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1.
Acta Neurol Scand ; 143(2): 206-209, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1388169

ABSTRACT

BACKGROUND: Lockdown due to the SARS-CoV-2 pandemic became a challenge to maintain care for patients with epilepsy; we aimed to find out how the pandemic affected them. METHODS: We sent an online 22-item questionnaire to patients from our outpatient clinic, a reference centre in Spain for drug-resistant epilepsy, inquiring about the effects of lockdown, from March to May 2020. RESULTS: We sent the survey to 627 patients; 312 (58% women) sent a complete response and were included. Of all respondents, 57% took >2 antiseizure medications. One-third of respondents (29%) declared an associated cognitive or motor disability. A minority had confirmed infection with SARS-CoV-2 (1.92%). Seizure frequency remained like usual in 56% of patients, while 31.2% reported an increase. Less than 10% needed emergent assistance. Almost half reported anxiety or depression, and 25% increased behavioural disorders. Mood (F: 5.40; p: 0.002) and sleep disorders (F = 2.67; p: 0.05) were associated with increase in seizure frequency. Patients were able to contact their physicians when needed and were open to a future telematic approach to follow-up visits. CONCLUSIONS: Seizure frequency and severity remained unchanged in most patients during the lockdown. Mood and sleep disorders were common and associated with seizure worsening. Patients were open to telematic care in the future.


Subject(s)
COVID-19 , Epilepsy/therapy , Pandemics , Quarantine/statistics & numerical data , Adult , Anticonvulsants/therapeutic use , Anxiety/complications , COVID-19/complications , COVID-19/epidemiology , Cognition Disorders/complications , Communicable Disease Control , Depression/complications , Disabled Persons , Epilepsy/complications , Female , Humans , Male , Mental Disorders/complications , Mental Disorders/epidemiology , Middle Aged , Motor Disorders/complications , Outpatients , Seizures/epidemiology , Sleep Wake Disorders/classification , Sleep Wake Disorders/epidemiology , Spain/epidemiology , Surveys and Questionnaires , Telemedicine
2.
Seizure ; 92: 89-93, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1373266

ABSTRACT

OBJECTIVES: To explore the rate, characteristics, risk factors, and prognosis of children presenting with seizures as the main symptom of acute COVID-19 (coronavirus disease 2019). METHODS: We conducted a systematic retrospective study to identify all children who presented to the emergency departments of a tertiary academic medical center between March 1st and December 31st 2020 and had a SARS-CoV-2 infection based on RT-PCR (reverse transcription-polymerase chain reaction) from nasopharyngeal swab. Clinical and demographic data were extracted from the electronic medical records and reviewed. RESULTS: Total of 175 children were diagnosed with acute SARS-CoV-2 infection in the emergency departments during the study period. Of those, 11 presented with seizures. Age ranged from six months to 17 years and 4 were girls. Five presented with status epilepticus and responded to loading doses of anti-seizure medications. Six had fever. Seven had prior history of neurological disorder. Full recovery was the rule. SIGNIFICANCE: Unlike in adults, seizures occur early and may be the main manifestation of acute COVID-19 in children. Seizures, including status epilepticus, may occur without fever even in children with no history of epilepsy and are not associated with severe disease. A high index of suspicion is required for early diagnosis thus infection control measures can be taken.


Subject(s)
COVID-19 , Status Epilepticus , Adult , Child , Female , Humans , Infant , Retrospective Studies , SARS-CoV-2 , Seizures/diagnosis , Seizures/drug therapy , Seizures/epidemiology
3.
Epilepsia ; 62(10): 2322-2332, 2021 10.
Article in English | MEDLINE | ID: covidwho-1371818

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has affected the care of all patients around the world. The International League Against Epilepsy (ILAE) COVID-19 and Telemedicine Task Forces examined, through surveys to people with epilepsy (PWE), caregivers, and health care professionals, how the pandemic has affected the well-being, care, and services for PWE. The ILAE included a link on their website whereby PWE and/or their caregivers could fill out a survey (in 11 languages) about the impact of the COVID-19 pandemic, including access to health services and impact on mental health, including the 6-item Kessler Psychological Distress Scale. An anonymous link was also provided whereby health care providers could report cases of new-onset seizures or an exacerbation of seizures in the context of COVID-19. Finally, a separate questionnaire aimed at exploring the utilization of telehealth by health care professionals since the pandemic began was available on the ILAE website and also disseminated to its members. Seventeen case reports were received; data were limited and therefore no firm conclusions could be drawn. Of 590 respondents to the well-being survey (422 PWE, 166 caregivers), 22.8% PWE and 27.5% caregivers reported an increase in seizure frequency, with difficulty in accessing medication and health care professionals reported as barriers to care. Of all respondents, 57.1% PWE and 21.5% caregivers had severe psychological distress (k score >13), which was significantly higher among PWE than caregivers (p<0.01). An increase in telemedicine use during the COVID-19 pandemic was reported by health care professionals, with 40% of consultations conducted by this method. Although 74.9% of health care providers thought that this impacted positively, barriers to care were also identified. As we move forward, there is a need to ensure ongoing support and care for PWE to prevent a parallel pandemic of unmet health care needs.


