Zinc supplementation induced seizures in Covid 19 Patients: Case Series

Abstract

Introduction: COVID-19 started in Wuhan, China. About 36.5% manifest with CNS symptoms like- Acute Ischemic Stroke, Guillain-barre Syndrome, Seizures and Encephalopathy. Since the pandemic has started many newer treatment modalities have been incorporated like antibiotics, antiviral agents and also as an adjuvant therapy with vitamin supplements are being used. Knowing the above treatment modalities various complications was noted and one of the major unpredictable events such as seizures/ convulsions, so to deduce the reason this study was taken up.

Patients studied: COVID isolation ward with history of high grade fever, headache, breathlessness and myalgia for 4 days On the Day 5 of illness (2^nd post admission day) they developed first episode of Seizure of General Tonic Clonic Seizures. The confirmed COVID-19 - RT PCR positive patients were admitted with history of high grade fever, headache, breathlessness and myalgia for 3-4 days, with the age of the patients being in the range of 40- 55 years, with no past history of seizures/ trauma/ head injury / ear discharge, whose vitals were stable and no neurological deficits found on physical examination done on the day of admission. An initially Empirical antibiotic was started with Tab. Azithromycin 500mg OD- PO for 5days with Cap. Oseltamivir 75mg BD for 3 days followed by supportive medication such as Tab. Cetirizine 10mg, Vitamin supplementation with Tab. Vit C 500mg and Tab. Zinc 50mg were given to the RT PCR positive patients.

Conclusion: The probability of alternative diagnosis is unlikely and low with the background of the pandemic setting. The temporal association positive RT PCR and the onset of seizures coinciding 2 days after onset of symptoms and the mild laboratory changes may be one of the contributory factors to the seizures, with zinc supplementation being the other causative factor suspected to potentiate seizure activity.