Our aim was to clarify the incidence and risk of acute symptomatic seizures in people with coronavirus disease 2019 . This multicenter retrospective study enrolled people with COVID-19 from January 18 to February 18, 2020 at 42 government-designated hospitals in Hubei province, the epicenter of the epidemic in China; Sichuan province; and Chongqing municipality. Data were collected from medical records by 11 neurologists using a standard case report form. A total of 304 people were enrolled, of whom 108 had a severe condition. None in this cohort had a known history of epilepsy. Neither acute symptomatic seizures nor status epilepticus was observed. Two people had seizurelike symptoms during hospitalization due to acute stress reaction and hypocalcemia, and 84 (27%) had brain insults or metabolic imbalances during the disease course known to increase the risk of seizures. There was no evidence suggesting an additional risk of acute symptomatic seizures in people with COVID-19. Neither the virus nor potential risk factors for seizures seem to be significant risks for the occurrence of acute symptomatic seizures in COVID-19. K E Y W O R D Sacute symptomatic seizures, COVID-19, epilepsy, SARS-CoV-2 2 | LU et aL.

Disasters and pandemics pose unique challenges to health care delivery. As health care resources continue to be stretched due to the increasing burden of the coronavirus disease (COVID-19) pandemic, telemedicine, including tele-education, may be an effective way to rationally allocate medical resources. During the COVID-19 pandemic, a multimodal telemedicine network in Sichuan Province in Western China was activated immediately after the first outbreak in January 2020. The network synergizes a newly established 5G service, a smartphone app, and an existing telemedicine system. Telemedicine was demonstrated to be feasible, acceptable, and effective in Western China, and allowed for significant improvements in health care outcomes. The success of telemedicine here may be a useful reference for other parts of the world.

Objective:To investigate new-onset neurologic impairments associated with coronavirus disease 2019 (COVID-19).Methods:A retrospective multicenter cohort study conducted between 18 January and 20 March 2020 including people with confirmed COVID-19 from 56 hospitals officially designated in three Chinese regions; data were extracted from medical records. New-onset neurologic events as assessed by neurology consultants based on manifestations, clinical examination and investigations, in which critical events included disorders of consciousness, stroke, CNS infection, seizures and status epilepticus.Results:We enrolled 917 people with average age 48.7 years and 55% were male. The frequency of new onset critical neurologic events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe or critical COVID-19. These were impaired consciousness (n=25) or/and stroke (n=10). The risk of critical neurologic events was highly associated with age above 60 years and previous history of neurological conditions. Non-critical events were seen in less than 1% (7/917), including muscle cramp, unexplained headache, occipital neuralgia, tic and tremor. Brain CT in 28 people led to new findings in nine. Findings from lumbar puncture in three with suspected CNS infection, unexplained headache or severe occipital neuralgia were unremarkable.Conclusions:People with COVID-19 aged over 60 and neurologic comorbidities were at higher risk of developing critical neurologic impairment, mainly impaired consciousness and cerebrovascular accidents. Brain CT should be considered when new-onset brain injury is suspected, especially in people under sedation or showing an unexplained decline in consciousness. Evidence of direct acute insult of SARS-COV-2 to the CNS is still lacking.

SummaryObjectiveThis study was undertaken to investigate the COVID‐19 vaccine uptake rate and possible postvaccination effects in adults with epilepsy.MethodsWe invited adults with epilepsy attending three centers in China from July 24 to August 31, 2021 to participate in this study. We also asked age‐ and sex‐matched controls among people attending for other chronic neuropsychiatric conditions and healthy controls accompanying people with illness attending the hospitals to participate. We excluded people who, under the national guidelines, had evident contradictions to vaccination. Participants were interviewed face‐to‐face using questionnaires. Vaccine uptake and postvaccine adverse events among the people with epilepsy were compared with those with neuropsychiatric conditions and controls. We also compared the willingness and reasons for hesitancy among unvaccinated participants.ResultsWe enrolled 981 people, of whom 491 had epilepsy, 217 had other neuropsychiatric conditions, and 273 were controls. Forty‐two percent of those with epilepsy had had the first dose of a vaccine, compared with 93% of controls and 84% of the people with neuropsychiatric conditions (p < .0001). The majority (93.8%) of those immunized had inactivated vaccines. Among the unvaccinated people with epilepsy, 59.6% were willing to have the vaccine. Their main reasons for hesitation were potential adverse effects (53.3%) and concerns about losing seizure control (47.0%). The incidence of adverse events in the epilepsy group was similar to controls. Nineteen people with epilepsy reported an increase in seizure frequency. No episode of status epilepticus or prolonged seizures was reported. Two controls had their first‐ever seizure, which was unlikely related to the vaccine.SignificanceThe vaccine uptake rate in people with epilepsy was lower than in their same‐age controls. The postvaccination effect was no higher than in controls. We found no evidence suggesting worsening seizures after vaccination. Measurement and education focused on increasing the vaccination rate in epilepsy are warranted.

