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1.
Acta Clin Croat ; 60(Suppl 3): 50-56, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-2145889

ABSTRACT

The most common neurological symptoms in patients with SARS-CoV-2 infection are headache, myalgia, encephalopathy, dizziness, dysgeusia and anosmia, making more than 90 percent of neurological manifestations of COVID-19. Other neurological manifestations such as stroke, movement disorder symptoms or epileptic seizures are rare but rather devastating, with possible lethal outcome. The primary aim of this study was to estimate the prevalence of acute symptomatic seizures among COVID-19 patients, while secondary aim was to determine their possible etiology. Out of 5382 patients with COVID-19 admitted to Dubrava University Hospital from November 1, 2020 until June 1, 2021, 38 (seizure rate 0.7%) of them had acute symptomatic seizures. Of these 38 patients, 29 (76.3%) had new-onset epileptic seizures and nine (23.7%) patients with previous epilepsy history had breakthrough seizures during COVID-19. Although acute symptomatic seizures are an infrequent complication of COVID-19, seizure risk must be considered in these patients, particularly in the group of patients with a severe course of the disease. Accumulation of proinflammatory cytokines may contribute to the occurrence of seizures in patients with COVID-19, but seizures may also be secondary to primary brain pathology related to COVID-19, such as stroke or encephalitis.


Subject(s)
COVID-19 , Epilepsy , Stroke , Humans , Incidence , COVID-19/complications , COVID-19/epidemiology , SARS-CoV-2 , Seizures/epidemiology , Seizures/etiology , Seizures/diagnosis , Epilepsy/epidemiology , Epilepsy/etiology , Stroke/complications , Stroke/epidemiology
5.
Iran J Med Sci ; 47(6): 588-593, 2022 11.
Article in English | MEDLINE | ID: covidwho-2100905

ABSTRACT

Background: Previous studies have shown that patients with epilepsy (PWE) perceived significant disruption in the quality and provision of care due to the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to investigate the effect of this pandemic on seizure control status and changes in seizure frequency in PWE. Methods: A consecutive sample of adult PWE registered in the database of Shiraz Epilepsy Center (Shiraz, Iran) was included in the study. In July 2021, phone interviews were conducted with all selected patients. Information such as age, sex, last seizure, seizure type, and frequency during the 12 months before the study, and history of COVID-19 contraction was extracted. The seizure control status of the patients in 2019 (pre-pandemic) was compared with that during the COVID-19 pandemic. Data were analyzed using SPSS software with the Fisher's exact test and Pearson's Chi squared test. P<0.05 was considered statistically significant. Results: A total of 158 patients were included in the study, out of which 62 (39.2%) patients had a stable seizure control status, 47 (29.7%) had fewer seizures, and 50 (31.6%) had more seizures. Breakthrough seizures were reported by 32 (34.4%) patients. Seizure frequency increased in 18 (27.7%) and decreased in 46 (70.7%) patients. Conclusion: Overall, the COVID-19 pandemic has not been a major precipitating factor nor has it affected the seizure control status of PWE. In treated epilepsy, a fluctuating course with periods of seizure freedom followed by relapses is part of its natural history.


Subject(s)
COVID-19 , Epilepsy , Adult , Humans , Infant , Pandemics , COVID-19/epidemiology , Seizures/epidemiology , Epilepsy/complications , Epilepsy/epidemiology , Recurrence
7.
Seizure ; 102: 51-53, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2042128

ABSTRACT

PURPOSE: This study assesses investigations, referrals and admissions in patients presenting to the Emergency Department (ED) with seizures, and the effect of the COVID-19 pandemic on such management. Outcomes in patients with learning disabilities, active significant mental health concerns, and from the most socioeconomically deprived areas were compared to those of the general cohort. METHODS: Investigations, referrals and admissions were recorded for 120 patients across two cohorts; pre-pandemic (September 2019) and during the pandemic (December 2020). Retrospective review of individual patient electronic health care records was used for data collection. RESULTS: There was a decrease in patient numbers from 2019 to 2020. A greater proportion of patients presented with organic cause seizures and fewer presented with non-epileptic attacks. Frequent use of CT heads (45%) is likely to represent improper use of limited resources. There were low referral rates, both to acute neurology (28%) and to the adult epilepsy team (32%). Patients with active significant mental health concerns were significantly less likely to be referred to neurology or admitted. CONCLUSIONS: Despite a greater proportion of admissions during the Covid-19 pandemic, referrals to acute neurology and the epilepsy team remained low. Failure to refer prevents the most vulnerable seizure patients from receiving appropriate support, as seen in patients with active significant mental health concerns. Neurology staff were unaware of a significant number of patients presenting with seizures, which is of concern in an already over-stretched department. This offers an opportunity to improve care for people with epilepsy.


