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Background Telehealth use is limited in developing countries. Therefore, a modified approach with early physical consultation was designed and applied in our hospital. This study aimed to determine the efficacy of this early physical consultation in reducing the clinical and psychological impacts of COVID-19, which enabled insight into its global feasibility. Method Participants were contacted and offered early physical consultation with a neurologist. Patients who participated in the Phase 1 study on the impacts of the COVID-19 pandemic on people with epilepsy and treated in our hospital were recruited. Clinical and psychological outcomes of COVID-19 were assessed with the Hospital Anxiety Depression Scale (HADS) and Quality of Life in Epilepsy Inventory (QOLIE-31). Result A total of 312 patients completed this study with a mean age of 39.13±16.13 years, majority female (51.0%), and experienced seizures at least once yearly (64.7%). There was 12.6% who experienced seizure worsening related to the COVID-19 pandemic. After receiving early clinical intervention, 30.8% achieved better seizure control with another 51.1% had no seizure occurrence. The mean HADS anxiety score improved immediately post-intervention (5.27±4.32 vs. 4.79±4.26, p< 0.01), and at 2 weeks post-intervention (5.58±4.46 vs. 4.73±3.95, p <0.01). The mean HADS depression score also improved immediately post-intervention (4.12±3.69 vs. 3.84±3.76, p <0.05) and at 2-weeks post-intervention (4.38±3.81 vs. 3.73±3.63, p <0.05). The intervention resulted in significant improvement in energy-fatigue and social function subscales in QOLIE-31 but a reduction in cognitive and medication effects subscales. Conclusion Early physical consultation with stringent precautionary measures is feasible and effective in improving the psychological outcome during COVID-19 pandemic.

Complementary and alternative medicine (CAM) usage were reported in Europe, the United States of America and monoethnic Asian countries such as Korea and Taiwan. However, limited literature is available on the variability of CAM usage patterns among people with epilepsy (PWE) in a multi-racial country in particular Malaysia. This cross-sectional study assessed the prevalence, types, predictors and impact of CAM use among adult PWE and their adherence to anti-epileptic drugs (AEDs) treatment.140 patients were recruited, with a median age of 37.5 (IQR,28.0-51.5) years, majority female, had secondary or lower education level, earn <USD1077 and seizure frequency of <1 per month. One quarter (25.7%) used CAM for seizure control, of which 94.4% adhered to AEDs treatment while on CAM. Common CAM used were prayers, traditional herbal remedies, massage, and acupuncture. Only 33.3% have discussed CAM usage with their physician. The main reason for CAM usage was patients’ willingness to try other alternatives for seizure control. Although most patients had not used CAM, 20.2% were receptive to using CAM as concomitant treatment. Buddhists were more open to CAM while Muslims uses CAM selectively and avoid amulets, acupuncture, chiropractic, Ayurveda, yoga, and reiki. Logistic regression analysis showed Buddhist’s religion (OR,11.01), Muslims (OR,4.04), ≥1 seizure per month (OR,3.85) and monthly income of ≥USD1077 (OR,2.92) as the predictors for CMA usage.   CAM use is common in Malaysia, especially among Buddhists and Muslims, with higher socio-economic status, and uncontrolled seizures. CAM is mostly used to complement but not in replacement of AEDs.