COVID-19 does appear to raise the risk of developing seizures and epilepsy, though the increase is modest in absolute terms. A large retrospective study comparing people diagnosed with COVID-19 to those who had influenza found that epilepsy was diagnosed within six months in about 0.3% of COVID patients, roughly twice the rate seen after flu. The relationship between COVID and new-onset epilepsy is real but uneven, shaped by age, disease severity, and biological mechanisms that researchers are still working to untangle.
How Much Higher Is the Risk, and How Do We Know?
The most-cited data on this question comes from a large retrospective study published in Neurology that compared people after a COVID-19 diagnosis to people after an influenza diagnosis. Within six months, about 0.81% of COVID patients experienced seizures, compared to 0.51% of flu patients. For epilepsy specifically, the numbers were 0.30% versus 0.17%. That translates to a hazard ratio of roughly 1.55 for seizures and 1.87 for epilepsy, meaning the COVID group had about 55% higher odds of seizures and nearly double the odds of an epilepsy diagnosis compared to those recovering from flu.1PubMed Central. Incidence of Epilepsy and Seizures Over the First 6 Months After a COVID-19 Diagnosis: A Retrospective Cohort Study
Those relative numbers sound alarming, but the absolute risk is worth keeping in perspective. More than 99% of people in the COVID group did not develop seizures or epilepsy within the study period. Still, when you consider how many hundreds of millions of people have been infected worldwide, even a small percentage adds up to a meaningful number of new epilepsy cases.
Not every study agrees on the size of the effect. A Danish population-wide study of over 1.2 million COVID-positive individuals and a matched control group found no overall increased risk of epilepsy at the whole-population level, with a hazard ratio right at 1.01. The discrepancy likely comes down to study design. The Neurology study compared COVID to influenza specifically, while the Danish study compared COVID patients to the general population regardless of infection status. Both approaches have strengths, but the difference in comparison groups matters when interpreting the results.2PubMed Central. Epilepsy diagnosis after Covid-19: A population-wide study
Age Changes the Picture Dramatically
Where the Danish study gets really interesting is in its age-specific breakdown. While the overall population showed no increased risk, adults between 61 and 80 years old who had COVID were about 66% more likely to be diagnosed with epilepsy afterward compared to uninfected controls. In the 81-to-100 age group, the risk was roughly 77% higher.2PubMed Central. Epilepsy diagnosis after Covid-19: A population-wide study
Even after the researchers adjusted for conditions that independently raise epilepsy risk, such as stroke, traumatic brain injury, and brain tumors, the elevated risk in older adults held. In the 61-to-80 group, the adjusted hazard ratio was still 1.50. In the oldest group, it dropped to 1.34 and lost statistical significance once mechanical ventilation was factored in, hinting that intensive care itself may play a role in that age bracket.
On the other end of the age spectrum, the Neurology study noted that the hazard ratio for epilepsy after COVID was actually greater in people who had not been hospitalized and in those younger than 16 years. That is a counterintuitive finding: milder infections and younger patients seeing a relatively higher bump in epilepsy risk. It suggests that disease severity alone does not explain the link, and that immune or inflammatory responses may drive new-onset epilepsy independently of how sick someone gets with the virus itself.1PubMed Central. Incidence of Epilepsy and Seizures Over the First 6 Months After a COVID-19 Diagnosis: A Retrospective Cohort Study
How COVID Could Trigger Seizures
Researchers have proposed several pathways by which SARS-CoV-2 could push the brain toward seizure activity. These are not mutually exclusive, and in many patients, multiple mechanisms may overlap.
The most discussed route involves neuroinflammation. COVID-19 triggers an intense immune response that can spill into the central nervous system. The virus appears to compromise the blood-brain barrier, the tightly regulated boundary that normally keeps blood-borne immune cells and proteins out of brain tissue. When that barrier breaks down, proteins like albumin leak in, disrupting the brain’s delicate chemical balance and promoting abnormal electrical activity.3Multiple Sclerosis and Related Disorders. How does the COVID-19 cause seizure and epilepsy in patients? The potential mechanisms The barrier breakdown also allows peripheral inflammatory molecules called cytokines to enter the brain directly, amplifying the inflammatory cascade inside neural tissue.
