LitCovid-sentences  

PMC:7445677 / 1120-12397 JSONTXT 16 Projects

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Id Subject Object Predicate Lexical cue
T10 0-12 Sentence denotes Introduction
T11 13-152 Sentence denotes The COVID-19 outbreak continues to evolve, currently with spread throughout the United States, which remains the epicenter of the pandemic.
T12 153-279 Sentence denotes In all areas of medicine, there is a critical need for accurate information to inform an appropriate response to the outbreak.
T13 280-530 Sentence denotes There are an increasing number of clinical studies for COVID-19, but our current understanding in relationship to seizures and epilepsy remains limited by relative lack of cohort studies, especially in patients with preexisting seizures and epilepsy.
T14 531-814 Sentence denotes Realizing both the need for and limitation of current information, this summary provides a focused summary of pertinent clinical diagnostic information about neurological involvement of SARS-CoV-2 virus and COVID-19, especially in relationship to patients with seizures and epilepsy.
T15 816-830 Sentence denotes General Issues
T16 831-1120 Sentence denotes There are multiple factors which influence frequency of epileptic seizures, including systemic and environmental factors.1 COVID-19 therefore may exacerbate epileptic seizures from associated systemic effects not directly related to SARS-CoV-2 virus central nervous system (CNS) infection.
T17 1121-1200 Sentence denotes Reports of seizures in COVID-19 patients should be interpreted in this context.
T18 1201-1523 Sentence denotes As detailed below, cohort studies of patients with COVID-19 show that neurological complications are relatively uncommon and occur with increased frequency in patients with more severe systemic illness.2,3 Lack of early neurological signs and symptoms suggest absence of early direct CNS infection by the SARS-CoV-2 virus.
T19 1524-1729 Sentence denotes Later neurological manifestations of COVID-19 could be related to either systemic complications of severe infection or direct CNS infection by SARS-CoV-2 virus, which remains uncertain from available data.
T20 1731-1784 Sentence denotes Cohort Studies of Clinical Manifestations of COVID-19
T21 1786-1832 Sentence denotes Initial Presenting COVID-19 Signs and Symptoms
T22 1833-1961 Sentence denotes In a retrospective study of 1099 patients with laboratory-confirmed COVID-19 in China, Guan et al2 reported presenting symptoms.
T23 1962-2035 Sentence denotes The cohort included patients in both the hospital and outpatient setting.
T24 2036-2117 Sentence denotes There were no reported definitive neurological signs or symptoms on presentation.
T25 2118-2223 Sentence denotes Additionally, seizures and epilepsy were not listed among coexisting disorders before COVID-19 infection.
T26 2224-2449 Sentence denotes The reported presenting symptoms of headache (13.6%), fatigue (38.1%), and myalgia or arthralgia (14.9%), theoretically neurologically related, are more typically related to systemic effects of the associated viral infection.
T27 2450-2506 Sentence denotes Additionally, there were no reported neurological signs.
T28 2507-2859 Sentence denotes Two subsequently published hospital-based studies reporting initial clinical features COVID-19 showed similar findings, with no definitive presenting neurological signs or symptoms.4,5 Focusing on the pediatric population, Dong et al6 reported a retrospective nationwide Chinese epidemiological case series of 2135 patients <18 years old with COVID-19.
T29 2860-3041 Sentence denotes Only 6% of children in the study developed severe or critical disease, in contrast to other comparably designed studies in adult patients showing more severe COVID-19 complications.
T30 3042-3194 Sentence denotes However, infants (less than 1 year old) and young children (1-5 years old) were at higher risk of a worse clinical course than older pediatric patients.
T31 3195-3239 Sentence denotes There was no reported incidence of seizures.
T32 3241-3291 Sentence denotes Neurological Findings in Severe COVID-19 Infection
T33 3292-3452 Sentence denotes In a retrospective case series, Mao et al3 reviewed 214 COVID-19 confirmed hospitalized patients in Wuhan, China, 74 of whom had neurological signs or symptoms.
T34 3453-3677 Sentence denotes Comparing patients with severe and nonsevere COVID-19 infections as defined by international guidelines for community-acquired pneumonia, patients with severe infection were more likely to have CNS manifestations of disease.
