Care Delivery for Children With Epilepsy During the COVID-19 Pandemic: An International Survey of Clinicians

Abstract

Objective: To evaluate the effect of the COVID-19 pandemic on global access to care and practice patterns for children with epilepsy. Methods: We conducted a cross-sectional, online survey of pediatric neurologists across the world affiliated with the International Child Neurology Association, the Chinese Child Neurology Society, the Child Neurology Society, and the Pediatric Epilepsy Research Consortium. Results were analyzed in relation to regional burden of COVID-19 disease. Results: From April 10 to 24, 2020, a sample of 212 respondents from 49 countries indicated that the COVID-19 pandemic has dramatically changed many aspects of pediatric epilepsy care, with 91.5% reporting changes to outpatient care, 90.6% with reduced access to electroencephalography (EEG), 37.4% with altered management of infantile spasms, 92.3% with restrictions in ketogenic diet initiation, 93.4% with closed or severely limited epilepsy monitoring units, and 91.3% with canceled or limited epilepsy surgery. Telehealth use had increased, with 24.7% seeing patients exclusively via telehealth. Changes in practice were related both to COVID-19 burden and location. Conclusions: In response to COVID-19, pediatric epilepsy programs have implemented crisis standards of care that include increased telemedicine, decreased EEG use, changes in treatments of infantile spasms, and cessation of epilepsy surgery. The long-term impact of these abrupt changes merit careful study.

Epilepsy and COVID-19: Updated evidence and narrative review

“…In fact, in a survey of 212 pediatric neurologists in 49 countries, more than 90% of physicians responding stated that in-person outpatient visits had decreased and use of telemedicine had increased. [ 31 ], The same study also found an approximately 90% decrease in EEG. As for the number of EEG tests, a survey of more than 200 Italian centers found a 75% reduction in the number of EEGs during the crisis compared to the pre-COVID-19 baseline, particularly in specific EEGs such as long-term monitoring/ambulatory EEG/polysomnography/video-EEG.…”

COVID-19, de novo seizures, and epilepsy: a systematic review

“…EEG-related papers (Table 4): While change in mental status has frequently been reported in patients with COVID-19 [26,27,55,60,65,66,70], and while there are many reports on clinical and subclinical seizures and status epilepticus in these patients [33-47, 63, 66], EEG studies have been significantly ignored and underused in these patients globally. Three studies showed that EEG services have been significantly disrupted by the pandemic of COVID-19 [18,19,57]. Three other studies showed that many of the patients with COVID-19 and encephalopathy/seizures had epileptiform discharges/seizures in their EEG [29,54,55].…”

Impact of COVID-19 pandemic on pediatric patients with epilepsy – The caregiver perspective

“…Generally, care of patients changed dramatically during the lockdown period [9,11,12]. In regions with high COVID-19 burden, hospitals restructured and postponed, rescheduled, or even canceled outpatient visits by patients with chronic disorders, including epilepsy, both to respect physical distancing rules and to aid in resourcing for managing SARS-CoV-2 infections [1,13].…”