key: cord-0810686-0w7pfj9b
authors: Swarz, Jeffrey A.; Daily, Sarah; Niemi, Emily; Hilbert, Samuel G.; Ibrahim, Hala Ali; Gaitanis, John N.
title: COVID-19 Infection Presenting as Acute Onset Focal Status Epilepticus
date: 2020-07-31
journal: Pediatr Neurol
DOI: 10.1016/j.pediatrneurol.2020.07.012
sha: 86de494b832f2e3794c5813b271fa25ee4dbc092
doc_id: 810686
cord_uid: 0w7pfj9b

nan

To the Editor, Documented cases of neurological complications in patients with SARS-CoV-2 are accumulating. Status epilepticus and encephalopathy has now been reported as a presenting symptom in adults and children with COVID-19. 1,2 Our team admitted a nine year old boy with no medical history following an episode of focal status epilepticus and encephalopathy. He was afebrile and without signs of meningismus at the time of admission. One milligram of lorazepam IV terminated his symptoms with rapid return to baseline mental status. Laboratory studies did not reveal leukocytosis or electrolyte abnormalities. A CT scan of the head was normal. Video EEG showed continuous delta slowing throughout the right hemisphere without epileptiform features. A lumbar puncture and antibiotics were deferred given his rapid improvement. Eight hours after admission, he developed a fever with intractable vomiting. PCR testing for COVID-19 returned positive. An MRI following discharge was normal and he has remained seizure free off of anti-seizure medications.

Our attention necessarily turns to the neuropathophysiology of COVID-19. In their letter, our colleagues McAbee et al note several proposed mechanisms by which the novel corona virus may cause seizures and encephalopathy: direct infection, autoimmune response, postinfectious process, and vascular processes including thrombosis and infarction. We would like to add dysregulated cytokine signaling to the list of proposed mechanisms. Given what we are learning about the cytokine cascade triggered by this novel coronavirus, a mechanism involving this system should logically be explored. 3 Proinflammatory cytokines such as IFNγ, IL-6, and IL-8 are associated with febrile seizure. 4 More intriguing perhaps, CSF IL-6 has been associated with complex febrile seizures. 5 Insights gained through the exploration of cytokine response activated by SARS-CoV-2 may also illuminate the elusive causal pathway leading to febrile seizures and as other colleagues have suggested, perhaps unknown targets for futures anticonvulsants. 6 

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