Subject(s)
COVID-19 , Epilepsy , Adult , Humans , Pandemics , COVID-19/epidemiology , Seizures/diagnosis , Seizures/epidemiology , Seizures/therapy , Epilepsy/diagnosis , Epilepsy/epidemiology , Epilepsy/therapy , Hospitals , Emergency Service, Hospital , Retrospective Studies
8.
J Psychosom Res ; 162: 111046, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2041977

ABSTRACT

OBJECTIVE: Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures but are not due to underlying epileptic activity and in some cases coexist alongside epilepsy. We described the clinical characteristics of patients with PNES as reported in the literature from the outbreak of the COVID-19 pandemic. We evaluated differences between patients with a diagnosis made immediately before the pandemic (pPNES) and those newly diagnosed during it (nPNES). METHODS: A systematic search with individual patient analysis of PNES cases published since the COVID-19 pandemic outbreak was performed. Differences between pPNES and nPNES were analyzed using Chi-square or Fisher exact test. RESULTS: Eleven articles were included, with 133 patients (106 pPNES and 27 nPNES). In the pPNES group, PNES frequency increased during the pandemic in 20/106 patients, whereas in 78/106, the frequency remained stable or decreased. nPNES was associated with higher risks of SARS-CoV-2 infection and epilepsy diagnosis, whereas psychiatric comorbidities were less frequent. CONCLUSIONS: During the pandemic, most patients with pPNES remained stable or improved, whereas nPNES was associated with a lower burden of psychiatric comorbidities. These intriguing findings suggest that, at least in some patients, the COVID-19 pandemic may not necessarily lead to worsening in the frequency of PNES and quality of life.


Subject(s)
COVID-19 , Epilepsy , COVID-19/epidemiology , Electroencephalography , Epilepsy/diagnosis , Epilepsy/epidemiology , Humans , Pandemics , Quality of Life/psychology , SARS-CoV-2 , Seizures/diagnosis
9.
Handb Clin Neurol ; 187: 407-427, 2022.
Article in English | MEDLINE | ID: covidwho-1990833

ABSTRACT

Neuropathological examination of the temporal lobe provides a better understanding and management of a wide spectrum of diseases. We focused on inflammatory diseases, epilepsy, and neurodegenerative diseases, and highlighted how the temporal lobe is particularly involved in those conditions. Although all these diseases are not specific or restricted to the temporal lobe, the temporal lobe is a key structure to understand their pathophysiology. The main histological lesions, immunohistochemical markers, and molecular alterations relevant for the neuropathological diagnostic reasoning are presented in relation to epidemiology, clinical presentation, and radiological findings. The inflammatory diseases section addressed infectious encephalitides and auto-immune encephalitides. The epilepsy section addressed (i) susceptibility of the temporal lobe to epileptogenesis, (ii) epilepsy-associated hippocampal sclerosis, (iii) malformations of cortical development, (iv) changes secondary to epilepsy, (v) long-term epilepsy-associated tumors, (vi) vascular malformations, and (vii) the absence of histological lesion in some epilepsy surgery samples. The neurodegenerative diseases section addressed (i) Alzheimer's disease, (ii) the spectrum of frontotemporal lobar degeneration, (iii) limbic-predominant age-related TDP-43 encephalopathy, and (iv) α-synucleinopathies. Finally, inflammatory diseases, epilepsy, and neurodegenerative diseases are considered as interdependent as some pathophysiological processes cross the boundaries of this classification.