Subject(s)
COVID-19 , Epilepsy/therapy , Pandemics , Caregivers , Communication , Delivery of Health Care/statistics & numerical data , Epilepsy/psychology , Health Services Accessibility , Humans , Psychological Distress , Seizures/epidemiology , Stress, Psychological/etiology , Stress, Psychological/psychology , Surveys and Questionnaires , Telemedicine
4.
Epilepsy Behav ; 123: 108255, 2021 10.
Article in English | MEDLINE | ID: covidwho-1364517

ABSTRACT

Although psychogenic nonepileptic seizures (PNES) are a common neurologic condition, there remains a paucity of literature on the COVID-19 pandemic's effect on these patients. Using a cross-sectional questionnaire study, our group examined the experience of patients with PNES at a single Comprehensive Epilepsy Center in New York City, the epicenter of the initial COVID-19 outbreak in the United States. Among our cohort of 18 subjects with PNES, 22.2% reported an improvement in seizure control during the peak of the COVID-19 pandemic in New York City. Compared to the cohort of subjects with epilepsy without PNES, subjects with PNES were significantly more likely to report an improvement (p = 0.033). Our findings signal that sleep and stress may be relevant variables in both conditions that should be further investigated and potentially intervened upon. Larger dedicated studies of patients with PNES are needed to understand the impact of the pandemic's widespread societal effects on these patients.


Subject(s)
COVID-19 , Epilepsy , Cross-Sectional Studies , Electroencephalography , Epilepsy/epidemiology , Humans , New York City/epidemiology , Pandemics , SARS-CoV-2 , Seizures/epidemiology
5.
J Trop Pediatr ; 67(3)2021 07 02.
Article in English | MEDLINE | ID: covidwho-1345743

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) usually leads to a mild infectious disease course in children, while serious complications may occur in conjunction with both acute infection and neurological symptoms, which have been predominantly reported in adults. The neurological complications in these patients vary based on patient age and underlying comorbidities. Data on clinical features, particularly neurological features, and prognostic factors in children and adolescents are limited. This study provides a concise overview of neurological complications in pediatric COVID-19 cases. MATERIALS AND METHODS: The retrospective study reviewed medical records of all patients who were admitted to our hospital and were diagnosed with COVID-19 by real-time reverse-transcription polymerase-chain-reaction (RT-PCR) assay between 11 March 2020 and 30 January 2021. Patients with a positive PCR result were categorized into two groups: outpatient departments patients and inpatient departments (IPD). RESULTS: Of the 2530 children who underwent RT-PCR during the study period, 382 (8.6%) were confirmed as COVID-19 positive, comprising 188 (49.2%) girls and 194 (50.8%) boys with a mean age of 7.14±5.84 (range, 0-17) years. Neurological complications that required hospitalization were present in 34 (8.9%) patients, including seizure (52.9%), headache (38.2%), dizziness (11.1%) and meningoencephalitis (5.8%). CONCLUSION: The results indicated that neurological manifestations are not rare in children suffering from COVID-19. Seizures, headaches, dizziness, anosmia, ageusia and meningoencephalitis are major neurological manifestations during acute COVID-19 disease. Although seizures were the most common cause of hospitalization in IPD patients, the frequency of meningoencephalitis was quite high. Seizures were observed as febrile seizures for children under 6 years of age and afebrile seizures for those over 6 years of age. Febrile seizure accounted for half of all seizure children.


Subject(s)
COVID-19 , Adolescent , Adult , Child , Child, Preschool , Female , Headache/epidemiology , Headache/etiology , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , SARS-CoV-2 , Seizures/epidemiology , Seizures/etiology
6.
Epilepsy Behav ; 122: 108184, 2021 09.
Article in English | MEDLINE | ID: covidwho-1305328

ABSTRACT

OBJECTIVE: To investigate whether published studies that identified a causal relationship between psychological stress and seizure worsening in patients with epilepsy during the coronavirus disease 2019 (COVID-19) pandemic considered the temporality of Hill's criteria. METHOD: A systematic review approach was used to comprehensively search MEDLINE, CENTRAL, EMBASE, and ClinicalTrials.gov databases for relevant studies. Studies that reported an association between psychological stress and seizure worsening in patients with epilepsy during the COVID-19 pandemic were included accordingly. The quality of assessments in each study was evaluated and an assessment for considering temporality in the causal relationship between the two events in each study was carried out. RESULTS: Seventeen studies were included in the analysis. Most (14/17) were cross-sectional studies and only four out of these 17 studies (23.5%) considered temporality in the causality. Further, these four studies did not consider temporality in the study design, they only described it as a limitation. CONCLUSION: We found that many articles reported a causal relationship between psychological stress and seizure worsening without considering temporality. As both researchers and readers, we need to consider temporality when interpreting the causal relationship between increased psychological stress and seizure worsening in patients with epilepsy during the COVID-19 pandemic.


