J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://jnr.elmerpub.com

Review

Volume 16, Number 2, June 2026, pages 67-76

Seizures and Epilepsy in Children With SARS-CoV-2 Infection: Clinical Phenotypes, Mechanisms, and Long-Term Outcomes

↓ Figure 1. Proposed pathophysiological mechanisms underlying seizures in pediatric SARS-CoV-2 infection. Seizures in children arise from systemic and neuroinflammation, fever and metabolic stress, immune-mediated CNS injury, and host susceptibility. Cytokines, BBB disruption, and developmental or genetic factors modulate seizure risk and clinical severity. BBB: blood–brain barrier; CNS: central nervous system; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

↓ **Table 1.** Risk-Stratified Diagnostic Considerations for Children Presenting With Seizures in the Context of SARS-CoV-2 Infection
Clinical presentation	Key clinical features	Recommended diagnostic approach	Prognostic considerations	References
CNS: central nervous system; CSF: cerebrospinal fluid; EEG: electroencephalography; MIS-C: multisystem inflammatory syndrome in children; MRI: magnetic resonance imaging; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.
Isolated simple febrile seizure	Generalized, brief (< 15 min), single seizure, rapid return to baseline	No routine EEG or neuroimaging; supportive care	Generally benign; low risk of subsequent epilepsy	[4–6]
Complex febrile seizure	Prolonged (> 15 min), focal features, or recurrent seizures within 24 h	Consider EEG and targeted neuroimaging based on clinical context	Slightly increased risk compared with simple febrile seizures; prognosis generally favorable	[4, 5]
Afebrile acute symptomatic seizure	New-onset seizure without fever, preserved consciousness between events	EEG and neuroimaging recommended to exclude structural or inflammatory causes	Outcome depends on underlying etiology; low epilepsy risk if no persistent CNS pathology	[3, 7, 9]
Persistent altered mental status or encephalopathy	Prolonged confusion, reduced consciousness, behavioral change	EEG, brain MRI, inflammatory markers; consider CSF analysis	Suggests inflammatory or immune-mediated CNS involvement; variable prognosis	[1–3, 9]
Status epilepticus	Prolonged or recurrent seizures without recovery	Urgent EEG, neuroimaging, metabolic and infectious workup	Higher morbidity; prognosis depends on etiology and treatment response	[18, 19, 24, 30]
Suspected MIS-C with neurological involvement	Seizures with systemic inflammation, shock, or multisystem involvement	Comprehensive evaluation including EEG, MRI, inflammatory markers, and cardiac assessment	Immune-mediated mechanisms predominate; outcome improves with timely immunomodulatory therapy	[1, 2, 28]
Suspected autoimmune encephalitis or demyelinating disease	Subacute seizures, encephalopathy, focal deficits	EEG, MRI, CSF studies, and autoimmune antibody testing	Early recognition and treatment associated with improved neurological outcomes	[13–15, 29]
Preexisting epilepsy with transient seizure worsening	Temporary increase in seizure frequency during acute illness	Review adherence, identify triggers; no routine escalation if control returns to baseline	Seizure control typically returns to baseline after recovery	[8, 25, 26]

↓ Table 1. Risk-Stratified Diagnostic Considerations for Children Presenting With Seizures in the Context of SARS-CoV-2 Infection

Clinical presentation

Key clinical features

Recommended diagnostic approach

Prognostic considerations

References

CNS: central nervous system; CSF: cerebrospinal fluid; EEG: electroencephalography; MIS-C: multisystem inflammatory syndrome in children; MRI: magnetic resonance imaging; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

Isolated simple febrile seizure

Generalized, brief (< 15 min), single seizure, rapid return to baseline

No routine EEG or neuroimaging; supportive care

Generally benign; low risk of subsequent epilepsy

[4–6]

Complex febrile seizure

Prolonged (> 15 min), focal features, or recurrent seizures within 24 h

Consider EEG and targeted neuroimaging based on clinical context

Slightly increased risk compared with simple febrile seizures; prognosis generally favorable

[4, 5]

Afebrile acute symptomatic seizure

New-onset seizure without fever, preserved consciousness between events

EEG and neuroimaging recommended to exclude structural or inflammatory causes

Outcome depends on underlying etiology; low epilepsy risk if no persistent CNS pathology

[3, 7, 9]

Persistent altered mental status or encephalopathy

Prolonged confusion, reduced consciousness, behavioral change

EEG, brain MRI, inflammatory markers; consider CSF analysis

Suggests inflammatory or immune-mediated CNS involvement; variable prognosis

[1–3, 9]

Status epilepticus

Prolonged or recurrent seizures without recovery

Urgent EEG, neuroimaging, metabolic and infectious workup

Higher morbidity; prognosis depends on etiology and treatment response

[18, 19, 24, 30]

Suspected MIS-C with neurological involvement

Seizures with systemic inflammation, shock, or multisystem involvement

Comprehensive evaluation including EEG, MRI, inflammatory markers, and cardiac assessment

Immune-mediated mechanisms predominate; outcome improves with timely immunomodulatory therapy

[1, 2, 28]

Suspected autoimmune encephalitis or demyelinating disease

Subacute seizures, encephalopathy, focal deficits

EEG, MRI, CSF studies, and autoimmune antibody testing

Early recognition and treatment associated with improved neurological outcomes

[13–15, 29]

Preexisting epilepsy with transient seizure worsening

Temporary increase in seizure frequency during acute illness

Review adherence, identify triggers; no routine escalation if control returns to baseline

Seizure control typically returns to baseline after recovery

[8, 25, 26]