Subject(s)
Epilepsy, Temporal Lobe , Epilepsy , Neurodegenerative Diseases , Epilepsy/epidemiology , Epilepsy/pathology , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/pathology , Hippocampus/pathology , Humans , Temporal Lobe/pathology
10.
Seizure ; 101: 11-14, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1983985

ABSTRACT

BACKGROUND: We aimed to investigate whether SARS-CoV-2 infection was associated with an increased risk of incident epilepsy. METHODS: National register-based matched study. Verified cases of SARS-CoV-2 infection were acquired from the system for communicable disease surveillance in Sweden (SmiNet) and linked to data from the National Patient Register (NPR) and Cause of Death register in Sweden. Cases and non-infected controls were compared using a Cox proportional hazards model. RESULTS: A total of 1,221,801 SARS-CoV-2 infected patients and 1,223,312 controls were included. Infection was not associated with an increased risk of epilepsy on a whole population level (HR 1.01, 95% CI 0.92-1.12). Statistically significant effects were observed in patients between 61 and 80 years (HR 1.66, 95% CI 1.37-2.02), also when adjusting for stroke, traumatic brain injury, tumours (same age group HR 1.50, 95% CI 1.24-1.82) and mechanical ventilation (HR 1.28, 95% CI 1.05-1.57). In patients 81-100 years, a similar significant difference was observed (HR 1.77, 95% CI 1.30-2.42), which remained after adjustment for stroke, traumatic brain injury and tumours (HR 1.51, 95% CI 1.10-2.05) but not when mechanical ventilation was included as a covariate (HR 1.34, 95% CI 0.97-1.84). CONCLUSIONS: On a whole population level, SARS-CoV-2 infections is not associated with an increased risk of epilepsy. In patients above 60 years, a moderately increased risk of epilepsy was observed. However, considering potential non-controllable bias and that Covid-19 patients in intensive care present with a lower risk than the general ICU population, the virus-induced epileptogenic effect is likely very small.


Subject(s)
Brain Injuries, Traumatic , COVID-19 , Epilepsy , Stroke , COVID-19/epidemiology , COVID-19 Testing , Epilepsy/epidemiology , Humans , SARS-CoV-2
11.
Intern Med ; 61(15): 2287-2293, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1968929

ABSTRACT

Objective To investigate seizure control in patients with epilepsy during the coronavirus disease 2019 (COVID-19) pandemic. Method A systematic review and meta-analysis was conducted, and the MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov databases were comprehensively searched for relevant studies. Studies that reported seizure control in patients with epilepsy during the COVID-19 pandemic were included. Pooled proportions with 95% confidence intervals (CIs) of patients with epilepsy who experienced seizure worsening during the COVID-19 pandemic were assessed using a random-effects model. The quality of the assessment for each study, heterogeneity between the studies, and publication bias were also evaluated. Subgroup analyses were performed, excluding studies with reports of seizures worsening from caregivers. Results A total of 24 studies with 6,492 patients/caregivers were included in the meta-analysis. The pooled proportion of seizure worsening was 18.5% (95% CI: 13.9-23.6; I2=96%; p<0.01). The pooled proportion of seizure worsening in the subgroup analysis was 18.9% (95% CI: 13.5-25.0; I2=96%; p<0.01). Conclusion Although the heterogeneity was high, our results showed a relatively high incidence of seizure worsening during the COVID-19 pandemic. During the COVID-19 pandemic, physicians should be aware of the likelihood of worsening seizures in patients with epilepsy.


Subject(s)
COVID-19 , Epilepsies, Partial , Epilepsy, Generalized , Epilepsy , Anticonvulsants/therapeutic use , COVID-19/epidemiology , Epilepsies, Partial/drug therapy , Epilepsy/complications , Epilepsy/drug therapy , Epilepsy/epidemiology , Epilepsy, Generalized/drug therapy , Humans , Pandemics , Seizures/drug therapy , Seizures/epidemiology
12.
Niger J Clin Pract ; 25(7): 1061-1068, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1954419

