Case presentation
A 29-year-old female was brought to the emergency department with frequent episodes of generalized tonic-clonic seizures. There was no history of prior seizure, headache, behavioral change, hemiparesis, and any other neurological symptoms. Likewise, she had no other symptoms regarding involvement of other organs by COVID-19 at the time of admission. The seizures were stopped with a loading dose of levetiracetam (3000 mg per day). Initial brain and chest computed tomography scans as well as brain magnetic resonance imaging with and without contrast did not show any abnormality (Figure 1). Using the real-time polymerase chain reaction (RT-PCR) test, the nasopharyngeal swab sample was positive for SARS-CoV-2. CSF analysis indicated normal opening pressure with normal glucose and protein levels. The CSF culture was negative for different microorganisms. Antibodies responsible for autoimmune encephalitis were also negative. However, the RT-PCR test for SARS-CoV-2 in the CSF was positive. The electroencephalogram revealed epileptiform discharges in bilateral temporal areas (figure 2). The summary of the laboratory data is shown in Table 1.
During hospitalization, the patient received a maintenance dose of levetiracetam (3000 mg/day) and sodium valproate (1600 mg/day). The antiviral treatment was also started with 200 mg remdesivir on day 1, followed by 100 mg daily for 4 days. After one week, the patient was discharged from the hospital with no seizure. The patient remained seizure-free during 2 months’ follow-up.