A systematic retrospective study established that seizures occur early and could be the primary manifestation of acute COVID-19 in children. The study included 175 children aged 6 months to 17 years, infected with COVID-19 out of which 11 had presented with seizures. It was found that these children may lack fever or other typical symptoms of COVID-19 infection and often were devoid of any severe diseases or history of epilepsy. 6 of them had fever, 9 presented with generalized tonic-clonic seizures. One patient with a prior history of uncontrolled epilepsy with multiple seizure types had a focal tonic seizure at presentation. Bilateral asymmetrical tonic-clonic seizure was observed in a 5-month-old infant. 5 patients were presented with status epilepticus and responded to the loading doses of anti-seizure medications. Early diagnosis of COVID-19 is important for infection control as these children might spread the infection without the direct symptoms of COVID-19. A high index of suspicion for COVID-19 must be maintained in children with new onset seizures or exacerbation of prior epilepsy.