ABSTRACT

Background: Affinity of coronavirus disease to the central nervous system is not well known. Aim: We aimed to share the data of COVID-19 patients with neurological complaints in a pandemia hospital. Material and Method: Consultation results requested from the neurology clinic of Konya Meram State Hospital were retrospectively examined. PCR test positive patients, PCR negative patients with positive clinical, laboratory and radiological findings with COVID-19 were evaluated. Age, gender, history of neurological diseases, and neurological symptoms were recorded. Results: The reason for consultation was acute neurological symptom in 96 (84.2%) patients, counseling for treatment in chronic disease in 15 (13.2%) patients, and worsening in chronic disease in 3 (2.6%) patients. As neurological disorders, 22 (19.3%) had a history of previous stroke, 10 (8.8%) had dementia, 4 (3.5%) had epilepsy, 4 (3.5%) had Parkinson's disease, 3 (2.6%) had multiple sclerosis, 2 (1.8%) had myasthenia graves, and 1 (0.9%) had restless legs syndrome respectively. The most common reason for requesting consultation was changes in consciousness (56.1%). Of the 114 patients who requested neurology consultation, 65 (57%) were discharged, 49 (43%) were died. Conclusion: The change in consciousness was the reason in more than half of the patients who requested neurology consultation during COVID-19 follow-up. Impaired consciousness in a patient with COVID-19 may indicate a poor prognosis. If the studies planned in the near future can shed light on the cause of the unconsciousness developing in COVID-19, it will be promising in terms of treatment plans to reduce mortality.


Subject(s)
COVID-19 , Epilepsy , Neurology , COVID-19/epidemiology , Epilepsy/diagnosis , Epilepsy/epidemiology , Hospitals , Humans , Pandemics , Referral and Consultation , Retrospective Studies
13.
Epilepsia ; 63(9): 2279-2289, 2022 09.
Article in English | MEDLINE | ID: covidwho-1916134

ABSTRACT

OBJECTIVE: Data on COVID-19 outcomes in persons with epilepsy (PWE) are scarce and inconclusive. We aimed to study the risk of hospitalization and death for COVID-19 in a large cohort of PWE from March 1, 2020 to October 31, 2021. METHODS: The historical cohort design (EpiLink Bologna) compared adult PWE grouped into people with focal epilepsy (PFE), idiopathic generalized epilepsy (PIGE), and developmental and/or epileptic encephalopathy (PDEE), and a population cohort matched (ratio 1:10) for age, sex, residence, and comorbidity (assessed with the multisource comorbidity score), living in the local health trust of Bologna (approximately 800 000 residents). Clinical data were linked to health administrative data. RESULTS: In both cohorts (EpiLink: n = 1575 subjects, 1128 PFE, 267 PIGE, 148 PDEE, 32 other; controls: n = 15 326 subjects), 52% were females, and the mean age was 50 years (SD = 18). Hospital admissions for COVID-19 in the whole period were 49 (3.1%) in PWE and 225 (1.5%) in controls. The adjusted hazard ratio (aHR) in PWE was 1.9 (95% confidence interval [CI] = 1.4-2.7). The subgroups at higher risk were PFE (aHR = 1.9, 95% CI = 1.3-2.8) and PDEE (aHR = 3.9, 95% CI = 1.7-8.7), whereas PIGE had a risk comparable to the controls (aHR = 1.1, 95% CI = .3-3.5). Stratified analyses of the two main epidemic waves (March-May 2020, October 2020-May 2021) disclosed a higher risk of COVID-19-related hospitalization during the first epidemic wave (March-May 2020; aHR = 3.8, 95% CI = 2.2-6.7). Polytherapy with antiseizure medications contributed to a higher risk of hospital admission. Thirty-day risk of death after hospitalization was 14% in both PWE and controls. SIGNIFICANCE: During the first 20 months since the outbreak of COVID-19 in Bologna, PWE had a doubled risk of COVID-19 hospital admission compared to a matched control population. Conversely, epilepsy did not represent a risk factor for COVID-19-related death.


