Electroencephalography at the height of a pandemic: EEG findings in patients with COVID-19

Clin Neurophysiol. 2022 May;137:102-112. doi: 10.1016/j.clinph.2022.03.001. Epub 2022 Mar 7.


Objective: To characterize continuous video electroencephalogram (VEEG) findings of hospitalized COVID-19 patients.

Methods: We performed a retrospective chart review of patients admitted at three New York City hospitals who underwent VEEG at the peak of the COVID-19 pandemic. Demographics, comorbidities, neuroimaging, VEEG indications and findings, treatment, and outcomes were collected.

Results: Of 93 patients monitored, 77% had severe COVID-19 and 40% died. Acute ischemic or hemorrhagic stroke was present in 26% and 15%, respectively. Most common VEEG indications were encephalopathy/coma (60%) and seizure-like movements (38%). Most common VEEG findings were generalized slowing (97%), generalized attenuation (31%), generalized periodic discharges (17%) and generalized sharp waves (15%). Epileptiform abnormalities were present in 43% and seizures in 8% of patients, all of whom had seizure risk factors. Factors associated with an epileptiform VEEG included increasing age (OR 1.07, p = 0.001) and hepatic/renal failure (OR 2.99, p = 0.03).

Conclusions: Most COVID-19 patients who underwent VEEG monitoring had severe COVID-19 and over one-third had acute cerebral injury (e.g., stroke, anoxia). Seizures were uncommon. VEEG findings were nonspecific.

Significance: VEEG findings in this cohort of hospitalized COVID-19 patients were those often seen in critical illness. Seizures were uncommon and occurred in the setting of common seizure risk factors.

Keywords: COVID-19; EEG; Electroencephalography; Seizures; neuroCOVID.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • COVID-19*
  • Electroencephalography / methods
  • Humans
  • Pandemics*
  • Retrospective Studies
  • Seizures / diagnosis
  • Seizures / epidemiology