New-Onset Focal to Bilateral Tonic-Clonic Seizure Following COVID-19 Vaccination

An 18-year-old male presented with new-onset focal to bilateral tonic-clonic seizures 5 days after receiving the first dose of COVID-19 vaccine. 3 days later, an identical seizure occurred lasting 1 min, leading to an acute presentation to the hospital. In hospital, the patient was loaded with intravenous phenytoin and started on levetiracetam with no further seizure recurrence. CT venogram and scalp EEG were unremarkable. MRI brain revealed generalised atrophy with mild bilateral hippocampal atrophy. The patient was maintained on 500 mg levetiracetam twice daily and advised to proceed with subsequent doses of vaccination. Vaccinations have been associated with breakthrough seizures. In this case, COVID-19 vaccination possibly unmasked an underlying predisposition for epilepsy.