Meta-analysis of EEG findings in patients with COVID-19

Abstract

Objective: To perform a systematic review and meta-analysis to summarize and quantitatively evaluate the electroencephalogram (EEG) findings in patients with coronavirus disease 2019 (COVID-19).

Methods: The MEDLINE, CENTRAL, and ClinicalTrials.Gov databases were comprehensively assessed and searched for observational studies with EEG findings in patients with COVID-19. Pooled proportions of EEG findings with 95% confidence intervals (CIs) were assessed using a random effects model. The quality of assessment for each study, heterogeneity between the studies, and publication bias were also evaluated.

Results: In total, 12 studies with 308 patients were included in the meta-analysis. Abnormal background activity and generalized slowing in the pooled proportions were common findings among the patients with COVID-19 (96.1% [95% CI: 89.4-99.9]; I² = 60%; p < 0.01 and 92.3% [95% CI: 81.2-99.3]; I² = 74%; p < 0.01, respectively). The proportion of patients with epileptiform discharges (EDs) was 20.3% ([95% CI: 9.85-32.9]; I² = 78%; p < 0.01). The proportion of EDs varied between patients with a history of epilepsy or seizures (59.5% [95% CI: 33.9-83.2]; I² = 0%; p = 0.49) and patients without them (22.4% [95% CI: 10.4-36.4]; I² = 46%; p = 0.07). The findings of seizures and status epilepticus on EEG were observed in 2.05% ([95% CI: 0.02-6.04]; I² = 39%; p = 0.08) and 0.80% ([95% CI: 0.00.-3.69]; I² = 28%; p = 0.17) of the patients, respectively.

Conclusion: The proportion of abnormal background activity in patients with COVID-19 was high (96.1%). Epileptiform discharges were present in 20.3% of the cases and the proportion varied between people who had a history of epilepsy/seizure and those who did not. However, the proportion of seizures and status epilepticus on EEG was low (2.05% and 0. 80%, respectively).

Keywords: COVID-19; EEG; Epilepsy; Neurology; Seizure; Status epilepticus.