Carroll Elizabeth, Melmed Kara R, Frontera Jennifer, Placantonakis Dimitris G, Galetta Steven, Balcer Laura, Lewis Ariane
Department of Neurology, NYU Langone Medical Center, New York, NY, USA.
Department of Neurology, NYU Langone Medical Center, New York, NY, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA.
Seizure. 2021 Jul;89:99-106. doi: 10.1016/j.seizure.2021.05.003. Epub 2021 May 17.
We reviewed the literature on cerebrospinal fluid (CSF) studies in patients who had a seizure in the setting of COVID-19 infection to evaluate for evidence of viral neuroinvasion. We performed a systematic review of Medline and Embase to identify publications that reported one or more patients with COVID-19 who had a seizure and had CSF testing preformed. The search ranged from December 1st 2019 to November 18th 2020. We identified 56 publications which described 69 unique patients who met our inclusion criteria. Of the 54 patients whose past medical history was provided, 2 (4%) had epilepsy and 1 (2%) had a prior seizure in the setting of hyperglycemia, but the remaining 51 (94%) had no history of seizures. Seizure was the initial symptom of COVID-19 for 15 (22%) patients. There were 26 (40%) patients who developed status epilepticus. SARS-CoV-2 PCR testing was performed in the CSF for 45 patients; 6 (13%) had a positive CSF SARS-CoV-2 PCR, only 1 (17%) of whom had status epilepticus. The cycle thresholds were not reported. Evaluation for CSF SARS-CoV-2 antibodies (directly or indirectly, via testing for CSF oligoclonal bands or immunoglobulins) was performed in 26 patients, only 2 (8%) of whom had evidence of intrathecal antibody synthesis. Of the 11 patients who had CSF autoimmune antibody panels tested, 1 had NMDA antibodies and 1 had Caspr-2 antibodies. Detection of SARS-CoV-2 in the CSF of patients with seizures who have COVID-19 is uncommon. Our review suggests that seizures in this patient population are not likely due to direct viral invasion of the brain.
我们回顾了关于新型冠状病毒肺炎（COVID-19）感染患者发生癫痫发作时脑脊液（CSF）研究的文献，以评估病毒神经侵袭的证据。我们对医学文献数据库（Medline）和荷兰医学文摘数据库（Embase）进行了系统检索，以确定报告了1例或更多例COVID-19患者发生癫痫发作且进行了CSF检测的出版物。检索时间范围为2019年12月1日至2020年11月18日。我们确定了56篇出版物，其中描述了69例符合我们纳入标准的独特患者。在提供既往病史的54例患者中，2例（4%）有癫痫病史，1例（2%）在高血糖情况下曾有过癫痫发作，但其余51例（94%）无癫痫发作史。癫痫发作是15例（22%）患者COVID-19的首发症状。有26例（40%）患者发生了癫痫持续状态。对45例患者的CSF进行了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）聚合酶链反应（PCR）检测；6例（13%）CSF SARS-CoV-2 PCR呈阳性，其中只有1例（17%）发生了癫痫持续状态。未报告循环阈值。对26例患者进行了CSF SARS-CoV-2抗体评估（直接或间接，通过检测CSF寡克隆带或免疫球蛋白），其中只有2例（8%）有鞘内抗体合成的证据。在11例进行了CSF自身免疫抗体检测的患者中，1例有N-甲基-D-天冬氨酸（NMDA）抗体，1例有接触蛋白相关蛋白2（Caspr-2）抗体。在患有COVID-19且发生癫痫发作的患者CSF中检测到SARS-CoV-2并不常见。我们的综述表明，该患者群体中的癫痫发作不太可能是由于病毒直接侵袭大脑所致。
