Afebrile benign convulsions with or without a reversible splenial lesion in two pediatric patients with COVID-19

Area of Science:

• Neurology
• Pediatrics
• Infectious Diseases

Background:

• Coronavirus disease 2019 (COVID-19) cases, particularly during the Omicron variant surge, showed a significant increase in seizures among children.
• While most COVID-19-related seizures occurred with fever, new-onset afebrile seizures were infrequently reported, necessitating further investigation into their clinical course.

Observation:

• Two pediatric patients with COVID-19 experienced recurrent afebrile seizures post-fever resolution.
• Seizures were bilateral, convulsive, lasted approximately one minute, and occurred multiple times within a few hours, with patients remaining alert between episodes.
• Brain MRI revealed a reversible splenial lesion in one patient, with normal EEG findings and slightly elevated serum uric acid.

Findings:

• The observed afebrile seizures in COVID-19 patients were characterized by their benign nature and lack of severe neurological compromise.
• The clinical presentation and imaging findings, including reversible splenial lesions, suggest a condition akin to 'benign convulsions with mild gastroenteritis'.

Implications:

• These findings suggest that COVID-19-associated afebrile seizures, especially those with reversible splenial lesions, may not require prolonged antiseizure medication.
• Further research is warranted to fully understand the long-term outcomes and management strategies for these specific seizure types in pediatric COVID-19 cases.