Seizures as the main presenting manifestation of acute SARS-CoV-2 infection in children

Seizure. 2021 Nov;92:89-93. doi: 10.1016/j.seizure.2021.08.017. Epub 2021 Aug 28.


Objectives: To explore the rate, characteristics, risk factors, and prognosis of children presenting with seizures as the main symptom of acute COVID-19 (coronavirus disease 2019).

Methods: We conducted a systematic retrospective study to identify all children who presented to the emergency departments of a tertiary academic medical center between March 1st and December 31st 2020 and had a SARS-CoV-2 infection based on RT-PCR (reverse transcription-polymerase chain reaction) from nasopharyngeal swab. Clinical and demographic data were extracted from the electronic medical records and reviewed.

Results: Total of 175 children were diagnosed with acute SARS-CoV-2 infection in the emergency departments during the study period. Of those, 11 presented with seizures. Age ranged from six months to 17 years and 4 were girls. Five presented with status epilepticus and responded to loading doses of anti-seizure medications. Six had fever. Seven had prior history of neurological disorder. Full recovery was the rule.

Significance: Unlike in adults, seizures occur early and may be the main manifestation of acute COVID-19 in children. Seizures, including status epilepticus, may occur without fever even in children with no history of epilepsy and are not associated with severe disease. A high index of suspicion is required for early diagnosis thus infection control measures can be taken.

Keywords: COVID-19; SARS-CoV-2; Seizures; Status epilepticus.

MeSH terms

  • Adult
  • COVID-19*
  • Child
  • Female
  • Humans
  • Infant
  • Retrospective Studies
  • SARS-CoV-2
  • Seizures / diagnosis
  • Seizures / drug therapy
  • Seizures / epidemiology
  • Status Epilepticus*