The coronavirus disease 2019 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic with people infected in almost all countries. The most efficient solution to end this pandemic is a safe and efficient vaccine. Classic platforms are used to develop vaccines including live-attenuated vaccine, inactivated vaccine, protein subunit vaccine, and viral vector. Nucleic acid vaccine uses next-generation platforms for their development. Vaccines are now rushing to the market. Eleven candidates are in advance development. These comprise inactivated vaccines, viral vector vaccine, nucleic acid vaccine, and the protein subunit vaccine platform, which are now quite advanced in trials in various geographic and ethnic populations. The reported severe adverse effects raised the worries about their safety. It becomes critical to know whether these vaccines will cause neurologic disorders like previously recognized vaccine-related demyelinating diseases, fever-induced seizure, and other possible deficits. We reviewed the most promising COVID-2 vaccines with a particular interest in mechanism(s) and adverse effect(s). We exemplify potential neurological problems these vaccines could cause by looking at previous studies. The current evidence indicated a minor risk of the acute neurological disorders after the application. The observation of the long-time effect is still needed.

Neurological side effects of COVID-19 vaccines are rareWe read with interest the letter by Finsterer & Scorza on our review of potential neurological effects of COVID-19 vaccines. 1 Their content is not dissimilar to our conclusion that post-vaccine neurological events are, at this time, relatively rare and that possible long-time effects will need further prospective monitoring. It is, of course, essential to remind Finisterer & Scorza that this is an evolving field, and evidence will change as time goes. Therefore, pontification with the help of the retroscope is always welcomed. Some new evidence needs to be updated and clarified.The main safety concerns in the viral vector platform are blood clots reported with Vaxzevria (previously COVID-19 Vaccine AstraZeneca). 2 By March 22, 2021, the EU drug safety database reported 62 cases of cerebral venous sinus thrombosis (CVST) in people who received the vaccine. This is a slight increase in the risk of this in the general population. 3 Conversely, another study compared the incidence rate of venous thromboembolic events between the Oxford-AstraZeneca vaccine population and the entire Danish population before vaccination. It suggested that the reported thromboembolic events do not increase. 4 The European Medicines Agency concluded that the combination of blood clots and low blood platelets is extremely rare. The causality of CVST with the vaccine requires further investigation. According to the Joint CDC and FDA Statement, the same blood blot incidence was also associated with the Johnson & Johnson viral vector vaccine, but still appears to be an extremely rare event. 5

Tremor is frequently observed in patients with epilepsy (PWE), which is generally attributed to the side-effect of antiepileptic drugs (AEDs) particularly valproate (VPA) with largely unknown mechanisms. The study aimed to assess the clinical features and related factors of tremor in PWE with tremor. Methods: PWE with tremor and a control group of age-and sex-matched PWE without tremor were enrolled. Detailed demographic and clinical information for each individual was recorded. PWE with tremor were evaluated by The Clinical Rating Scale for Tremor (CRST) and Tremor Related Activities of Daily Living (TRADL) questionnaire. Results: 132 individuals were enrolled, which including sixty-six (36 males) PWE with tremor with mean age of 33 years and epilepsy duration of 12.5 years. Tremor was postural in all, with median duration of four and one year from diagnosis and AED treatment to the onset of tremor respectively. The upper limbs were predominantly affected. VPA had been used in 62 (93.9%) PWE with tremor compared to 31 (47.0%) PWE without tremor (P < 0.001). The total CRST score was significantly associated with epilepsy duration and maximum VPA dosage (B = 0.30, p < 0.001; B = 0.32, p = 0.013). Patients with VPA dosage over 17.05 mg/kg/d might be more vulnerable to develop tremor. Conclusions: PWE with tremor were more frequently treated with VPA, however, tremor was mild in most without any functional impairment. Epilepsy duration and maximum VPA dosage were important factors of tremor severity, suggesting mechanisms underlying tremor in PWE may be an elaborate interplay of AEDs and disease itself.

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