Epilepsy in time of COVID‐19: A survey‐based study

Abstract

Collateral damage may occur in epilepsy management during the coronavirus (COVID-19) pandemic. We aimed to establish the impact of this pandemic on epilepsy patients in terms of patient-reported seizure control and emerging symptoms. Materials & Methods: This is a cross-sectional study including consecutive patients assessed by telephone contact in an epilepsy clinic during the first month of confinement. Demographic and clinical characteristics were recorded, and a 19-item questionnaire was systematically completed. Data regarding the impact of confinement, economic effects of the pandemic, and subjective perception of telemedicine were recorded. Additional clinical data were obtained in patients with a COVID-19 diagnosis. Results: Two hundred and fifty-five patients were recruited: mean age 48.2 ± 19.8 years, 121 (47.5%) women. An increase in seizure frequency was reported by 25 (9.8%) patients. Sixty-eight (26.7%) patients reported confinement-related anxiety, 22 (8.6%) depression, 31 (12.2%) both, and 72 (28.2%) insomnia. Seventythree (28.6%) patients reported a reduction in economic income. Logistic regression analysis showed that tumor-related epilepsy etiology [OR = 7.36 (95% CI 2.17-24.96)], drug-resistant epilepsy [OR = 3.44 (95% CI 1.19-9.95)], insomnia [OR = 3.25 (95% CI 1.18-8.96)], fear of epilepsy [OR = 3.26 (95% CI 1.09-9.74)], and income reduction [OR = 3.65 (95% CI 1.21-10.95)] were associated with a higher risk of increased seizure frequency. Telemedicine was considered satisfactory by 214 (83.9%) patients. Five patients were diagnosed with COVID-19, with no changes in seizure frequency. Conclusions: The COVID-19 pandemic has effects in epilepsy patients. Patients with tumor-related, drug-resistant epilepsy, insomnia, and economic difficulties are at a higher risk of increased seizure frequency. Telemedicine represents a suitable tool in this setting.

The Impact of the COVID-19 Pandemic on People With Epilepsy. An Italian Survey and a Global Perspective

“…Sleep changes were reported in 8.2-71.2% (3,4) and insomnia in 28.2% (3) of PwE. However, in a survey comparing PwE with controls without epilepsy, the quality of sleep did not differ significantly between the two groups: values out of range on the Pittsburgh Sleep Quality Index were reported in 46.9% of PwE and 42.4% of controls.…”

“…Seizure worsening was also associated with more disturbed sleep (3,9) and with depression and anxiety factors: history of depression, anti-depressant use, more severe depression and anxiety symptoms (9). Fear of epilepsy was associated with worsening in two studies (3,7).…”

“…Postponed neurological tests were reported by 14.5-61% of responders in three studies (3,9,12). Issues with drug supply were reported by 2.7-73% (3,5,6,8,9).…”

“…Nine questionnaires investigated seizure course during vs. prior to the emergency. The rate of seizure worsening ranged from 4 to 35% (3)(4)(5)(6)(7)(8)(9)(10)(11).…”

“…Worsening was significantly associated with several seizure and epilepsy factors: drug-resistant epilepsy (3, 7) number of anti-seizure medications (ASMs) (3, 9), and not being seizure free (9) or having more seizures at baseline (3,7). In single studies, tonic-clonic seizures during the COVID-19 pandemic (9) and tumor-related etiology (3) were associated with worsening.…”