ABSTRACT
Objective: To better understand the impact of the COVID-19 pandemic on seizure frequency in patients with epilepsy (PWE) with an RNS implanted. Background: The COVID-19 pandemic represents a challenge to care of PWE. Some reports suggest COVID-19 can cause increased seizures in PWE, which may be related to psychosocial distress during the pandemic. Conversely, the pandemic may have brought about a decrease in daily demands and stressors, which could cause decreased seizure frequency in PWE. While surveys and record reviews provide some indication of the effect of the pandemic on seizures, RNS can potentially provide more accurate counts. Design/Methods: Patients with an RNS system implanted before September 2019 were included. We analyzed the weekly number of long episodes counts (LEC) as a proxy for seizures for 6 months (26 weeks) prior to the COVID-19 pandemic declaration (Sep 2019-Mar 2020) and after the declaration (Mar 2020-Sep 2020). Additionally, telephone surveys and chart review were conducted to assess patient mental health during the pandemic. The correlation between change in LEC and reported stressors was assessed. Results: Twenty patients were included. The average age was 41.2 years (SD=11.9). Thirteen (65%) patients were male. Comparing the pre-COVID-19 period to COVID-19 period, we found 5 (25%) patients had increased LEC compared to 15 (75%) patients who did not have significant increase in LEC. Change in anti-seizure medications (p = 0.031) and bilateral seizure types (p=0.031) were associated with an increase in LEC. Anxiety(p=1.00), depression(p=0.58), and sleep disturbances(p=1.00) were not significantly correlated with increases in LEC. Conclusions: Contrary to some published literature, we did not find a significant increase in seizures following the pandemic when assessed using the objective measure of RNS LEC and subjective self-reports on a telephone survey. Additionally, we did not find a correlation between pandemic-related stress and seizures in those who were found to have increased seizures.
ABSTRACT
Objective: To present a case of Hemiconvulsion-Hemplegia-Epilepsy (HHE) Syndrome in a child with COVID-19 infection and Multisystem Inflammatory Syndrome in Children (MIS-C). Background: HHE Syndrome is a rare pediatric epilepsy syndrome that presents with prolonged unilateral convulsive status epilepticus in the setting of fever, followed by hemiparesis, unilateral hemispheric swelling and atrophy, and the development of epilepsy. Though it was first described over six decades ago, the pathophysiology is still poorly understood with multiple factors contributing, including hyperthermia, inflammation, and cytotoxic edema from prolonged ictal activity. Prognosis is variable, from the resolution of hemiplegia and seizures to permanent hemiparesis and refractory epilepsy. Design/Methods: This is a case report based on a chart review. Results: The patient is a 2-year-old boy with a history of one prior complex febrile seizure who presented with greater than one hour of convulsive status epilepticus in the setting of fever. The patient had a generalized tonic-clonic seizure with more prominent convulsions on the right side. The patient required intubation and was initially given multiple anti-seizure loads though continued to have persistent electrographic and electroclinical seizures. EEG showed lefthemispheric high amplitude spike/polyspike and wave discharges. The patient required continuous midazolam infusion with eventual control of seizures on levetiracetam, phenobarbital, and clobazam. The examination was notable for persistent right-sided hemiparesis with gradual improvement. MRI brain without contrast revealed T2 signal abnormality and restricted diffusion diffusely throughout the left cerebral hemisphere. Infectious workup was significant for positive COVID-19 PCR and elevated inflammatory markers, consistent with MIS-C. Conclusions: Our patient had prolonged focal convulsive status epilepticus in the setting of acute febrile illness secondary to COVID-19 and MIS-C leading to hemiparesis and diffuse left cerebral hemisphere edema on MRI brain consistent with HHE syndrome. More research is needed to elucidate further HHE syndrome's pathophysiology and assess long-term outcomes in patients with HHE syndrome.