Subject(s)
COVID-19 , Epilepsy , Adult , COVID-19/epidemiology , Cohort Studies , Comorbidity , Epilepsy/epidemiology , Female , Hospitalization , Humans , Male , Middle Aged
14.
Clin Neurol Neurosurg ; 219: 107310, 2022 08.
Article in English | MEDLINE | ID: covidwho-1866981

ABSTRACT

OBJECTIVE: We investigated whether the COVID-19 pandemic has influenced the characteristics of functional seizures (FS) at the onset of seizures. METHODS: This was a retrospective study of all patients with new-onset FS, who were admitted at the epilepsy monitoring unit at Shiraz University of Medical Sciences, Shiraz, Iran, during two time periods: the onset of FS and also the diagnosis of FS in 2017-2019 (pre-COVID era) and the onset of FS and also the diagnosis of FS in 2020-2021 (COVID era). RESULTS: Forty-five patients were studied (32 patients from the pre-COVID era and 13 patients from the COVID era). Patients who developed FS during the pandemic more likely had comorbid epilepsy compared with the patients who presented with FS before the pandemic [30.1% vs. 9.4%; Odds ratio (OR): 81.2]. Furthermore, those who developed FS during the pandemic more likely were employed compared with the patients who presented with FS before the pandemic (46.2% vs. 12.5%; OR: 16.2). A family history of seizures was associated with the FS timing as a trend (OR: 8.4); those who developed FS during the pandemic more likely had a family history of seizures compared with the patients who presented with FS before the pandemic (53.8% vs. 18.8%). CONCLUSION: This study showed that patients who developed FS during the COVID-19 pandemic had significant underlying differences (i.e., employment status, comorbid epilepsy, and a family history of seizures) compared with those who presented with FS before the pandemic.


Subject(s)
COVID-19 , Epilepsy , Age of Onset , COVID-19/epidemiology , Electroencephalography , Epilepsy/diagnosis , Epilepsy/epidemiology , Humans , Pandemics , Retrospective Studies , Seizures/diagnosis
15.
MMWR Morb Mortal Wkly Rep ; 71(21): 703-708, 2022 May 27.
Article in English | MEDLINE | ID: covidwho-1865662

ABSTRACT

Seizures, transient signs or symptoms caused by abnormal surges of electrical activity in the brain, can result from epilepsy, a neurologic disorder characterized by abnormal electrical brain activity causing recurrent, unprovoked seizures, or from other inciting causes, such as high fever or substance abuse (1). Seizures generally account for approximately 1% of all emergency department (ED) visits (2,3). Persons of any age can experience seizures, and outcomes might range from no complications for those with a single seizure to increased risk for injury, comorbidity, impaired quality of life, and early mortality for those with epilepsy (4). To examine trends in weekly seizure- or epilepsy-related (seizure-related) ED visits† in the United States before and during the COVID-19 pandemic, CDC analyzed data from the National Syndromic Surveillance Program (NSSP).§ Seizure-related ED visits decreased abruptly during the early pandemic period. By the end of 2020, seizure-related ED visits returned almost to prepandemic levels for persons of all ages, except children aged 0-9 years. By mid-2021, however, this age group gradually returned to baseline as well. Reasons for the decrease in seizure-related ED visits in 2020 among all age groups and the slow return to baseline among children aged 0-9 years compared with other age groups are unclear. The decrease might have been associated with fear of exposure to COVID-19 infection in EDs deterring parents or guardians of children from seeking care, adherence to mitigation measures including avoiding public settings such as EDs, or increased access to telehealth services decreasing the need for ED visits (5). These findings reinforce the importance of understanding factors associated with ED avoidance among persons with epilepsy or seizure, the importance that all eligible persons be up to date¶ with COVID-19 vaccination, and the need to encourage persons to seek appropriate care for seizure-related emergencies** to prevent adverse outcomes.


Subject(s)
COVID-19 , Epilepsy , COVID-19/epidemiology , COVID-19 Vaccines , Child , Child, Preschool , Emergency Service, Hospital , Epilepsy/epidemiology , Humans , Infant , Infant, Newborn , Pandemics , Quality of Life , Seizures/epidemiology , United States/epidemiology
16.
J Clin Neurosci ; 101: 112-117, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1851610

