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Continuous EEG findings in patients with COVID-19 infection admitted to a New York academic hospital system

Pellinen, Jacob; Carroll, Elizabeth; Friedman, Daniel; Boffa, Michael; Dugan, Patricia; Friedman, David E; Gazzola, Deana; Jongeling, Amy; Rodriguez, Alcibiades J; Holmes, Manisha
OBJECTIVE:There is evidence for central nervous system complications of coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Encephalopathy caused by or arising from seizures, especially nonconvulsive seizures (NCS), often requires electroencephalography (EEG) monitoring for diagnosis. The prevalence of seizures and other EEG abnormalities among COVID-19-infected patients is unknown. METHODS:Medical records and EEG studies of patients hospitalized with confirmed COVID-19 infections over a 2-month period at a single US academic health system (four hospitals) were reviewed to describe the distribution of EEG findings including epileptiform abnormalities (seizures, periodic discharges, or nonperiodic epileptiform discharges). Factors including demographics, remote and acute brain injury, prior history of epilepsy, preceding seizures, critical illness severity scores, and interleukin 6 (IL-6) levels were compared to EEG findings to identify predictors of epileptiform EEG abnormalities. RESULTS:Of 111 patients monitored, most were male (71%), middle-aged or older (median age 64 years), admitted to an intensive care unit (ICU; 77%), and comatose (70%). Excluding 11 patients monitored after cardiac arrest, the most frequent EEG finding was moderate generalized slowing (57%), but epileptiform findings were observed in 30% and seizures in 7% (4% with NCS). Three patients with EEG seizures did not have epilepsy or evidence of acute or remote brain injury, although all had clinical seizures prior to EEG. Only having epilepsy (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.4-21) or seizure(s) prior to EEG (OR 4.8, 95% CI 1.7-13) was independently associated with epileptiform EEG findings. SIGNIFICANCE/CONCLUSIONS:Our study supports growing evidence that COVID-19 can affect the central nervous system, although seizures are unlikely a common cause of encephalopathy. Seizures and epileptiform activity on EEG occurred infrequently, and having a history of epilepsy or seizure(s) prior to EEG testing was predictive of epileptiform findings. This has important implications for triaging EEG testing in this population.
PMID: 32875578
ISSN: 1528-1167
CID: 4590162

SARS-CoV-2-Associated Guillain-Barre Syndrome With Good Response to Plasmapheresis

Granger, Andre; Omari, Mirza; Jakubowska-Sadowska, Katarzyna; Boffa, Michael; Zakin, Elina
PMID: 32833726
ISSN: 1537-1611
CID: 4575182

Keeping the team together: Transformation of an inpatient neurology service at an urban, multi-ethnic, safety net hospital in New York City during COVID-19

Lord, Aaron S; Lombardi, Nicole; Evans, Katherine; Deveaux, Dewi; Douglas, Elizabeth; Mansfield, Laura; Zakin, Elina; Jakubowska-Sadowska, Katarzyna; Grayson, Kammi; Omari, Mirza; Yaghi, Shadi; Humbert, Kelley; Sanger, Matt; Kim, Sun; Boffa, Michael; Szuchumacher, Mariana; Jongeling, Amy; Vazquez, Blanca; Berberi, Nisida; Kwon, Patrick; Locascio, Gianna; Chervinsky, Alexander; Frontera, Jennifer; Zhou, Ting; Kahn, D Ethan; Abou-Fayssal, Nada
The COVID-19 pandemic dramatically affected the operations of New York City hospitals during March and April of 2020. This article describes the transformation of a neurology division at a 450-bed tertiary care hospital in a multi-ethnic community in Brooklyn during this initial wave of COVID-19. In lieu of a mass redeployment of staff to internal medicine teams, we report a novel method for a neurology division to participate in a hospital's expansion of care for patients with COVID-19 while maintaining existing team structures and their inherent supervisory and interpersonal support mechanisms.
PMCID:7430288
PMID: 32877768
ISSN: 1872-6968
CID: 4583362

Seizure, fever, hallucinations, and vision loss: A circuitous route to dual diagnoses [Meeting Abstract]

Carroll, Elizabeth; Wallach, Asya; Kurzweil, Arielle; Frucht, Steven; Berk, Thomas; Boffa, Michael; Kister, Ilya
ISI:000536058006022
ISSN: 0028-3878
CID: 4561582

Case Report: Seizure, Fever, Hallucinations, & Vision Loss : A circuitous route to dual diagnoses. [Case Report]

Carroll, Elizabeth; Wallach, Asya I; Kurzweil, Arielle; Frucht, Steven; Berk, Thomas; Boffa, Michael; Kister, Ilya
ORIGINAL:0014463
ISSN: 1540-1367
CID: 4216692

Frequency of Parsaomnias in Patients with Non-Epileptic Seizures [Meeting Abstract]

Miglis, Mitchell G.; Boffa, Michael; Thawani, Sujata; Rodriguez, Alcibiades; Singh, Anuradha
ISI:000296419500088
ISSN: 0364-5134
CID: 150586