Doctors race to understand epilepsy in the time of COVID-19

Abstract

We enjoyed reading the recent article entitled, "Epilepsy self-management during a pandemic: Experiences of people with epilepsy" by Miller and colleagues published in your esteemed journal [1]. Although these data are extremely interesting, we have to be very careful when discussing them. Firstly, it is evident to all scientists that the new coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) infection has become a worldwide pandemic and a global health threat that mobilized healthcare workers in all disciplines [2]. Despite ongoing advances, careful clinical, diagnostic, and epidemiological studies are still necessary to acknowledge manifestations and the burden of neurological disease caused by SARS-CoV-2 [3], including epilepsy [4]. Because of the clinical importance of these considerations, we would like to add some thoughts that may open the debate about the possible increase in cases of sudden unexpected death in epilepsy (SUDEP) during this current serious pandemic. In fact, the SARS-CoV-2 pandemic that hit the central Chinese city of Wuhan in late December 2019 and subsequently spread rapidly to all provinces of China and all countries worldwide has had a negative impact on global public health [5]. Severe acute respiratory syndrome coronavirus 2 is characterized by a high contagiousness. In this sense, in 85% of cases, it causes subclinical or mild disease, but compared with flu, it easily causes more respiratory complications (e.g., severe pneumonia [ground glass opacities] and interstitial pneumonia) in 10-15% of cases [5]. Moreover, 5% of infected patients require intensive care unit (ICU) admission [5]. During these catastrophic scenarios, lethality is estimated at around 0.7-7% [5,6]. On the basis of knowledge of other coronaviruses, the contagiousness of SARS-CoV-2 is higher, but the mortality is decidedly lower compared with the severe acute respiratory syndrome (SARS) of 2002 and the Middle East respiratory syndrome (MERS) of 2012, both of them related with higher mortality (9.5% and 34.4%, respectively) [5,6]. Furthermore, it has been suggested that for patients with severe or critical illness, besides the respiratory supportive treatment, a more careful assessment and the treatment of various affected organs are important [6]. Thus, the neurological implications of SARS-CoV-2 infection have received special attention [3], and neuroscientists have established consensus recommendations on how to provide the best possible care for people with epilepsy during the novel coronavirus 2019 era [1,7-10]. In this context, although the medical team's first reaction was to limit access to clinics and neurological centers to preserve patients with epilepsy from being infected [10], some interesting proposals regarding healthcare facilities logistics, medical procedures and treatment (ensuring a regular supply of antiepileptic drugs), and telemedicine have also been discussed among various epileptologists operating in different regions of the world [4,7