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Association of Clinical, Biological, and Brain Magnetic Resonance Imaging Findings With Electroencephalographic Findings for Patients With COVID-19

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To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Can electroencephalography (EEG), combined with clinical, biological, and magnetic resonance imaging (MRI) analyses, help to better characterize patients with neurologic coronavirus disease 2019 (COVID-19) and diagnose specific COVID-19–related encephalopathy?

Findings  Neurologic manifestations, biological findings, EEG findings, and brain MRI images were analyzed in a cohort study of 78 adult patients with COVID-19. Nine patients had no identified cause of brain injury, as revealed by biological and MRI findings; their injury was defined as COVID-19–related encephalopathy.

Meaning  This study suggests that, although neurologic manifestations, EEG findings, and MRI findings may appear heterogeneous and nonspecific, multimodal monitoring may better identify patients with COVID-19–related encephalopathy and guide treatment strategy.

Abstract

Importance  There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19–related encephalopathy and guide clinical management.

Objectives  To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19–related encephalopathy.

Design, Setting, and Participants  This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020.

Exposures  Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription–polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest.

Main Outcomes and Measures  Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records.

Results  Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter–enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19–related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter–enhancing lesions.

Conclusions and Relevance  The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19–related encephalopathy and guide treatment strategy.

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Article Information

Accepted for Publication: January 22, 2021.

Published: March 15, 2021. doi:10.1001/jamanetworkopen.2021.1489

Correction: This article was corrected on June 16, 2022, to include the nonauthor collaborator names in a supplement.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Lambrecq V et al. JAMA Network Open.

Corresponding Author: Virginie Lambrecq, MD, PhD, Sorbonne Université, Assistance Publique des Hôpitaux de Paris, Neurophysiology Department, GH Pitié-Salpêtrière-Charles Foix, 47-83 Boulevard de l’Hôpital, Paris 75013, France (virginie.lambrecq@aphp.fr).

Author Contributions: Drs Lambrecq and Hanin had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Lambrecq and Hanin contributed equally to this work as co–first authors.

Concept and design: Lambrecq, Hanin, Munoz-Musat, Damiano, Lubetzki, Naccache, Navarro.

Acquisition, analysis, or interpretation of data: Lambrecq, Hanin, Munoz-Musat, Chougar, Gassama, Delorme, Cousyn, Borden, Frazzini, Huberfeld, Landgraf, Nguyen-Michel, Pichit, Sangare, Chavez, Morélot-Panzini, Morawiec, Raux, Luyt, Rufat, Galanaud, Corvol, Rohaut, Demeret, Pyatigorskaya, Navarro.

Drafting of the manuscript: Lambrecq, Hanin, Munoz-Musat, Nguyen-Michel, Navarro.

Critical revision of the manuscript for important intellectual content: Lambrecq, Chougar, Gassama, Delorme, Cousyn, Borden, Damiano, Frazzini, Huberfeld, Landgraf, Nguyen-Michel, Pichit, Sangare, Chavez, Morélot-Panzini, Morawiec, Raux, Luyt, Rufat, Galanaud, Corvol, Lubetzki, Rohaut, Demeret, Pyatigorskaya, Naccache, Navarro.

Statistical analysis: Hanin, Cousyn, Pichit, Rufat, Pyatigorskaya.

Obtained funding: Corvol.

Administrative, technical, or material support: Lambrecq, Munoz-Musat, Morélot-Panzini, Galanaud, Corvol.

Supervision: Lambrecq, Hanin, Frazzini, Landgraf, Corvol, Naccache, Navarro.

Conflict of Interest Disclosures: Dr Huberfeld reported receiving personal fees from Advicenne, GW Pharma, and EISAI outside the submitted work. Dr Morélot-Panzini reported receiving personal fees from Astra-Zeneca, GSK, SOS Oxygène, ADEP, ISIS, Resmed, Chiesi, Menarini, Vivisol, Air Liquide, and Lowenstein outside the submitted work. Dr Raux reported receiving personal fees from Chiesi outside the submitted work. Dr Luyt reported receiving personal fees from Bayer Healthcare, Merck, ThermoFischer Brahms, Carmat, and Biomérieux outside the submitted work. Dr Corvol reported receiving grants from Fédération Internationale pour l’Automobile and Investissements d’avenir program during the conduct of the study; personal fees from Biogen, UCB, Prevail Therapeutic, Idorsia, Ever Pharma, Denali, Air Liquide, and Theranexus; and grants from Sanofi outside the submitted work. Dr Lubetzki reported receiving personal fees from Biogen, Merck-Serono, Roche, Rewind, and Ipsen outside the submitted work. Dr Pyatigorskaya reported receiving personal fees from GE Healthcare and Biogen; and grants from ANR outside the submitted work. Dr Navarro reported receiving personal fees from UCB Pharma, Liva Nova, and EISAI outside the submitted work. No other disclosures were reported.

Funding/Support: The Cohort COVID-19 Neurosciences (CoCo Neurosciences) study was sponsored by Assistance Publique des Hôpitaux de Paris and funded by the Fédération Internationale pour l’Automobile Foundation and donors of the Paris Brain Institute–ICM. This work received support from the Investissements d’avenir program (grant ANR-10-IAIHU-06), from the Fondation pour la Recherche Médicale (grant FDM20170839111), and from the Fondation Assistance Publique-Hôpitaux de Paris (EPIRES-Marie Laure PLV Merchandising) for the conduct of the study.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: The Cohort COVID-19 Neurosciences (CoCo Neurosciences) Study Group Members are listed in Supplement 2.

Additional Contributions: Aurore Besnard, PhD, Neurophysiology Department, Pitié-Salpêtrière Hospital, and Meriem Bouguerra, Paris Brain Institute, assisted with data recording; they were not compensated for their contributions. We thank the EEG technicians, the Cohort COVID-19 Neurosciences (CoCo Neurosciences) and the COVID SMIT PSL study groups for their participation to conduct the study and to data collection.

Additional Information: All anonymized data are available on request.

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