A 2025 PET imaging study brought some of the strongest visual evidence of this process. Researchers scanned the brains of people with temporal lobe epilepsy whose seizures had worsened after COVID-19 and found widespread neuroinflammation, along with elevated levels of inflammatory cytokines in their blood plasma. The correlation between specific blood markers and brain inflammation was strong enough that the authors suggested these markers could eventually be used to monitor neuroinflammation without repeated brain scans.4PubMed Central. Neuroimmune activation in temporal lobe epilepsy patients with worsening seizure following the COVID-19 pandemic: A [(18)F]DPA-714 PET/MR study
A second mechanism involves autoimmunity. SARS-CoV-2 has been shown to trigger the production of autoantibodies that attack brain receptors. Systematic reviews have documented cases of autoimmune encephalitis developing days to weeks after COVID respiratory symptoms, with the hyperinflammation triggered by the infection appearing to be the leading cause in most cases.5PubMed Central. Autoimmune encephalitis associated with COVID-19: A systematic review Antibodies directed against specific neural targets have been linked to temporal lobe seizures, memory problems, and behavioral changes.6PubMed Central. Autoimmune Encephalitis in COVID-19 Infection: Our Experience and Systematic Review of the Literature
A third pathway runs through the blood vessels. COVID-19 promotes abnormal clotting, elevating markers like D-dimer and fibrinogen while lowering platelet counts. This hypercoagulable state can lead to small strokes, and stroke is one of the most well-established causes of epilepsy, particularly in older adults.7PubMed Central. COVID‑19 and ischemic stroke: Mechanisms of hypercoagulability (Review)
Whether the virus directly invades brain tissue remains uncertain. The possibility of SARS-CoV-2 entering the brain through the olfactory nerve tract or crossing the blood-brain barrier via the bloodstream has been raised.8Frontiers in Drug Delivery. Neurotropism and blood-brain barrier involvement in COVID-19 However, a postmortem study examining brain tissue from 22 patients who died after infection with different variants found no viral protein or RNA in any brain samples, despite finding signs of hypoxic injury and small hemorrhages. That study suggests the brain damage is likely driven by the body’s response to the virus rather than by the virus colonizing brain tissue directly.9Oxford Academic. Neuropathological features of SARS-CoV-2 delta and omicron variants
Seizures During Recovery and Long COVID
An important question for patients and doctors is timing. Seizures can occur during an active COVID infection, but they can also appear days or weeks after the respiratory illness has resolved and the virus is no longer detectable. This delayed presentation caught clinicians off guard early in the pandemic. One of the first documented cases involved a 71-year-old man who initially had stroke-like symptoms during his COVID illness, recovered, and then returned six days later with seizure activity. By that point, his RT-PCR test was negative. His EEG showed rhythmic abnormal activity spreading from the right side of his brain across both hemispheres.10PubMed Central. Post-COVID seizure: A new feature of “long-COVID”
The authors of that case report proposed that lingering inflammation and elevated cytokines within the central nervous system could produce neurological symptoms well after the acute infection clears. This pattern aligns with other long COVID symptoms: the virus may be gone, but the immune system keeps firing. For seizures specifically, persistent neuroinflammation may lower the seizure threshold enough that electrical activity becomes disordered even in people who never had epilepsy before.
A broader study looking at two years of follow-up found that people who had been hospitalized with COVID-19 faced a greater risk of seizures and epilepsy compared to people hospitalized for other reasons. The elevated risk extended to other neurological and psychiatric conditions including encephalitis, dementia, cognitive deficits, and mood and anxiety disorders.11PubMed Central. Risks of neurological and psychiatric sequelae 2 years after hospitalisation or intensive care admission with COVID-19 compared to admissions for other causes
What About Children?
Parents understandably worry about seizures in children, especially since febrile seizures (seizures brought on by fever) are common in young kids with any viral illness. A case-control study looking specifically at whether COVID raised the risk of febrile seizures found that about 2.7% of pediatric COVID patients had a febrile seizure. However, when the researchers controlled for confounding variables, COVID did not appear to increase febrile seizure risk compared to other fever-causing infections.12PubMed Central. The Association Between COVID-19 and Febrile Seizure: A Retrospective Case-Control Study
The picture shifted during the Omicron wave. A study from an urban hospital documented 16 pediatric patients who presented with seizures and COVID during the Omicron surge, more than during previous variant waves. Of these children, half presented in status epilepticus, a prolonged seizure state that constitutes a medical emergency. Eighty-eight percent had what researchers termed complex provoked seizures, meaning the seizures had focal features, lasted more than five minutes, or occurred multiple times within 24 hours. Five of the 16 children had a prior history of epilepsy, but the rest did not.13PubMed Central. Provoked seizures and status epilepticus in a pediatric population with COVID-19 disease
The takeaway from the pediatric research is mixed. Ordinary febrile seizures in children with COVID seem to occur at rates comparable to other febrile illnesses. But certain viral variants may trigger more severe seizure presentations, and any child with COVID and prolonged or unusual seizure features should be evaluated urgently.