ABSTRACT

We describea series of patients with COVID-19 who presented with seizures, reported in the Spanish Society of Neurology's COVID-19 Registry. This observational, descriptive,multicentre, registry-based study includes patients with confirmed COVID-19 who experienced seizures during active infection.Wedescribe theclinicalpresentation of COVID-19,seizures,and resultsof complementary tests.Wealsodescribe the suspectedaetiologyof the seizures. Of 232 reported cases, 26 (11.2%) presented with seizures;7 of these patients (26.9%) had prior history of epilepsy, whereas the remaining 19 (73.1%) had no history of seizures.In most cases, seizures presented on days 0 and 7 after onset of COVID-19. By seizure type, 8 patients (30.7%) presentedgeneralised tonic-clonic seizures, 7 (26.9%) status epilepticus, 8 (30.7%) focal impaired-awareness seizures, and 4 (11.7%) secondary generalised seizures.Six patients (23.1%) also presented other neurological symptoms, includingaltered mental status and decreased level of consciousness. Predisposing factors for seizures (eg, dementia, tumour, cerebrovascular disease) were observed in 10 of the 19 patients with no prior history of epilepsy (52.6%). Patients with COVID-19 may present with seizures over the course of the disease,either alone or in the context of encephalopathy.Seizures may present in patients with no prior history of epilepsy; however, most of these patients present predisposing factors.


Subject(s)
COVID-19 , Epilepsy, Tonic-Clonic , Epilepsy , Neurology , Anticonvulsants/therapeutic use , COVID-19/complications , Electroencephalography , Epilepsy/drug therapy , Epilepsy/epidemiology , Epilepsy/etiology , Epilepsy, Tonic-Clonic/drug therapy , Humans , Registries , Seizures/drug therapy , Seizures/epidemiology , Seizures/etiology
17.
Neurology ; 98(19): e1893-e1901, 2022 05 10.
Article in English | MEDLINE | ID: covidwho-1833443

ABSTRACT

BACKGROUND AND OBJECTIVES: Persons with epilepsy, especially those with drug resistant epilepsy (DRE), may benefit from inpatient services such as admission to the epilepsy monitoring unit (EMU) and epilepsy surgery. The COVID-19 pandemic caused reductions in these services within the US during 2020. This article highlights changes in resources, admissions, and procedures among epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC). METHODS: We compared data reported in 2019, prior to the COVID-19 pandemic, and 2020 from all 260 level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level, center population category, and geographical location. Qualitative responses from center directors to questions regarding the impact from COVID-19 were summarized utilizing thematic analysis. Responses from the NAEC center annual reports as well as a supplemental COVID-19 survey were included. RESULTS: EMU admissions declined 23% (-21,515) in 2020, with largest median reductions in level 3 centers [-55 admissions (-44%)] and adult centers [-57 admissions (-39%)]. The drop in admissions was more substantial in the East North Central, East South Central, Mid Atlantic, and New England US Census divisions. Survey respondents attributed reduced admissions to re-assigning EMU beds, restrictions on elective admissions, reduced staffing, and patient reluctance for elective admission. Treatment surgeries declined by 371 cases (5.7%), with the largest reduction occurring in VNS implantations [-486 cases (-19%)] and temporal lobectomies [-227 cases (-16%)]. All other procedure volumes increased, including a 35% (54 cases) increase in corpus callosotomies. DISCUSSION: In the US, access to care for persons with epilepsy declined during the COVID-19 pandemic in 2020. Adult patients, those relying on level 3 centers for care, and many persons in the eastern half of the US were most affected.


Subject(s)
COVID-19 , Drug Resistant Epilepsy , Epilepsy , Adult , Drug Resistant Epilepsy/surgery , Epilepsy/epidemiology , Epilepsy/surgery , Hospitalization , Humans , Pandemics , United States/epidemiology
18.
Neurology ; 98(19): e1886-e1892, 2022 05 10.
Article in English | MEDLINE | ID: covidwho-1833442

