https://doi.org/10.1016/j.jocn.2020.05.017

Nepal G, Rehrig JH, Shrestha GS, Shing YK, Yadav JK, Ojha R, et al. Neurological manifestations of COVID-19: a systematic review. Crit Care 2020; 24(1): 421.

https://doi.org/10.1186/s13054-020-03121-z.

Sharifian-Dorche M, Huot P, Osherov M, Wen D, Saveriano A, Giacomini PS, et al. Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic. J Neurol Sci 2020; 417: 117085.

https://doi.org/10.1016/j.jns.2020.117085.

Schmitt SE. Utility of Clinical Features for diagnosing Seizures in the Intensive Care sUnit. J Clin Neurophysiol 2017; 34(2): 158-161.

https://doi.org/10.1097/WNP.0000000000000335.

Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004; 62(10): 1743-1748. https://doi.org/10.1212/01.wnl.0000125184.88797.62.

Hirsch LJ. Continuous EEG monitoring in the intensive care unit: an overview. J Clin Neurophysiol 2004; 21(5): 332-340.

Young GB. Continuous EEG monitoring in the ICU: challenges and opportunities. Can J Neurol Sci 2009; 36 Suppl 2: S89-91.

Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al . Neurologic Manifestations of Hospitalised Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol 2020; 77(6): 683-690.

https://doi.org/10.1001/jamaneurol.2020.1127.

Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of COVID-19—preliminary report. N Eng J Med 2020; 383(19): 1813-1836.

Ahmad I, Rathore FA, Khan MN, Nazir SN. Risk factors associated with in-hospital death in adult COVID-19 patients in Karachi, Pakistan: a retrospective chart review. Pak Armed Forces Med J 2020; 70(1): S347-353.

Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020; 92(6): 552-555.

https://doi.org/10.1002/jmv.25728.

Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al . Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med 2020; 382(23): 2268-2270.

https://doi.org/10.1056/NEJMc2008597.

Canham LJW, Staniaszek LE, Mortimer AM, Nouri LF, Kane NM. Electroencephalographic (EEG) features of Encephalopathy in the setting of Covid-19: A case series. Clin Neurophysiol Pract 2020; 5: 199-205. https://doi.org/10.1016/j.cnp.2020.06.001.

Louis S, Dhawan A, Newey C, Nair D, Jehi L, Hantus S, et al. Continuous electroencephalography characteristics and acute symptomatic seizures in COVID-19 patients. Clin Neurophysiol 2020; 131(11): 2651-2656.

https://doi.org/10.1016/j.clinph.2020.08.003.

Galanopoulou AS, Ferastraoaru V, Correa DJ, Cherian K, Duberstein S, Gursky J, et al . EEG findings in acutely ill patients investigated for SARS-CoV-2/COVID-19: A small case series preliminary report. Epilepsia Open 2020; 5(2): 314-324. https://doi.org/10.1002/epi4.12399.

Chen W, Toprani S, Werbaneth K, Falco-Walter J. Status epilepticus and other EEG findings in patients with COVID-19: A case series. Seizure 2020; 81: 198-200.

https://doi.org/10.1016/j.seizure.2020.08.022.

Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy. Cureus 2020; 12(3): e7352.

https://doi.org/10.7759/cureus.7352.

Pellinen J, Carroll E, Friedman D, Boffa M, Dugan P, Friedman DE, et al. Continuous EEG findings in patients with COVID-19 infection admitted to a New York academic hospital system. Epilepsia 2020; 61(10): 2097-2105.

https://doi.org/10.1111/epi.16667.

Skorin I, Carrillo R, Perez CP, Sanchez N, Parra J, Troncoso P, Uribe-San-Martin R. EEG findings and clinical prognostic factors associated with mortality in a prospective cohort of inpatients with COVID-19. Seizure 2020; 83: 1-4.

https://doi.org/10.1016/j.seizure.2020.10.007