Discussion
Patients have presented with a wide ranging symptoms of COVID-19.
Seizures have been a documented presentation of COVID-19 occurring at
various stages of illness and even in individuals without underlying
neurological illness.1,2,3,4 Beta coronaviruses
SARS-CoV and MERS-CoV have been associated with neurological symptoms
are attributed to the upregulation of proinflammatory cytokines
following initial viral pneumonia.5
Potential mechanisms that could contribute to seizures in COVID-19
include interaction with angiotensin-converting enzyme 2 (ACE2) in
neuronal and glial cells, and cytokine storm effects, specifically
mediated by IL-6.6 Cytokine release syndrome (CRS) has
also been documented after administration of well-known monoclonal
antibody treatments7.
The BLAZE-1 study, which led to the emergency use authorization of
bamlanivimab, reported no cases of seizures or serious adverse
effects– other than anaphylaxis– in the 101 patients that received
bamlanivimab. However, only 3% of participants (9 patients) in BLAZE-1
who received bamlanivimab were 75 years of age or older and there was no
reported correlation of adverse events to age groups, making adverse
effects in older adults even less certain.8 When
applying the Adverse Drug Reaction Probability Scale, often known as the
Naranjo Algorithm, to this case, the likeliness of bamlanivimab causing
seizures in this case is “Possible” (score 3 of
13)9, suggesting a temporal sequence of events related
to bamlanivimab. This may also be explained by characteristics of the
patient’s diagnosis of COVID-19.