NEUROLOGICAL INVOLVEMENT WITH COVID-19: Consider Continuous EEG Monitoring in Some Patients
As many of you are aware, much of what is known about this disease comes to us from the experience in Wuhan, China. There, in a recently drafted retrospective case series of 214 patients, it was found that the central nervous system manifestations included headache, dizziness, impaired consciousness, ataxia, acute cerebrovascular disease, and epilepsy were present in over 1/3 of the patients. Severe cases were even more likely to have neurological symptoms, with acute cerebrovascular diseases and impaired consciousness 6-7 times as likely in the severe cohort than in the non-severe cohort. The presence of impaired consciousness in the ICU setting, particularly in the setting of acute cerebrovascular injury, is a strong indication for continuous EEG monitoring, per the American Clinical Neurophysiology Society (ACNS) guidelines. There is expert consensus that appropriate use of cEEG reduces mortality.
The American Academy of Pediatrics just published a national retrospective case series on over 2000 children in China. Children, in general, have milder forms of COVID-19 infection than adults. However, the younger the child, the higher the likelihood of critical symptoms, including encephalopathy, with children under the age of one, at the greatest risk. Impairment of consciousness in critically ill children is also a strong indication for continuous EEG monitoring. This is supported by the published evidence for the benefit of cEEG monitoring in functional outcomes and reduced mortality in children.
We want to emphasize to both adult and pediatric ICU providers that when patients present with severe respiratory compromise during the COVID-19 pandemic and are exhibiting impaired consciousness, brain monitoring may be in order. If circumstances require, CortiCare is fully equipped, ready and able to provide scalable remote monitoring services when needed for surge capacity.
Mao L, Wang M, Chen S, et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: A retrospective case series study. medRxiv 2020; Epub 2020 Feb 25. https://www.medrxiv.org/content/10.1101/2020.02.22.20026500v1
Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020; doi: 10.1542/peds.2020-0702
https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf
Nicholas S. Abend, Daniel H. Arndt, Jessica L. Carpenter, et al. Electrographic seizures in pediatric ICU patients: Cohort study of risk factors and mortality. Neurology 2013;81;383-391