Impact of the COVID-19 Pandemic on Epilepsy Center Practice in the United States

Abstract

Objective:Persons with epilepsy, especially those with drug resistant epilepsy (DRE), may benefit from inpatient services such as admission to the epilepsy monitoring unit (EMU) and epilepsy surgery. The COVID-19 pandemic caused reductions in these services within the U.S. during 2020. This article highlights changes in resources, admissions and procedures among epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC).Methods:We compared data reported in 2019, prior to the COVID-19 pandemic and 2020 from all 260 level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level, center population category and geographical location. Qualitative responses from center directors to questions regarding the impact from COVID-19 were summarized utilizing thematic analysis. Responses from the NAEC center annual reports as well as a supplemental COVID-19 survey were included.Results:EMU admissions declined 23% (-21,515) in 2020, with largest median reductions in level 3 centers [-55 admissions (-44%)] and adult centers [-57 admissions (-39%)]. The drop in admissions was more substantial in the East North Central, East South Central, Mid Atlantic, and New England U.S. Census divisions. Survey respondents attributed reduced admissions to re-assigning EMU beds, restrictions on elective admissions, reduced staffing and patient reluctance for elective admission. Treatment surgeries declined by 371 cases (5.7%), with the largest reduction occurring in VNS implantations [-486 cases (-19%)] and temporal lobectomies [-227 cases (-16%)]. All other procedure volumes increased, including a 35% (54 cases) increase in corpus callosotomies.Significance:In the U.S., access to care for persons with epilepsy declined during the COVID-19 pandemic in 2020. Adult patients, those relying on level 3 centers for care and many persons in the eastern half of the US were most affected.

Epilepsy and COVID-19's Double-Edged Sword

“…As a result of the pandemic, we all went through a crash course in telemedicine. Telehealth visits greatly increased during the pandemic, as reported by Ahrens et al 4 In some ways, this may have improved access to care, as transportation is a frequent barrier to care for people with epilepsy. The extent to which telehealth visits can provide the same level of care and meet the same needs of patients as traditional in-person visits remains to be seen.…”

“…6,7 In addition to the fact that people with epilepsy may face more severe disease if they have COVID-19, the pandemic has other adverse effects on their care. In a study of tertiary epilepsy centers in the United States, Ahrens et al 4 found that video-EEG admissions and epilepsy surgeries declined by about 23% in the summer of 2020 as compared to 2019. Hospital beds usually assigned to patients with epilepsy were filled with patients with COVID-19 and epilepsy monitoring units were closed.…”

“…The extent to which telehealth visits can provide the same level of care and meet the same needs of patients as traditional in-person visits remains to be seen. The data presented by Ahrens et al 4 suggest that there may have been important compromises for patients who required hospital-based procedures.…”

“…1,2 In this issue of Neurology® , 2 studies address the increased risks associated with COVID-19 for people with epilepsy and the effects the shutdown had on providing epilepsy care. 3,4…”

“…1,2 In this issue of Neurology ® , 2 studies address the increased risks associated with COVID-19 for people with epilepsy and the effects the shutdown had on providing epilepsy care. 3,4 In a thoughtful study of >200,000 adults (>20 years of age) who had PCR SARS-CoV-2 testing in The Republic of Korea, Yoo et al 3 found that people with epilepsy did not have a higher risk of acquiring SARS-CoV-2 infections (1.84% vs 2.12%; odds ratio [OR] 0.86, 95% CI 0.67-1.11) but those who developed COVID-19 infections had a higher risk of developing serious complications, including intensive care unit admission, mechanical ventilation, and death (18.06% vs 9.72%; OR 2.05, 95% CI 1.04-4.04). Mortality was higher but not significantly so (9.72% with and 6.48% without epilepsy; OR 1.55, CI 0.65-3.70).The effect sizes reported by Yoo et al 3 are comparable to those from a meta-analysis of studies done during the early part of the COVID-19 pandemic that suggested that severe outcomes were more common in people with than without epilepsy.…”