T35 3678-3765 Sentence denotes Specifically, impaired consciousness and acute stroke were more common in severe cases.
T36 3766-3823 Sentence denotes There was a single case of epilepsy, in the severe group.
T37 3824-4008 Sentence denotes Additionally, there was associated hypogeusia and hyposmia in 5.6% and 5.1% of patients, respectively, which showed no difference in occurrence between the severe and nonsevere groups.
T38 4009-4045 Sentence denotes Muscle injury was reported in 10.7%.
T39 4046-4281 Sentence denotes In a pediatric study, the International COVID-19 PICU Collaborative7 published a cross-sectional study of North American pediatric intensive care units describing the characteristics of 48 critically ill children positive for COVID-19.
T40 4282-4392 Sentence denotes Two patients had an uncharacterized “neurological” presentation, and 3 patients had seizures as a comorbidity.
T41 4393-4546 Sentence denotes The intensive care unit (ICU) mortality in this cohort was <5%, significantly lower than adult ICU mortality rates published in other comparable studies.
T42 4547-4915 Sentence denotes In the pediatric population, there are a growing number of children who present with a Kawasaki-like disease also known as multisystem inflammatory syndrome in children,8,9 which includes persistent fever, single or multi-organ dysfunction, headache, and meningeal signs.10 Multisystem inflammatory syndrome in children, however, has not been associated with seizures.
T43 4916-5124 Sentence denotes Taken as a whole, these studies show initial neurological involvement, especially in mild COVID-19 cases, is rare, but that neurological involvement can occur in more severe cases later in the disease course.
T44 5125-5299 Sentence denotes Additionally, pediatric patients show less severe COVID-19 manifestations, a finding apparent in initial studies.11 Epilepsy and seizures are a rare complication of COVID-19.
T45 5301-5334 Sentence denotes Neurological Findings in COVID-19
T46 5335-5580 Sentence denotes Despite findings from studies in the general population, there is great heterogeneity of neurological presentation for individual patients with viral illnesses, so a minority of COVID-19 patients may present with neurological signs and symptoms.
T47 5581-5760 Sentence denotes SARS-CoV-2 has been reported in the brains from both patients and experimental animals,12,13 supporting that clinical manifestations may be related to direct SARS-CoV-2 infection.
T48 5761-6030 Sentence denotes There are numerous comprehensive reviews of neurological involvement with COVID-19,14-18 outlining findings of headache, anosmia and ageusia, impaired consciousness, seizures, stroke and vascular events, and peripheral nerve disorders including Guillain-Barré syndrome.
T49 6031-6206 Sentence denotes In an expert consensus of neurologists from China,12 COVID-19-related neurological signs and symptoms include stroke, headache, seizures, impaired consciousness, and myalgias.
T50 6207-6320 Sentence denotes A few patients developed symptoms of neuropathy, for example, paresthesia and bowel/bladder function disturbance.
T51 6321-6671 Sentence denotes The report stresses that a significant number of patients present without fever, which is confirmed in other studies.19 Other clinical directives include the importance of treating clinical signs and symptoms appropriately if testing results for SARS-CoV-2 are ambiguous or unavailable, and that some patients had leukopenia before onset of symptoms.
T52 6673-6780 Sentence denotes Additional Studies Specifically Aimed at Defining the Relationship Between COVID-19, Seizures, and Epilepsy
T53 6781-6971 Sentence denotes Lu et al20 specifically collected data about new-onset acute symptomatic seizures between January and February 2020 at 42 hospitals in the Hubei province, the epicenter of COVID-19 in China.
T54 6972-7070 Sentence denotes They enrolled 304 patients, none with a prior history of epilepsy, 108 of whom had severe disease.
T55 7071-7252 Sentence denotes Patients presented with acute cerebrovascular disease and systemic disorders which could provoke seizures, but without seizures, febrile seizures, or episodes of status epilepticus.
T56 7253-7365 Sentence denotes Two patients had seizure-like events, diagnosed as seizure mimics due to acute stress reaction and hypocalcemia.