ABSTRACT

BACKGROUND AND OBJECTIVES: The goal of this work was to evaluate whether patients with epilepsy were more susceptible to coronavirus disease 2019 (COVID-19) infection and at greater risk of severe complications when infected with COVID-19 compared with patients without epilepsy. METHODS: We included participants who underwent at least 1 severe acute respiratory syndrome coronavirus 2 real-time reverse-transcription PCR test between January 1 and June 4, 2020, from the Korean nationwide COVID-19 dataset. Epilepsy was defined according to the presence of diagnostic code in health claims data before the COVID-19 diagnosis. To investigate the association between epilepsy and the susceptibility for or severe complications of COVID-19, a 1:6 ratio propensity score matching (PSM) and logistic regression analysis were performed. Severe complications with COVID-19 infection were defined as a composite of the incidence of mechanical ventilation, intensive care unit admission, and death within 2 months after COVID-19 diagnosis. RESULTS: Among 212,678 study participants who underwent a COVID-19 test, 3,919 (1.8%) had a history of epilepsy. After PSM, there was no significant difference in COVID-19 PCR positivity according to epilepsy history (odds ratio [OR] 0.86, 95% CI 0.67-1.11). Of the 7,713 individuals with confirmed COVID-19 infection, 72 (0.9%) had a history of epilepsy. Among the patients with COVID-19, severe complications occurred in 444 (5.8%) individuals. After PSM, the presence of epilepsy was associated with the occurrence of severe complications after COVID-19 infection (OR 2.05, 95% CI 1.04-4.04). Mortality after COVID-19 infection did not differ according to the presence of epilepsy history (OR 1.55, 95% CI 0.65-3.70). DISCUSSION: The presence of epilepsy was not associated with increased susceptibility to COVID-19 infection or mortality related to the infection. However, there was an increased risk of severe complications with COVID-19 in patients with epilepsy; therefore, careful management and monitoring may be necessary.


Subject(s)
COVID-19 , Epilepsy , COVID-19/complications , COVID-19/epidemiology , COVID-19 Testing , Cohort Studies , Epilepsy/epidemiology , Humans , SARS-CoV-2
19.
Epilepsia Open ; 7(2): 325-331, 2022 06.
Article in English | MEDLINE | ID: covidwho-1782589

ABSTRACT

OBJECTIVE: To investigate the effect of Coronavirus disease 2019 (COVID-19) measures on the hospitalization of patients with epilepsy and status epilepticus (SE). METHODS: This interrupted time series design included data from the Thai Universal Coverage Scheme electronic database between January 2017 and September 2020. The monthly hospitalization rate of epilepsy and SE was calculated by the number of hospitalizations divided by the midyear population. Segmented regression fitted by ordinary least squares (OLS) was used to detect the immediate and overtime effects of COVID-19 measures on the hospitalization rate. RESULTS: During January 2017 and September 2020, the numbers of epilepsy and SE patients admitted to the hospital were 129 402 and 15 547 episodes, respectively. The monthly trend of the hospitalization rate in epilepsy decreased immediately after the COVID-19 measure (0.739 per 100 000 population [95% CI: 0.219 to 1.260]). In particular, the number of children declined to 1.178 per 100 000 population, and the number of elderly individuals dropped to 0.467 per 100 000 population, while there was a nonstatistically significant change in SE. SIGNIFICANCE: COVID-19 measures reduced the hospital rate in epilepsy, particularly in children and adults. However, there was no change in SE patients.


Subject(s)
COVID-19 , Epilepsy , Status Epilepticus , Adult , Aged , COVID-19/epidemiology , Child , Epilepsy/epidemiology , Epilepsy/therapy , Hospitalization , Humans , Interrupted Time Series Analysis , Retrospective Studies , Status Epilepticus/diagnosis , Status Epilepticus/epidemiology , Status Epilepticus/therapy , Thailand/epidemiology
20.
Curr Opin Neurol ; 35(2): 169-174, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1722760

ABSTRACT

PURPOSE OF REVIEW: Epilepsy is a common, chronic neurologic disease with continued disparities in care. The COVID-19 pandemic and recent social movements have drawn greater attention to social determinants of health and our progress (or lack thereof) toward delivering more equitable care. RECENT FINDINGS: Recent studies continue to document racial and economic disparities in diagnosis, treatment, and overall care of epilepsy and associated conditions. Notably, an increasing number of studies are attempting to design healthcare pathways and other interventions to improve access and equity in epilepsy care. SUMMARY: The present literature highlights the importance of identifying and addressing the particular needs of vulnerable persons with epilepsy. Practitioners and researchers should continue to develop interventions aimed at improving care for all patients and, crucially, measure the impact of their changes to ensure that any interventions are truly advancing health equity.


Subject(s)
COVID-19 , Epilepsy , COVID-19/epidemiology , Epilepsy/diagnosis , Epilepsy/epidemiology , Epilepsy/therapy , Healthcare Disparities , Humans , Pandemics , SARS-CoV-2 , Socioeconomic Factors
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