Can COVID-19 Cause Seizures?

Seizures are an uncommon complication of COVID-19 and occur in fewer than 1% of people.

There has been no definitive association between COVID-19 and seizures, and researchers are still investigating the strength of the relationship and the possibility of a chance relationship.

How COVID-19 may cause seizures

There are a few potential ways that the SARS-CoV-2 virus may trigger seizures.

Viruses that target nerve tissue are called neurotropic viruses. Current research suggests that the SARS-CoV-2 virus doesn’t seem to be highly neurotropic, but there are still several ways it may directly or indirectly lead to seizures.

• Hypoxia: Severe COVID-19 can cause hypoxia, or low oxygen levels in your tissues. In one study, researchers found that hypoxia could potentially trigger anoxic encephalopathy (lack of blow flow to the brain), which could trigger seizures.
• Fever: Fever is one of the most common symptoms of COVID-19. Fever can cause febrile seizures in children.
• Psychological factors: According to the Epilepsy Foundation, emotional stress can trigger seizures. Emotional stress that develops because of COVID-19 could theoretically contribute to seizure development.
• Inflammation: COVID-19 can trigger an inflammatory reaction and a “cytokine storm,” which is the overproduction of pro-inflammatory molecules called cytokines. Some pro-inflammatory cytokines can cause neuron hyperexcitability and potentially result in seizures. In particular, interleukin-6 is associated with febrile seizures.
• Direct invasion of your central nervous system: The SARS-CoV-2 virus can potentially reach your brain and cause damage that contributes to seizure development. It may reach your brain by:
  • infecting cells that line the blood-brain barrier
  • binding to angiotensin-converting enzyme 2 receptors lining your blood-brain barrier or the tissue surrounding your brain called the menges
  • through the olfactory tract, the nerves that control your sense of smell
• Other factors: Other factors like electrolyte imbalances and fluxes in blood sugar levels also have the potential to trigger seizures.

Research examining the connection between seizures and COVID-19.

In an August 2022 review of studies, researchers found that 2.2% of 11,526 people hospitalized with COVID-19 presented with seizures. About one-third of these people had a previous history of epilepsy.

In a March 2022 study from South Korea, researchers found that 6 out of 1,487 people hospitalized with COVID-19 developed new-onset seizures. Those were among 169 people admitted to the intensive care unit with severe or critical COVID-19 requiring intensive care and mechanical ventilation. The incidence of new-onset seizures in this severely ill subgroup was 3.6%.

In an October 2022 study from Sweden, researchers analyzed the risk of epilepsy in 1.2 million people with COVID-19 and an equal number of people in a control group.

The researchers found that COVID-19 infection was not linked to an increased risk of epilepsy overall, but there was a moderately increased risk in people over 60. The researchers concluded that the ability of the virus to induce epilepsy was likely very small.

There’s currently a lack of robust data on seizure development after COVID-19 infection.

However, in an August 2022 study, researchers found that among 1.3 million people who had COVID-19, the risk of seizures, brain fog, dementia, and psychotic disorders was still increased 2 years later.

According to the International League Against Epilepsy, research suggests that there’s a low risk of seizures getting worse for most people with epilepsy. Getting sick or having a fever, in general, can make seizures more frequent, however.

According to the researchers of a May 2022 study, COVID-19 vaccines may increase the likelihood of seizures due to the inflammation or sleep disruption that can follow vaccination.

However, the risk of developing seizures after vaccination is thought to be very small, and the benefits of getting vaccinated are thought to outweigh the risks. The risk of neurological complications after COVID-19 infection is up to 617 times higher than after COVID-19 vaccination.

In a May 2022 study using data from the Centers for Disease Control (CDC), researchers estimated that the incidence of seizures following COVID-19 vaccination was 3.19 per 100,000 people per year.They also estimated that the risk was 0.090 per 100,000 people per year for flu vaccines.

In a 2020 study, researchers identified seven people with COVID-19 who presented with seizures. Five of the people develop generalized tonic-clonic seizures. COVID-19 has also been linked to febrile seizures, which are seizures in children triggered by high fevers.

Older adults and people with multiple health conditions seem to be at the highest risk of developing seizures related to COVID-19.

In a July 2022 study, researchers assessed the risk of seizure among 17,806 people admitted to two hospitals in Adana, Turkey. The researchers discovered neurological symptoms in 877 of 17,806 people. Of these, 0.25% of people had seizures. Seizures were most common in people over 65 and in people with multiple other health conditions.

In the 2022 study from South Korea, each of the 1,487 people with confirmed COVID-19 who developed seizures had severe or critical disease.

Seizures in children after COVID-19

Seizures or convulsions have been reported in children with COVID-19, but they seem to be rare.

Unlike adults, some children may experience seizures as the main symptom of COVID-19. Seizures may occur in children with no history of epilepsy and aren’t associated with severe disease.

Some people have lingering COVID-19 symptoms for weeks or months after their infection. It’s a good idea to see a doctor if you have lingering symptoms for 4 weeks or more.

According to the International League Against Epilepsy, medical or hospital treatment might be needed if:

• a seizure lasts more than 5 minutes or occurs in clusters with no rescue medication available
• the seizure occurs in water
• the seizure causes prolonged symptoms such as confusion
• the seizure causes a potentially serious injury

It’s important to seek medical attention if you develop a seizure for the first time or develop a new type of seizure.

Treatment for seizures depends on whether there is a known cause. When the precipitating cause is known (such as a high fever, severe infection, or electrolyte imbalance), treatment strategies are focused on reversing the abnormality.

Most seizures have no known cause. In that situation, treatment depends on factors like the:

• type of seizures you have
• seizure frequency
• severity of seizures

Treatment often includes antiseizure medications. Finding the type of medication that’s most effective for you can be difficult and might be a matter of trial and error. Your doctor may recommend multiple medications.

Depending on the underlying cause and how you respond to medication, your doctor may also recommend:

• vagus nerve stimulation
• ketogenic diet
• brain surgery

COVID-19 has been linked to many types of neurological complications including seizures. Seizures aren’t common in people with COVID-19, and a definitive association hasn’t been made yet. The virus seems to primarily trigger seizures through indirect means, such as increased levels of pro-inflammatory molecules in your brain.

Seizures seem to be most common in people with severe COVID-19 and in older adults. There’s also some evidence that seizures may be a rare complication of COVID-19 vaccines. However, the chance of having seizures after a COVID-19 vaccination is very small compared to the chance of having them after COVID-19 infection.