Abstract
Background: The pandemic of COVID-19/SARS-CoV-2 has revealed new complexities in the management of neurological complications, including epilepsy seizures. The study investigates the association between hyponatremia and the exacerbation of seizures in COVID-19/SARS-CoV-2-positive patients.
Methods: This retrospective observational research analyzed 206 hyponatremic COVID-19 epilepsy patients, with (n:46) and without seizures (n:160). It assessed clinical and laboratory parameters, including sodium levels, and utilized statistical tools like ROC analysis and logistic regression to explore the role of hyponatremia in seizure occurrence.
Results: Our analysis showed a correlation between active COVID-19 infection and seizures (P=0.001). Sodium, potassium, chloride, neutrophils, and white blood cells differed between groups (p=0.005, 0.046, 0.002, 0.028, and 0.053, respectively). Sodium levels behaved as a predictor of seizure occurrence, with its lower levels associated with a higher likelihood of seizures in hyponatremia. ROC analysis showed a moderate discrimination capability (AUC: 0.319; p=0.002), with a sodium level below 130.2 mmol/L being a critical cutoff for increased seizure risk, at sensitivity of 71% and specificity of 74.3%. In logistic regression, the Exponential value of 0.878 suggested that for each unit increase in sodium levels, the likelihood of having a seizure decreases by 12.2% (p<0.001).
Conclusion: Hyponatremic conditions can have a crucial effect on the exacerbation of seizures, indicating the need for diligent electrolyte management in COVID-19 patients.

Key words: COVID-19, Epilepsy, Seizures, Hyponatremia, Neurological Complications