Covid-19 and Epilepsy

Dr( Col) Joy Dev Mukherji, MD:DM;FRCP(Edin), Principal Director and Head department of Neurology, Max Super Specialty Hospital, Saket New Delhi

BRAND CONNECT

Published: Jun 14, 2021 03:55:53 PM IST

Updated: Jun 16, 2021 10:50:38 AM IST

Neurological complications following COVID-19 are being reported in large numbers .Among 236 379 patients diagnosed with COVID-19, the estimated incidence of a neurological or psychiatric diagnosis in the following 6 months was 33•62% as reported by Maxime Taquet et al in Lancet Psychiatry 2021; 8: 416–27.

The neurologic manifestations of the disease can be classified into central nervous system (CNS) symptoms and peripheral nervous system (PNS) symptoms.The common neurological conditions associated with Covid-19 infection include:

Delirium ,
Confusion ( Brain Fog)
Loss of sense of smell and taste,
Weakness of limbs due to myelin loss of nerves
Stroke
Epilepsy

Mechanism of Central Nervous System (CNS) Involvement

SARS-CoV-2 uses its spike protein (S-protein) to bind to angiotensin-converting enzyme 2 (ACE2), which the functional receptor of the virus. This results in cleavage of the S-protein. This results in attachment of the virus to the human cell membrane and subsequent entry of the viral genome into the cell. The host cell then propagates the virus as well as mounts the immune response .

There are three proposed routes for direct CNS invasion and injury, as well as several suggested mechanisms for indirect neurologic injury (Nordvig AS et al. Potential neurological manifestations of COVID-19. Neurol Clin Pract. 2020 Jun 30: Epub)

The proposed direct CNS mechanisms are

1. Infection of the peripheral nerve, which may occur via entry through the olfactory nerve covering by way of the olfactory nerve to the olfactory bulb, entry into the neurons in a direct manner, and retrograde nerve transmission;

2. Disruption of the blood-brain barrier (BBB) .BBB separates the brain from the general circulation.

3. The Trojan horse entry method, wherein virally infected immune cells covertly pass through the BBB to the CNS. In addition, the virus can exert injury by way of inflammation, demyelination, endothelial invasion, and hypoxia. Regardless of the mechanism of entry and damage, the subsequent neurologic manifestations profoundly impact patients.

Epilepsy in Covid

Epilepsy in Covid usually happens secondary to:

Encephalitis (Inflammation of the Brain ),
Encephalopathy (Toxic substances in the milieu of the Brain or lack of oxygen,salt etc),
Drug induced by medications used in treatment of Covid
Missing out medication in those with previous history of Epilepsy and on drugs
Reactivation of epileptic focus in the brain by Covid virus infection
Secondary to stroke caused by Covid infection

Special precautions

Those on antiepileptic drugs must continue their anti-epileptic medications. It’s a usual practice to initiate anti-epileptic medications prophylactically in those who are vulnerable like patients with Encephalitis. Airway protection is a must to avoid choking.

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