What to know about seizures and COVID-19

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Anybody can acquire the SARS-CoV-2 infection and develop COVID-19. However, some individuals may be at a higher risk of COVID-19 and its potential complications. These people include those who are older, have a weakened immune system, or have underlying health conditions, such as diabetes, chronic respiratory diseases, or cancer.

Experts have known that coronaviruses, such as SARS-CoV-2, can attack the nervous system. A retrospective 2020 case series notes that 36.4% of the participants with COVID-19 had neurological manifestations, which sometimes included seizures.

COVID-19 can also cause symptoms, including fever, lack of sleep, and tiredness, that may trigger seizures and make them longer and more intense. However, a 2020 review suggests that the risk of having COVID-19-related seizures is low unless a person is critically ill or in the terminal stage of the illness.

A 2019 study also found that 8–34% of all critically ill patients have seizures, regardless of COVID-19. These individuals can experience severe symptoms, such as low oxygen levels in the blood, shock, hypoglycemia, hyperglycemia, metabolic and electrolyte imbalance, and multiorgan damage, all of which, can cause seizures.

A 2021 study also indicates that people with COVID-19 and inflammation of the brain or the membranes that surround it — known as encephalitis and meningitis, respectively — commonly experience seizures.

Epilepsy is a neurological condition that causes repeated seizures.

The International League Against Epilepsy (ILAE) mentions that a person living with epilepsy who develops COVID-19 has a low risk of their typical seizures becoming worse.

This is possible because illnesses, particularly with a fever, can stress the body and increase the risk and frequency of seizures.

However, the ILAE also states that there is currently no evidence that people with epilepsy have an increased risk of SARS-CoV-2 infection.

The organization adds that unless an individual has a compromised immune system or other ongoing medical challenges, epilepsy is unlikely to increase the risk of complications from the virus. It also notes that anti-seizure medications do not increase the risk of infection or complications.

Should people with epilepsy get the vaccine?

A joint statement from the ILAE and the International Bureau for Epilepsy (IBE) affirms that all individuals with epilepsy should still receive the COVID-19 vaccine unless they are allergic to its ingredients.

Currently, no evidence indicates an association between epilepsy and a higher risk of potential COVID-19 vaccine side effects, including seizures. A 2021 study in Germany found that the vaccine is well-tolerated by people with epilepsy, with only 2 out of 54 patients experiencing epilepsy-related side effects.

However, a common vaccine side effect is a fever, which could lower the seizure threshold in some people. Taking paracetamol or acetaminophen regularly for 48 hours after the vaccine or for the duration of the fever should minimize this risk.

Most health experts advise that for people with epilepsy, the risk of COVID-19 and its potential complications far outweighs the possible risk of vaccine side effects.

Does COVID-19 treatment interfere with epilepsy medication?

The ILAE states that there is no evidence to suggest that anti-seizure medications may increase the risk of SARS-CoV-2 infection or possible complications.

Although a 2020 study highlights the importance of considering potential adverse effects and drug interactions in people with epilepsy who acquire a SARS-CoV-2 infection, most guidelines advise that people maintain a regular supply of medication to minimize their risk of seizure exacerbation.

Seizures may sometimes be a symptom of COVID-19 in children. According to research by the American Academy of Pediatrics (AAP), about 7% of children experience neurological symptoms from COVID-19, which can include seizures.

A systematic retrospective study conducted in 2021 found that seizures can occur in children as young as 6 months old following a COVID-19 infection.

However, only 11 of the 175 children in the study were found to experience seizures, suggesting that seizures may not be so common.

On the other hand, these seizures can occur even if the child does not have a fever and is not living with epilepsy. Other research looking at three children seems to support that seizures can occur in children with COVID-19, particularly the omicron variant.

Can COVID-19 cause febrile seizures in children?

Febrile seizures result from a rise in body temperature due to infection or inflammation. They are different from epileptic seizures and may affect anyone, though they are more common in children.

A 2022 study found that among 8,854 pediatric patients, only 0.5% of the children received a diagnosis of febrile seizures while treated for COVID-19, suggesting this phenomenon is likely rare.

There have been occasional reports of people having seizures for the first time after recovering from COVID-19. A case study suggests that seizures may be a potential manifestation of long COVID.

A 2020 case study reports on a person experiencing refractory status epilepticus due to post-infectious inflammation after recovering from COVID-19.

Another case study from 2021 describes a person experiencing an epileptic seizure after recovering from COVID-19.

The best way to prevent seizures due to SARS-CoV-2 infection is to avoid and limit exposure to the virus, as much as possible. The Centers for Disease Control and Prevention (CDC) recommends that people help protect themselves and others by:

• staying up to date with COVID-19 vaccinations
• wearing a mask
• observing physical distancing
• limiting their attendance at poorly ventilated areas and crowded places
• washing their hands often
• cleaning and disinfecting surfaces regularly
• observing proper coughing and sneezing etiquette
• accomplishing daily health monitoring

People who find that fever, infection, and stress trigger their seizures may wish to consult a doctor for specific recommendations and an action plan.

It is advisable for people with epilepsy to avoid crowded spaces, continue with their medical appointments, take their medications as prescribed, and ensure that they have an ample supply of medication.

If a person has a loved one with epilepsy living in a long-term care facility or group setting, they should confirm the safety precautions with the facility and ask the healthcare team whether any adjustments are necessary.

If a person has received a diagnosis of epilepsy and they think they may have COVID-19, they should see a doctor. If a person experiences a seizure they have never had before, they should go to the emergency room to rule out any serious conditions and be tested for the virus.

If a person does not have any seizure-like symptoms, they can also take a home antigen test, as these are fairly reliable, detecting the virus about 80% of the time.

If a person tests negative at home but still has a fever or difficulty breathing, they may still want to see a doctor to rule out COVID-19. In the meantime, they should self-isolate until they can confirm whether or not they have the virus.

Meanwhile, a person should follow the most current guidelines from the CDC for isolation and quarantine. These guidelines may depend on the person’s COVID-19 vaccination status.

Some evidence suggests that seizures may be a rare neurological symptom that can occur during SARS-CoV-2 infection or after COVID-19 recovery.

People living with epilepsy do not have an increased risk of SARS-CoV-2 infection or complications of COVID-19. Health experts advise that individuals receive the vaccine and continue taking anti-seizure medications.