Iran Red Crescent Med J. 2020 March; 22(3):e102828.
Published online 2020 March 28.
Frequent Convulsive Seizures in an Adult Patient with COVID-19: A
Narges Karimi 1, * , Athena Shariﬁ Razavi2and Nima Rouhani 2
1Immunogenetics Research Center, School of Medicine, Clinical Research Development Unit of Bou Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
2School of Medicine, Clinical Research Development Unit of Bou Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
*Corresponding author: Bou Ali Sina Hospital, Pasdararn Blvd, Postal code: 4815838477, Sari, Iran. Tel: +98-1133343018 , Fax: +98-1133344506, Email: email@example.com
Received 2020 March 18; Revised 2020 March 23; Accepted 2020 March 24.
Introduction: Coronavirus disease 2019 (COVID-19) is a novel coronavirus that was extracted from patients with respiratory tract
infections. The most common symptoms of patients are fever and respiratory tract involvement. In this report, we describe one
patient with frequent seizures probably due to COVID-19 infection for the ﬁrst time.
Case Presentation: A 30-year-old previously healthy female was admitted with generalized tonic-clonic seizure in the neurology
emergency room. The patient complained of dr y cough ﬁve days before the admission. She had seizures (ﬁve times) approximately
every 8 hours. Brain MRI was normal and chest CT revealed focal ground-glass opacities. The respiratory specimen was positive for
COVID-19 using real-time PCR assay. The symptoms of the patient improved with anticonvulsive and antiviral medications.
Conclusions: Tothe best of our knowledge, this is the ﬁrst case study to report an association between frequent seizures and COVID-
19. In our opinion, there is a hypothesis about this subject that the etiology of seizure may be due to encephalitis and invasion virus
to the brain or toxic eﬀect of inﬂammatory cytokines.
Keywords: Seizure, COVID-19, Novel Coronavirus, Case Report, Convulsion
Coronavirus disease 2019 (COVID-19) is a novel coron-
avirus that was extracted from patients with respiratory
tract infection of unknown causes on December 31, 2019,
in Wuhan, Hubei, China (1-3). The infected patients’ symp-
toms ranged from asymptomatic to severe (4). The most
common complaints of patients are fever (98%), cough
(76%), dyspnea (55%), myalgia, and fatigue (44%) (5-7). Some
pieces of evidence reported gastrointestinal involvement,
acute cardiac injury, and acute kidney injury due to COVID-
19 (7,8). Mao et al. (9) reported neurological manifesta-
tions of patients with COVID-19. The most common symp-
toms were dizziness, headache, hypogeusia, and hypos-
mia (9). Severe patients had ischemic or hemorrhagic
stroke, and loss of consciousness (9). At this time, the like-
lihood of COVID-19 should be considered primarily in pa-
tients with fever and/or respiratory tract symptoms who
had close contact with a conﬁrmed or suspected patient
of COVID-19 (1). Real-time polymerase chain reaction (real-
time PCR) and next-generation sequencing were used for
deﬁnitive diagnosis of this novel coronavirus (5). To the
best of our knowledge, up to now, no seizure was reported
due to COVID-19. In this report, we describe one patient
with frequent seizures probably owing to COVID19 for the
2. Case Presentation
A 30-year-old previously healthy female was admit-
ted with generalized tonic-clonic seizure in the neurol-
ogy emergency room in Bou Ali Sina Hospital, Mazandaran
Province, Iran. The patient had no history of drug and alco-
hol abuse. She complained of dry cough ﬁve days before
admission. Three days prior to admission, she had fever
(T = 38°C axillary) and fatigue. The ﬁrst generalized tonic-
clonic seizure (GTC) of the patient occurred in the sleep,
two days before the admission. Then, recurrent seizures
(ﬁve times) happened approximately every 8 hours. Also,
one seizure attack arose in the hospital, at the admission
time. As the seizure ended, the patient was sleepy and con-
fused for thirty minutes to one hour. The patient was con-
scious between attacks. She neither had a history of epilep-
tic seizures nor a family history concerning seizure disor-
ders. At the time of hospitalization in the Emergency De-
partment, the body temperature was 38.8°C, blood pres-
sure 130/70 mmHg, heart rate 98 beats/minute, respiratory
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Karimi N et al.
rate 20/minute and oxygen saturation of 96% on room air.
The bedside serum glucose level was 108 mg/dL. In terms
of neurological examination, the patient was drowsy with
disorientation to time. The cranial nerves were intact.
