Survey of Clinical Neurophysiology and Epilepsy Fellowship Programs in the United States During COVID-19.

PURPOSE: The COVID-19 pandemic impacted clinical practice, education, and research in Neurophysiology/Epilepsy. Although there is published literature on clinical impact, its educational impact is not well described. A national survey of Clinical Neurophysiology (CNP) and Epilepsy fellowship programs was conducted to assess the impact of COVID-19 on fellowship education. METHODS: A list of accredited Clinical Neurophysiology and Epilepsy fellowship programs was obtained from the Accreditation Council for Graduate Medical Education. Program directors at individual locations were contacted to complete a brief survey about the program and impact of COVID-19. Fellows from responding programs were subsequently invited to share their perceptions about the impact of the pandemic on their training. RESULTS: From 176 programs, 40 PDs responded (22.7%). From these 40 programs, fellows from 26 completed surveys (65.0% response). There was a reduction in EEG and epilepsy monitoring unit volumes post-COVID-19, with a trend of change for EMG, whereas continuous EEG volumes were mostly unchanged. The impact of the pandemic on training was rated as moderate to severe (≥50%) by 30.0% of PDs and 49.0% of trainees. In remarkable agreement, 20.0% of PDs and 20.4% of fellows believed that additional fellowship training was needed before graduation. Lack of fellow satisfaction was correlated with the perceived impact of the pandemic on education (p = 0.008). CONCLUSIONS: This survey revealed a considerable impact on EEG/EMG clinical volume because of COVID-19, although continuous EEG was not as impacted. More fellows than PDs believed that training was considerably impacted by COVID-19, but a similar number thought that additional training was needed. It was unclear from this study whether the fellows' perception of educational impact was solely because of the pandemic or in addition to preexisting training deficiencies in the training programs.

Seizure control during the COVID-19 pandemic: Correlating Responsive Neurostimulation System data with patient reports.

OBJECTIVE: To understand the impact of the Coronavirus Disease-2019 (COVID-19) pandemic on seizure frequency in persons with epilepsy with a Responsive Neurostimulation (RNS) system implanted. METHODS: Weekly long episode counts (LEC) were used as a proxy for seizures for six months pre-COVID-19 and during the COVID-19 period. Telephone surveys and chart reviews were conducted to assess patient mental health during the pandemic. The change in LEC between the two time periods was correlated to reported stressors. RESULTS: Twenty patients were included. Comparing the pre-COVID-19 period to the COVID-19 period, we found that only 5 (25%) patients had increased seizures, which was positively correlated with change in anti-seizure medications (ASM, p = 0.03) and bitemporal seizures (p = 0.03). Increased seizures were not correlated to anxiety (p = 1.00), depression (p = 0.58), and sleep disturbances (p = 1.00). The correlation between RNS-detected and patient-reported seizures was poor (p = 0.32). CONCLUSIONS: Most of our patients did not have an increase in seizures following the COVID-19 pandemic. Changes in ASM and bitemporal seizures were positively correlated to increased LEC. There was no correlation between pandemic-related stress and seizures in those found to have increased seizures. SIGNIFICANCE: This is the first study correlating RNS-derived objective LECs with patient self-reports and potential seizure risk factors during the COVID-19 pandemic.

Systematic review of EEG findings in 617 patients diagnosed with COVID-19.

OBJECTIVE: We performed a systematic review of the literature to synthesize the data on EEG findings in COVID-19. Frontal EEG patterns are reported to be a characteristic finding in COVID-19 encephalopathy. Although several reports of EEG abnormalities are available, there is lack of clarity about typical findings. METHODS: Research databases were queried with the terms "COVID" OR "coronavirus" OR "SARS" AND "EEG". Available data was analyzed from 617 patients with EEG findings reported in 84 studies. RESULTS: The median age was 61.3 years (IQR 45-69, 33.3 % female). Common EEG indications were altered mental status (61.7 %), seizure-like events (31.2 %), and cardiac arrest (3.5 %). Abnormal EEG findings (n = 543, 88.0 %) were sub-classified into three groups: (1) Background abnormalities: diffuse slowing (n = 423, 68.6 %), focal slowing (n = 105, 17.0 %), and absent posterior dominant rhythm (n = 63, 10.2 %). (2) Periodic and rhythmic EEG patterns: generalized periodic discharges (n = 35, 5.7 %), lateralized/multifocal periodic discharges (n = 24, 3.9 %), generalized rhythmic activity (n = 32, 5.2 %). (3) Epileptiform changes: focal (n = 35, 5.7 %), generalized (n = 27, 4.4 %), seizures/status epilepticus (n = 34, 5.5 %). Frontal EEG patterns comprised of approximately a third of all findings. In studies that utilized continuous EEG, 96.8 % (n = 243) of the 251 patients were reported to have abnormalities compared to 85.0 % (n = 311) patients who did not undergo continuous EEG monitoring (χ2 = 22.8, p =< 0.001). SIGNIFICANCE: EEG abnormalities are common in COVID-19 related encephalopathy and correlates with disease severity, preexisting neurological conditions including epilepsy and prolonged EEG monitoring. Frontal findings are frequent and have been proposed as a biomarker for COVID-19 encephalopathy.