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1.
Epilepsy Behav ; 125: 108379, 2021 12.
Article in English | MEDLINE | ID: covidwho-1458792

ABSTRACT

BACKGROUND: To assess the prevalence, severity, and mortality of COVID-19 in people with epilepsy (PWE) and evaluate seizure control in PWE during and after COVID-19. METHODS: Retrospective, observational, multicenter study conducted in 14 hospitals. Medical records of randomly selected PWE followed at neurology outpatient clinics were reviewed. Proportion of PWE with a positive test for SARS-CoV-2 during 2020 was calculated. Risk factors associated with COVID-19 and its morbimortality were evaluated. RESULTS: 2751 PWE were included, mean age 48.8 years (18-99), 72.4% had focal epilepsy, and 35% were drug-refractory. COVID-19 prevalence in PWE was 5.53%, while in the Spanish population was 4.26%. Proportion of admissions to hospital, ICU, and deaths in PWE were 17.1%, 2%, and 4.61% of COVID-19 cases, while in Spanish population were 10.81%, 0.95%, and 2.57%, respectively. A severe form of COVID-19 occurred in 11.8%; dyslipidemia, institutionalization at long-term care facilities, intellectual disability, and older age were associated risk factors. Older age, hypertension, dyslipidemia, cardiac disease, and institutionalization were associated with mortality from COVID-19. Seizure control was stable in 90.1% of PWE during acute COVID-19, while 8.6% reported an increase in seizure frequency. During post-COVID-19 follow-up, 4.6% reported seizure control worsening. CONCLUSIONS: COVID-19 was moderately prevalent in PWE. One out of 5 patients required medical attention and 4.6% died due to COVID-19. Older age, dyslipidemia, institutionalization, and intellectual disability were significant risk factors associated with severe COVID-19. Seizure control remained stable during COVID-19 and throughout long-term follow-up in most PWE who contracted the infection.


Subject(s)
COVID-19 , Epilepsy , Aged , Epilepsy/epidemiology , Humans , Middle Aged , Prevalence , Retrospective Studies , SARS-CoV-2
2.
Front Immunol ; 12: 665300, 2021.
Article in English | MEDLINE | ID: covidwho-1226978

ABSTRACT

The irruption of SARS-CoV-2 during 2020 has been of pandemic proportions due to its rapid spread and virulence. COVID-19 patients experience respiratory, digestive and neurological symptoms. Distinctive symptom as anosmia, suggests a potential neurotropism of this virus. Amongst the several pathways of entry to the nervous system, we propose an alternative pathway from the infection of the gut, involving Toll-like receptor 4 (TLR4), zonulin, protease-activated receptor 2 (PAR2) and zonulin brain receptor. Possible use of zonulin antagonists could be investigated to attenuate neurological manifestations caused by SARS-CoV-19 infection.


Subject(s)
COVID-19/complications , Haptoglobins/metabolism , Nervous System Diseases/complications , Protein Precursors/metabolism , Blood-Brain Barrier/metabolism , Blood-Brain Barrier/virology , Brain/metabolism , Brain/virology , COVID-19/metabolism , COVID-19/virology , Complement System Proteins/metabolism , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/metabolism , Gastrointestinal Diseases/virology , Humans , Nervous System Diseases/metabolism , Nervous System Diseases/virology , SARS-CoV-2/metabolism , SARS-CoV-2/pathogenicity , Toll-Like Receptor 4/metabolism
3.
Epilepsy Behav ; 112: 107396, 2020 11.
Article in English | MEDLINE | ID: covidwho-745902

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.


Subject(s)
Anticonvulsants/therapeutic use , Anxiety/physiopathology , Coronavirus Infections , Epilepsy/physiopathology , Pandemics , Pneumonia, Viral , Stress, Psychological/physiopathology , Adolescent , Adult , Anxiety/psychology , Betacoronavirus , COVID-19 , Depression/physiopathology , Depression/psychology , Disease Progression , Epilepsy/drug therapy , Epilepsy/psychology , Exercise , Female , Humans , Male , Middle Aged , Recurrence , Registries , Retrospective Studies , Risk Factors , SARS-CoV-2 , Seizures/physiopathology , Sleep Deprivation/physiopathology , Spain , Status Epilepticus/physiopathology , Stress, Psychological/psychology
4.
Neurology ; 95(8): e1060-e1070, 2020 08 25.
Article in English | MEDLINE | ID: covidwho-459488

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) has spread worldwide since December 2019. Neurologic symptoms have been reported as part of the clinical spectrum of the disease. We aimed to determine whether neurologic manifestations are common in hospitalized patients with COVID-19 and to describe their main characteristics. METHODS: We systematically reviewed all patients diagnosed with COVID-19 admitted to the hospital in a Spanish population during March 2020. Demographic characteristics, systemic and neurologic clinical manifestations, and complementary tests were analyzed. RESULTS: Of 841 patients hospitalized with COVID-19 (mean age 66.4 years, 56.2% men), 57.4% developed some form of neurologic symptom. Nonspecific symptoms such as myalgias (17.2%), headache (14.1%), and dizziness (6.1%) were present mostly in the early stages of infection. Anosmia (4.9%) and dysgeusia (6.2%) tended to occur early (60% as the first clinical manifestation) and were more frequent in less severe cases. Disorders of consciousness occurred commonly (19.6%), mostly in older patients and in severe and advanced COVID-19 stages. Myopathy (3.1%), dysautonomia (2.5%), cerebrovascular diseases (1.7%), seizures (0.7%), movement disorders (0.7%), encephalitis (n = 1), Guillain-Barré syndrome (n = 1), and optic neuritis (n = 1) were also reported, but less frequent. Neurologic complications were the main cause of death in 4.1% of all deceased study participants. CONCLUSIONS: Neurologic manifestations are common in hospitalized patients with COVID-19. In our series, more than half of patients presented some form of neurologic symptom. Clinicians need to maintain close neurologic surveillance for prompt recognition of these complications. The mechanisms and consequences of severe acute respiratory syndrome coronavirus type 2 neurologic involvement require further studies.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Nervous System Diseases/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Registries , Aged , Betacoronavirus/pathogenicity , COVID-19 , Comorbidity , Female , Humans , Male , Pandemics , SARS-CoV-2 , Spain/epidemiology
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