Details

Autor(en) / Beteiligte

• Balloy, Gaëlle
• Leclair-Visonneau, Laurène
• Péréon, Yann
• Magot, Armelle
• Peyre, Arnaud
• Mahé, Pierre-Joachim
• Derkinderen, Pascal

Titel

Non-lesional status epilepticus in a patient with coronavirus disease 2019

Ist Teil von

• Clinical neurophysiology, 2020-08, Vol.131 (8), p.2059-2061

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2020

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals Complete

Beschreibungen/Notizen

• A 59-year-old man with a history of atrial fibrillation and treated obstructive sleep apnea presented to the emergency department on March 26, 2020 with fever, dry cough, dyspnea and headache. He had no history of personal or familial seizures. A first reverse-transcriptase–polymerase-chain-reaction (RT-PCR) of nasopharyngeal swab test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was negative but SARS-CoV-2 infection was subsequently confirmed by RT-PCR assay performed on tracheal secretions and by computed tomography scan of the chest. The illness rapidly progressed to hypoxemic respiratory failure warranting the initiation of invasive mechanical ventilation on March 28. Lung bacterial overinfection by Hafnia alveii and Proteus vulgaris was diagnosed and sequentially treated with amoxicillin-clavulanic acid/rovamycine (7 days), tazobactam-piperacillin (5 days) and finally with cefepime (7 days). Deep sedation with midazolam was stopped on April 8 and the patient was extubated the following day.From April 10, the patient started to exhibit short episodes of impaired consciousness together with confusion and behavioral disturbances. Forty-nine minute electroencephalogram (EEG), performed when the patient was awake but confused, showed background fluctuating alertness with preserved responses to simple orders (Fig. 1b) and two widespread long rhythmic delta discharges with superimposed spikes in predominantly frontal localization simultaneous with impaired awareness (Fig. 1c), highly suggestive of epileptic seizures. The first seizure lasted 6 minutes (Fig. 1c), followed by a moderate interictal frontal activity (Fig. 1d) and the second seizure lasted at least 5 minutes (Fig. 1e), leading to the diagnosis of non-convulsive status epilepticus. Laboratory blood tests and brain MRI were normal; plasma cefepime concentrations were within the normal range. Routine cerebrospinal fluid (CSF) analysis was unremarkable and CSF SARS-CoV2 RT-PCR was negative. Clobazam (30 mg/day) and levetiracetam (1.5 g/day) were introduced. On April 14, the patient had only one brief episode of impaired consciousness and his long-term EEG monitoring was normal. He is now clinically stable and discharged from ICU.