Influence of the COVID-19 outbreak in people with epilepsy: Analysis of a Spanish population (EPICOVID registry)

Abstract

Background The aim of this study was to have a better understanding of the influence of the coronavirus disease 2019 (COVID-19) pandemic in people with epilepsy (PWE) and to assess whether there have been changes in seizure control during the current COVID-19 outbreak, exploring the possible causes thereof. Methods This is an observational, retrospective study based on prospective data collection of 100 successive patients who attended an epilepsy outpatient clinic either face-to-face or telephonically during the months of the COVID-19 outbreak and national state of emergency. Results One hundred patients were included, 52% women, mean age 42.4 years. During the COVID-19 period, 27% of the patients presented an increase of > 50% of seizure frequency. An increase of stress/anxiety (odds ratios (OR): 5.78; p = 0.008) and a prior higher seizure frequency (OR: 12.4; p = 0.001) were associated with worsening of seizures. Other risk factors were exacerbation of depression, sleep deprivation, less physical activity, and history of epilepsy surgery. Three patients had status epilepticus (SE) and one a cluster of seizures. Likewise, 9% of patients improved their seizure control. Reduction in stress/anxiety (OR: 0.05; p = 0.03) and recent adjustment of antiepileptics (OR: 0.07; p = 0.01) acted as protecting factors. Conclusions A high proportion of PWE suffered a significant worsening of their seizure control during the months of the COVID-19 pandemic. Emotional distress due to home confinement was the main factor for the change in seizure control. Promoting physical activity and adequate sleep may minimize the potential impact of the pandemic in PWE. Ensuring correct follow-up can prevent decompensation in those PWE at high risk.

Impact of COVID-19 on quality of life in people with epilepsy, and a multinational comparison of clinical and psychological impacts

“…[13] It was postulated that these logistic issues may be the cause of seizure worsening, but only AEDs issues (dose adjustment and supply) were reported as a factor for seizure control during COVID-19 period. [5,11] In our study, seizure worsening was shown to be related to access of all related healthcare services including emergency, outpatient, and pharmacy services. Consequently, about 10% of the respondents adjusted their dose to avoid depletion of their AEDs and this was associated with seizure worsening, thus should be discouraged.…”

“…In Malaysia, seizure worsening was reported in 13% of the respondents, compatible with China but lower than the European countries and Saudi Arabia. [4,6,[9][10][11][12][13] As shown in Table 5, the rates were higher in countries with higher percentage of COVID-19 cases, similarly in the rates of anxiety and depression. These differences might also be related to the cultural differences in these countries, which influence the national policy and individual reaction toward the pandemic, but also can be disease specific.…”

“…[20] As a comparison, we found different pattern in cancer studies during the pandemic, in which the rates of depression and anxiety were lower in Malaysia but not in China, whereas for European countries the rates were high but not in USA. [21][22][23][24] Stress or anxiety was commonly associated with seizure worsening, [4][5][6]9,11] but not depression. In our study, though depression was associated with seizure worsening in univariate analysis, the association was not significant in multivariate analysis.…”

“…The responses are summed to obtain the total score for each subscale. The total score for each subscale were then categorized into normal (0-7), and abnormal -borderline (8)(9)(10) and definite (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). HADS was validated in epilepsy cohort, age 18 years and above, with high internal consistency reported for HAD-Anxiety (Cronbach's α = 0.88) and HAD-Depression (Cronbach's α = 0.82).…”

“…[3] The complete restriction of movement and assembly resulted in postponement of healthcare visits in Malaysia, similarly in many other countries. This unprecedented loss of access to healthcare is postulated to give rise to worsening seizure control and anxiety, which were reported in many countries in most continents, including China [4][5][6], Hong Kong [7], Pakistan [8] and Saudi Arabia [9] in Asia, Brazil [10] in South America, Spain [11,12] and Italy [13] in Europe, and United Stated of America. [14] However, most studies analyze mainly on the direct impact of AEDs on the psychological and clinical consequences, but not the access to emergency and outpatient services.…”