Elective inpatient video-EEG monitoring during the COVID-19 pandemic.

To evaluate the safety and feasibility of admission for elective video-EEG monitoring during the SARS-CoV-2 pandemic. We performed a retrospective review of elective inpatient epilepsy monitoring unit admissions at our institution from May 3rd, 2020 to August 12th, 2020. All patients were screened by telephone for symptoms concerning infection or recent diagnosis of SARS-CoV-2 or excess medical risk prior to admission. Patients deemed eligible for admission underwent testing via a nasopharyngeal swab for SARS-CoV-2 within three days of admission, and were directed to self-quarantine between testing and admission. The community seven-day case rate for SARS-CoV-2 (new cases per 100,000 population) ranged from 2.8 to 28.9 during the study period in our region. A total of 95 patients (63 adults and 32 children) were admitted. One adult patient developed mild SARS-CoV-2 infection and one adult patient tested positive for asymptomatic SARS-CoV-2 infection. These findings illustrate that inpatient epilepsy monitoring can be safely performed in carefully selected patients when appropriate processes are in place, even in the setting of the SARS-CoV-2 pandemic. There is a risk of nosocomial spread, and the potential benefits of admission should be balanced against the risks of infection.

Importance of access to epilepsy monitoring units during the COVID-19 pandemic: Consensus statement of the International League against epilepsy and the International Federation of Clinical Neurophysiology.

Restructuring of healthcare services during the COVID-19 pandemic has led to lockdown of Epilepsy Monitoring Units (EMUs) in many hospitals. The ad-hoc taskforce of the International League Against Epilepsy (ILAE) and the International Federation of Clinical Neurophysiology (IFCN) highlights the detrimental effect of postponing video-EEG monitoring of patients with epilepsy and other paroxysmal events. The taskforce calls for action to continue functioning of Epilepsy Monitoring Units during emergency situations, such as the COVID-19 pandemic. Long-term video-EEG monitoring is an essential diagnostic service. Access to video-EEG monitoring of the patients in the EMUs must be given high priority. Patients should be screened for COVID-19, before admission, according to the local regulations. Local policies for COVID-19 infection control should be adhered to during the video-EEG monitoring. In cases of differential diagnosis where reduction of antiseizure medication is not required, consider home video-EEG monitoring as an alternative in selected patients.

The COVID-19 outbreak and approaches to performing EEG in Europe.

The coronavirus SARS-CoV-2 disease (COVID-19) pandemic affects availability and performance of neurophysiological diagnostic methods, including EEG. Our objective was to outline the current situation regarding EEG-based investigations across Europe. A web-based survey was distributed to centres within the European Reference Network on rare and complex epilepsies (ERN EpiCARE). Responses were collected between April 9 and May 15, 2020. Results were analysed with Microsoft Excel, Python Pandas and SciPy. Representants from 47 EpiCARE centres from 22 countries completed the survey. At the time of completing the survey, inpatient video-EEGs had been stopped or restricted in most centres (61.7% vs. 36.2% for adults, and 38.3% vs. 53.2% for children). Invasive investigations and epilepsy surgery were similarly affected. Acute EEGs continued to be performed, while indications for outpatient EEGs were limited and COVID-19 triage put in place. The strictness of measures varied according to extent of the outbreak in a given country. The results indicate a profound impact of COVID-19 on neurophysiological diagnostics, especially inpatient video-EEGs, invasive investigations, and epilepsy surgery. The COVID-19 pandemic may hamper care for patients in need of EEG-based investigations, particularly patients with seizure disorders. ERN EpiCARE will work on recommendations on how to rapidly adapt to such situations in order to alleviate consequences for our patients.