P-EP021. Impact of COVID-19 on people with epilepsy: Understanding their needs

Introduction. The Coronavirus disease 2019 (COVID-19) pandemic with the implementation of the movement control order (MCO) resulted in unprecedented loss of access to healthcare in Malaysia. This study aimed to identify the impact of COVID-19 on people with epilepsy (PWE) in terms of their clinical, logistics and psychological aspects. Methods. This is a cross-sectional anonymized web-based study on PWE in University Malaya Medical Centre (UMMC) and Malaysia Epilepsy Society. An online questionnaire was used to assess the direct and indirect impact of COVID-19 to the epilepsy patients, including Hospital Anxiety Depression Scale (HADS) and Quality of Life in Epilepsy Inventory (QOLIE- 31). Results. 461 patients were included in this study, with a mean age of 39.21±15.88 years, majority female (50.1%), with focal epilepsy (54.0%), and experienced seizures at least once yearly (62.5%). There were 11.1% reported increased seizure frequency during COVID period. The associated factors of increased seizure frequency during COVID period included focal seizures, baseline seizures frequency >1 per month, unemployed status, lower education, and precipitating factors such as inadequate sleep and stress. There were 30.2% worried of seizure worsening due to difficulty in re-scheduling clinic appointments, 28.9% were afraid of going to the emergency unit, 11.5% had self-adjusted medication dosages to avoid running out of supply. A significant number experienced anxiety (27.6%) and depression (18.8%), which were correlated with poorer quality of life (p = 0.01). Conclusion. This study highlights the clinical and psychological impacts of the COVID-19 on PWE in Malaysia.

Impact of COVID-19 pandemic on people with epilepsy: An interventional study using early physical consultation.

BACKGROUND: Telehealth use is limited in developing countries. Therefore, a modified approach with early physical consultation was designed and applied in our hospital. This study aimed to determine the efficacy of this early physical consultation in reducing the clinical and psychological impacts of coronavirus disease-19 (COVID-19), which enabled insight into its global feasibility. METHOD: Participants were contacted and offered early physical consultation with a neurologist. Patients who participated in the Phase 1 study on the impacts of the COVID-19 pandemic on people with epilepsy and treated in our hospital were recruited. Clinical and psychological outcomes of COVID-19 were assessed with the Hospital Anxiety Depression Scale (HADS) and Quality of Life in Epilepsy Inventory (QOLIE-31). RESULT: A total of 312 patients completed this study with a mean age of 39.13 ±â€¯16.13 years, majority female (51.0%), and experienced seizures at least once yearly (64.7%). There was 12.6% who experienced seizure worsening related to the COVID-19 pandemic. After receiving early clinical intervention, 30.8% achieved better seizure control with another 51.1% had no seizure occurrence. The mean HADS anxiety score improved immediately post-intervention (5.27 ±â€¯4.32 vs. 4.79 ±â€¯4.26, p < 0.01), and at 2-week post-intervention (5.58 ±â€¯4.46 vs. 4.73 ±â€¯3.95, p < 0.01). The mean HADS depression score also improved immediately post-intervention (4.12 ±â€¯3.69 vs. 3.84 ±â€¯3.76, p < 0.05) and at 2-week post-intervention (4.38 ±â€¯3.81 vs. 3.73 ±â€¯3.63, p < 0.05). The intervention resulted in significant improvement in energy-fatigue and social function subscales in QOLIE-31 but a reduction in cognitive and medication effects subscales. CONCLUSION: Early physical consultation with stringent precautionary measures is feasible and effective in improving the psychological outcome during COVID-19 pandemic.

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

BACKGROUND: This study aimed to determine the relationship among the clinical, logistic, and psychological impacts of COVID-19 on people with epilepsy (PWE), and the impact of COVID-19 on the quality of life. METHOD: This is a cross-sectional anonymized web-based study on PWE, using an online questionnaire to assess the clinical, logistic, and psychological impacts of COVID-19, including Hospital Anxiety Depression Scale (HADS) and Quality of Life in Epilepsy Inventory (QOLIE-31). RESULT: 461 patients were recruited, with a mean age of 39.21 ±â€¯15.88 years, majority female (50.1%), with focal epilepsy (54.0%), and experienced seizures at least once yearly (62.5%). There were 13.0% experienced seizure worsening during COVID-19 period, which were associated with baseline seizures frequency ≥ 1 per month (32.0% vs. 6.2%, p < 0.001), worries of seizure worsening (18.0% vs. 10.9%, p < 0.001), difficulty to go emergency unit (24.4% vs. 10.4%, p < 0.001), AEDs ran out of stock (23.2% vs. 11.6%, p < 0.05), self-adjustment of AED dosages (26.4% vs. 11.3%, p < 0.001), inadequate sleep (22.4% vs. 9.2%, p < 0.001), and stress (23.4% vs.10.1%, p < 0.01). Participants experiencing seizure worsening reported greater anxiety (8.10 ±â€¯5.011 vs. 4.84 ±â€¯3.989, p < 0.001) and depression (6.05 ±â€¯3.868 vs. 3.86 ±â€¯3.589, p < 0.001). Logistic regression showed baseline seizures frequency >1 per month (OR, 14.10) followed by anxiety (OR, 3.90), inadequate sleep (OR, 0.37), and treated in UMMC (OR, 0.31) as the predictors for seizure worsening during COVID-19 period. Poorer total QOLIE-31 score was noted in those with seizure worsening (48.01 ±â€¯13.040 vs. 62.15 ±â€¯15.222, p < 0.001). Stepwise regression highlighted depression as the main negative predictor for quality of life (ß = -0.372, p < 0.001), followed by anxiety (ß = -0.345, p < 0.001). CONCLUSION: A significant number of PWE experienced seizure worsening during COVID-19 period, which was related to the clinical, logistic, and psychological factors. Quality of life was affected by the seizure worsening and the psychological stress.