Pupils were midsize and reactive to light and accommo-
dation. There was no optic disc swelling bilaterally. The
patient was able to move all four extremities and there
was no stiﬀ neck and nuchal rigidity. Deep tendon reﬂexes
were normal. Considering general examination, no skin
rash was observed and other systems, including cardiac
and abdominal examination, were normal. Primary labo-
ratory tests discovered a normal blood sugar, electrolytes,
calcium, phosphor, magnesium, liver function test, urea,
and creatinine. The blood sample revealed the following
results: white blood cell count 5,500 cells per microliter
with 26% lymphocytes and 70% neutrophils, mildly ele-
vated erythrocyte sedimentation rate (ESR = 35 mm/hour),
and normal C-reactive protein (CRP). Lumbar puncture was
done and the cerebrospinal ﬂuid (CSF) showed normal pro-
tein, glucose, with ﬁve cell counts (all of them were lym-
phocytes). There was no bacterial growth after 48 hours of
incubation. Brain MRI was normal. Given that the patient
had cough and fever, the chest computed tomography (CT)
was done and revealed focal ground-glass opacities (Fig-
ure 1). Respiratory specimens, including nasal and phar yn-
geal swabs, and CSF sample were tested for COVID-19 using
real-time PCR in the Health Center no. 5 (Shahid Ghasemi)
Laboratory. This center is under the supervision of Mazan-
daran University of Medical Sciences. Nasal and pharyn-
geal samples were positive for COVID-19. The CSF sample
was unremarkable for COVID-19 infection. The patient was
treated with intravenous phenytoin and levetiracetam. In
addition, the patient received chloroquine 200 mg BD and
Lopinavir-ritonavir 400/100 mg bd. The patient was mon-
itored for one week. Fever and seizure of the patient were
Coronavirus disease 2019 (COVID-19) is beta coron-
aviruses, similar to severe acute respiratory syndrome
coronavirus (SARS-CoV) in 2003 but with a diﬀerent mono-
phyletic group. Both viruses bind to receptor angiotensin-
converting enzyme 2 (ACE2) to enter the cell (10,11). The
most well-known clinical symptoms of this virus are respi-
ratory symptoms. Moreover, Mao et al. (9) described neu-
rological presentations of infected patients with COVID-19.
The most common reported symptoms were headache and
dizziness. In this report, we reported a case with COVID-19
and frequent seizures, with no past medical history. There
are many diﬀerent viruses that play a role in the develop-
ment of seizures and convulsions (12). The causes of seizure
Figure 1. Chest computer tomography in the patient with COVID-19 is shown
may be due to a primary infection or due to reactivation of
the latent virus. There are several mechanisms for the eti-
ology of seizure in the patients who suﬀer from viral infec-
tions, including direct inﬁltration of brain tissue and pro-
duction of toxins by the virus or production of inﬂamma-
tory mediators by the brain (13). Huang et al. (2) reported
that COVID-19 provokes the inﬂammatory cascade and as
a result, releases inﬂammatory cytokines, including inter-
leukins 2, 6, 7, and 10, tumor necrotizing αand the granu-
locyte colony-stimulating factor. Previous studies reported
that TNF-αand IL-6 cytokines and C3 of the complement
system are the main factors of stimulating the immune sys-
tem. Consecutively, these cytokines can drive neuronal hy-
perexcitability via activation of glutamate receptors and
play a role in the development of acute seizures(14-16).
To the best of our knowledge, this is the ﬁrst case study
that reports an association between frequent seizures and
COVID-19. In our opinion, there is a hypothesis about this
subject that the etiology of seizure may be encephalitis
and the invasion of the virus to the brain or toxic eﬀect of
We thank the patient for her consent to publish the
2Iran Red Crescent Med J. 2020; 22(3):e102828.
Karimi N et al.
Authors’ Contribution: Study concept and design:
Narges Karimi and Nima Rouhani. Interpretation of
data: Narges Karimi and Athena Shariﬁ Razavi. Drafting
of the manuscript: Narges Karimi. Critical revision of
the manuscript for important intellectual content: Nima
Rouhani and Athena Shariﬁ Razavi.
Conﬂict of Interests: No conﬂict of interest was reported
regarding this case report.
Ethical Approval: Mazandaran University of Medical Sci-
ences approved the publication of this case report.
Funding/Support: Not applicable.
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