T57 7366-7558 Sentence denotes The authors concluded that COVID-19 poses minimal risk for acute symptomatic seizures, though a significant portion of severely ill patients had increased potentially provocative risk factors.
T58 7559-7715 Sentence denotes A limitation of this study was lack of routine or long-term EEG recordings to investigate these seizure-like episodes or to assess for subclinical seizures.
T59 7716-7789 Sentence denotes There are studies describing EEG findings for COVID-19 positive patients.
T60 7790-7908 Sentence denotes Helms et al21 reported neurologic features in severe COVID-19 with acute respiratory distress syndrome in 58 patients.
T61 7909-8020 Sentence denotes Eight patients underwent EEG, all of whom had nonspecific findings with no epileptiform discharges or seizures.
T62 8021-8188 Sentence denotes Galanopoulou et al22 reported a study of 28 patients under investigation for COVID-19 who underwent hospitalization and EEG studies (either routine or continuous EEG).
T63 8189-8586 Sentence denotes Of the initial 28 patients, subsequent testing defined COVID-19 positive (n = 22) and negative (n = 6) groups, with respective comparisons of the groups showing indications for EEG testing as new-onset encephalopathy (68.2% vs 33.3%) and seizure-like events (14/22, 63.6%; 2/6, 33.3%). “Seizure-like” events were reported in patients without a prior history of seizures (11/17, 64.7%; 2/6, 33.3%).
T64 8587-8747 Sentence denotes Intermittent epileptiform discharges, most typically as frontal sharp waves, were present in 40.9% of COVID-19-positive and 16.7% of COVID-19-negative patients.
T65 8748-8802 Sentence denotes There were no electrographic seizures in either group.
T66 8803-9187 Sentence denotes There are now numerous case reports describing seizures and other paroxysmal events in association with COVID-19.23 Individual reports include a new-onset generalized tonic clonic seizure during likely COVID-19 presentation,24 focal status epilepticus,25 seizures in critically ill patients,26 and COVID-19 presenting with paroxysmal events (possibly seizures) in a 6-week-old male.27
T67 9188-9337 Sentence denotes As compared to population-based studies of the initial clinical presentation of COVID-19, studies in patients with seizures and epilepsy are lacking.
T68 9338-9470 Sentence denotes However, available studies are consistent with the general concept that seizures and epilepsy are infrequently worsened by COVID-19.
T69 9471-9686 Sentence denotes Case studies, despite their inherent drawbacks in accounting for the multifactorial causes of seizures and epilepsy, highlight that some patients will present with seizures early in the course of COVID-19 infection.
T70 9688-9695 Sentence denotes Summary
T71 9696-9800 Sentence denotes Multiple reports on COVID-19 show that neurological complications are most associated with severe cases.
T72 9801-10059 Sentence denotes Individual case reports provide helpful details of acute symptomatic seizures during the clinical course of COVID-19 infection, but overall leave open the question as to whether systemic complications or direct CNS SARS-CoV-2 virus infections cause seizures.
T73 10060-10347 Sentence denotes While a neuroinvasive mechanism of SARS-CoV-2 virus CNS infection remains a postulated cause of clinical neurological disease,16 investigation of new-onset neurological impairments associated with COVID-19 found lack of evidence for direct acute insult of SARS-CoV-19 virus to the CNS.28
T74 10348-10559 Sentence denotes There is no conclusive evidence from cohort studies that seizures due to epilepsy are worsened in COVID-19 patients, but there are few cohort studies focusing on patients with a history of seizures and epilepsy.
T75 10560-10849 Sentence denotes Among the multiple systemic and environmental factors related to COVID-19 infection causing seizures, the underlying susceptibility for seizures due to epilepsy is likely the most significant factor.1 Therefore, there is a need for further studies evaluating COVID-19 in epilepsy patients.
T76 10850-11056 Sentence denotes However, clinical experience with seizures and epilepsy in general indicates that exacerbation of seizures, especially from systemic effects such as those caused by severe COVID-19, will be a major concern.
T77 11057-11277 Sentence denotes Given this likelihood, health care providers should take extra care to assist their patients in preventing potential COVID-19 infection and closely monitor epilepsy patients with COVID-19 for worsening of their seizures.