Pediatric Neurology 116 (2021) 31

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Pediatric Neurology
journal homepage: www.elsevier.com/locate/pnu

Correspondence

Is SARS-CoV-2 Infection a Risk for Potentiation of Epileptic Seizures in

Children With Pre-existing Epilepsy?
Published reports describing the neurological manifestations in
children with COVID-19 are expanding the COVID-19 phenotype.1
Whether seizure exacerbation might be an issue for children with
pre-existing epilepsy and SARS-CoV-2 infection is unknown. We
describe two children with reappearance of seizures during a
COVID-19 infection after a long seizure-free period.
The first child is a five-year-old girl who had experienced a
perinatal ischemic stroke. Her focal epilepsy had been fully
controlled by levetiracetam, but after four years without seizures,
she developed focal motor status epilepticus that resolved
following intravenous midazolam. She had a two-day history of
fever and rhinitis. Her electroencephalography showed postictal
focal slowing, and her magnetic resonance imaging was
unchanged.
The second child is an 11-year-old girl with fragile X syndrome
and recurrent status epilepticus usually triggered by febrile
episodes. She had been seizure-free for six years with
hypothesized, such as the up-regulation of components of the
renin-angiotensin system, mediating proinflammatory and
vasoconstrictive effects, or the increase in pro-inflammatory
cytokine levels such as interleukin-6.2
A seizure recurrence risk in patients with pre-existing epilepsy
should be considered in children with mild COVID-19, especially
after a long seizure-free period, due to possible lowering of the
seizure threshold. The epileptogenic effect of SARS-CoV-2 requires
further confirmations.
References
1. McAbee GN, Brosgol Y, Pavlakis S, et al. Encephalitis associated with COVID-19
infection in an 11-year-old child. Pediatr Neurol. 2020;109:94.
2. Vohora D, Jain S, Tripathi M, et al. COVID-19 and seizures: is there a link?
Epilepsia. 2020;61:1840e1853.

levetiracetam. After two days of fever she developed prolonged

focal seizures requiring intravenous midazolam. Blood Giacomo Brisca, MD, PhD
examinations detected transient respiratory acidosis. Her Sub-Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
electroencephalography showed an irregular background activity E-mail address: giacomobrisca@gaslini.org.
and rare sharp abnormalities.
Laura Siri, MD
Polymerase chain reaction testing for COVID-19 was positive in
Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences
both girls. Both children were discharged after six days with no
Department, IRCCS Giannina Gaslini Institute, Genoa, Italy
need for respiratory support, no seizure recurrence, and no increase
in their antiepileptic drug dosing. Camilla Olcese, MD, Bernadette Marre  Brunenghi, MD
So far, there is no clear evidence that COVID-19 triggers seizure Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics,
relapses in epileptic patients. Considering the extreme ratio Maternal and Child Health (DINOGMI), University of Genoa, Genoa,
between reported COVID-19 cases with seizures and the overall Italy
increasing number of reported COVID-19 cases, as well as the
Daniela Pirlo, MD
high prevalence of epilepsy, this association could be merely a
Sub-Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
coincidence.
The occurrence of seizures during febrile illnesses in children Maria Margherita Mancardi, MD, PhD
with epilepsy is well-known, and we cannot be certain that Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences
SARS-CoV-2 merely triggered the seizures in the same fashion as Department, IRCCS Giannina Gaslini Institute, Genoa, Italy
other pathogens. Hypoxia, sepsis or direct brain infection is
unlikely in our patients. Other mechanisms have been Available online 3 December 2020

Funding: This research did not receive any specific grant from funding agencies
in the public, commercial, or not-for-profit sectors.
Declarations of Interest: None.

https://doi.org/10.1016/j.pediatrneurol.2020.11.021
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