If You Already Live with Epilepsy
For people with pre-existing epilepsy, COVID-19 poses a specific concern: worsening seizure control. A study of 1,557 people with epilepsy found that just over half caught COVID during the Omicron wave, and among those infected, about 16% experienced worsening seizures. The strongest predictors of this worsening were having active (not well-controlled) epilepsy and a history of fever-triggered seizures.14PubMed Central. Risk of COVID-19 infection and seizure exacerbation among patients with epilepsy during the peak of Omicron wave
Another study followed 107 epilepsy patients through a two-month period after COVID infection and found a measurable increase in seizure frequency despite patients staying on the same medication doses. The unvaccinated group had higher rates of frequent seizures compared to those who had been vaccinated. Anxiety and depression scores also worsened after infection, which is relevant because stress and poor sleep are well-known seizure triggers in their own right.15PubMed Central. Effect of SARS-CoV-2 infection on seizure, anxiety, and depression in 107 patients with epilepsy
This worsening likely stems from the same inflammatory mechanisms described earlier. Fever, systemic illness, sleep disruption, and direct neuroinflammation all lower the seizure threshold. For people whose seizure control is already tenuous, that combination can tip the balance.
COVID Vaccines and Seizure Risk
Given how frequently this comes up in online forums: the data consistently shows that COVID vaccines carry far less seizure risk than COVID infection itself. A systematic review and meta-analysis of randomized clinical trials published in JAMA Neurology found no significant association between SARS-CoV-2 vaccination and new-onset seizures.16JAMA Neurology. Association of New-Onset Seizures With SARS-CoV-2 Vaccines: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
For people with epilepsy specifically, a separate meta-analysis confirmed that while the vaccines produced small, measurable effects, those effects were far less than the seizure exacerbation risk seen with actual COVID infection.17PubMed. Association of seizure with COVID-19 vaccines in persons with epilepsy: A systematic review and meta-analysis A real-world study of epilepsy patients also found that COVID-19 infection carried a higher risk of increased seizure frequency than vaccination did, and that COVID vaccines did not differ from other routine vaccines in terms of seizure risk.18PubMed Central. Effects of COVID-19 Infection and Vaccines on Patients with Epilepsy: Real-Life Experiences
How Doctors Investigate Post-COVID Seizures
When someone develops seizures after COVID, the diagnostic workup looks much like it would for any new-onset seizure, with a few COVID-specific considerations. EEG monitoring captures the brain’s electrical activity and can confirm whether episodes are epileptic seizures rather than non-epileptic events. In documented post-COVID cases, EEG findings have included patterns consistent with temporal or fronto-temporal lobe epilepsy.19PubMed Central. Possible post-COVID epilepsy: A review of epilepsy monitoring unit admissions during the two years of COVID-19 pandemic
Brain MRI in post-COVID seizure patients has shown varied findings. Some patients show focal inflammation in the frontal lobes.20PubMed Central. Seizure after recovery from Covid-19 Others have non-lesional scans but reveal enlarged perivascular spaces, which can reflect fluid drainage changes in the brain.19PubMed Central. Possible post-COVID epilepsy: A review of epilepsy monitoring unit admissions during the two years of COVID-19 pandemic The lack of a consistent imaging signature makes diagnosis trickier, because doctors cannot simply look for one telltale lesion.
Blood biomarkers are gaining interest as an additional tool. A multicenter study of 279 patients found that neurofilament light chain, a protein released when nerve fibers are damaged, was significantly elevated in patients who developed neurological complications from COVID. Elevated levels of another marker, S100B, were associated with worsening functional outcomes. These biomarkers are not specific to epilepsy, but they help clinicians identify patients whose nervous system has taken a hit and who may warrant closer neurological monitoring.21Springer Link / Neurol Sci. Blood neurofilament light chain and S100B as biomarkers of neurological involvement and functional prognosis in COVID-19: a multicenter study
When Standard Seizure Drugs Are Not Enough
Most post-COVID seizures respond to standard anti-seizure medications, and many people who develop seizures during or shortly after acute infection do not go on to have chronic epilepsy. But in a subset of patients, the seizures prove stubbornly resistant. This has pushed neurologists to think beyond conventional anti-seizure drugs and consider treatments that target the underlying inflammation.
One case report described the use of tocilizumab, a drug that blocks the inflammatory signaling molecule IL-6, in a patient whose COVID-triggered status epilepticus was not responding to standard therapies. Because the evidence increasingly points to neuroinflammation as the driver of post-COVID seizures, drugs that calm the immune response rather than simply suppressing electrical brain activity have attracted attention as potential rescue therapies.22PubMed Central. Treatment of COVID-19-induced refractory status epilepticus by tocilizumab Similarly, the autoimmune encephalitis cases triggered by COVID respond to immunotherapy rather than anti-seizure drugs alone, reinforcing the idea that for this subset of patients, the immune system is the root problem.
Whether post-COVID epilepsy tends to be lifelong or self-limiting is still an open question. Some patients followed over months have continued to need medication; others have had their seizures resolve. Long-term registry data will eventually answer this, but for now, neurologists treating post-COVID epilepsy generally recommend the same follow-up monitoring they would for any new epilepsy diagnosis: regular check-ins, medication adjustment as needed, and repeat EEG or imaging if seizure patterns change.