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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Case report
Non-convulsive status epilepticus: COVID-19 or clozapine induced?
  1. Elisaveta Sokolov1,
  2. Shahrzad Hadavi1,
  3. Laura Mantoan Ritter2 and
  4. Franz Brunnhuber1
  1. 1Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom
  2. 2Department of Neurology, King's College Hospital, London, United Kingdom
  1. Correspondence to Dr Elisaveta Sokolov; elisaveta.sokolov{at}nhs.net

Abstract

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.

  • clinical neurophysiology
  • epilepsy and seizures
  • infection (neurology)

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2020-239015

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    Footnotes

    • Contributors All authors including ES, SH, LM and FB take full responsibility for the data collection, the analyses and interpretation of the data, and the conduct of the research. All four authors listed above contributed to the data analysis and interpretation, the conduct of the research and the discussion and conclusions outlined within the article.The corresponding author (ES) has full access to all of the data; and the author has the right to publish any and all data separate and apart from any sponsor. All authors and contributors have agreed to conditions noted by BMJ Case Reports. Consent forms from all participant in this study have been received and they are on file in case they are requested by the editor. The work described is consistent with the Journal’s guidelines for ethical publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.