Subject(s)
COVID-19 , Epilepsy , Cross-Sectional Studies , Epilepsy/complications , Epilepsy/epidemiology , Humans , Pandemics , SARS-CoV-2 , Seizures/epidemiology , Seizures/etiology , Stress, Psychological/epidemiology , Stress, Psychological/etiology
8.
Epilepsia ; 62(7): 1617-1628, 2021 07.
Article in English | MEDLINE | ID: covidwho-1262319

ABSTRACT

OBJECTIVE: Improvement in epilepsy care requires standardized methods to assess disease severity. We report the results of implementing common data elements (CDEs) to document epilepsy history data in the electronic medical record (EMR) after 12 months of clinical use in outpatient encounters. METHODS: Data regarding seizure frequency were collected during routine clinical encounters using a CDE-based form within our EMR. We extracted CDE data from the EMR and developed measurements for seizure severity and seizure improvement scores. Seizure burden and improvement was evaluated by patient demographic and encounter variables for in-person and telemedicine encounters. RESULTS: We assessed a total of 1696 encounters in 1038 individuals with childhood epilepsies between September 6, 2019 and September 11, 2020 contributed by 32 distinct providers. Childhood absence epilepsy (n = 121), Lennox-Gastaut syndrome (n = 86), and Dravet syndrome (n = 42) were the most common epilepsy syndromes. Overall, 43% (737/1696) of individuals had at least monthly seizures, 17% (296/1696) had a least daily seizures, and 18% (311/1696) were seizure-free for >12 months. Quantification of absolute seizure burden and changes in seizure burden over time differed between epilepsy syndromes, including high and persistent seizure burden in patients with Lennox-Gastaut syndrome. Individuals seen via telemedicine or in-person encounters had comparable seizure frequencies. Individuals identifying as Hispanic/Latino, particularly from postal codes with lower median household incomes, were more likely to have ongoing seizures that worsened over time. SIGNIFICANCE: Standardized documentation of clinical data in childhood epilepsies through CDE can be implemented in routine clinical care at scale and enables assessment of disease burden, including characterization of seizure burden over time. Our data provide insights into heterogeneous patterns of seizure control in common pediatric epilepsy syndromes and will inform future initiatives focusing on patient-centered outcomes in childhood epilepsies, including the impact of telemedicine and health care disparities.


Subject(s)
Cost of Illness , Electronic Health Records , Epilepsy/economics , Adolescent , Anticonvulsants/therapeutic use , Child , Child, Preschool , Common Data Elements , Epilepsies, Myoclonic/epidemiology , Epilepsy, Absence/epidemiology , Female , Humans , Lennox Gastaut Syndrome/epidemiology , Male , Seizures/epidemiology , Socioeconomic Factors , Telemedicine , Treatment Outcome
9.
Int J Environ Res Public Health ; 18(9)2021 04 30.
Article in English | MEDLINE | ID: covidwho-1231474

ABSTRACT

Neonatal brain injury or neonatal encephalopathy (NE) is a significant morbidity and mortality factor in preterm and full-term newborns. NE has an incidence in the range of 2.5 to 3.5 per 1000 live births carrying a considerable burden for neurological outcomes such as epilepsy, cerebral palsy, cognitive impairments, and hydrocephaly. Many scoring systems based on different risk factor combinations in regression models have been proposed to predict abnormal outcomes. Birthweight, gestational age, Apgar scores, pH, ultrasound and MRI biomarkers, seizures onset, EEG pattern, and seizure duration were the most referred predictors in the literature. Our study proposes a decision-tree approach based on clinical risk factors for abnormal outcomes in newborns with the neurological syndrome to assist in neonatal encephalopathy prognosis as a complementary tool to the acknowledged scoring systems. We retrospectively studied 188 newborns with associated encephalopathy and seizures in the perinatal period. Etiology and abnormal outcomes were assessed through correlations with the risk factors. We computed mean, median, odds ratios values for birth weight, gestational age, 1-min Apgar Score, 5-min Apgar score, seizures onset, and seizures duration monitoring, applying standard statistical methods first. Subsequently, CART (classification and regression trees) and cluster analysis were employed, further adjusting the medians. Out of 188 cases, 84 were associated to abnormal outcomes. The hierarchy on etiology frequencies was dominated by cerebrovascular impairments, metabolic anomalies, and infections. Both preterms and full-terms at risk were bundled in specific categories defined as high-risk 75-100%, intermediate risk 52.9%, and low risk 0-25% after CART algorithm implementation. Cluster analysis illustrated the median values, profiling at a glance the preterm model in high-risk groups and a full-term model in the inter-mediate-risk category. Our study illustrates that, in addition to standard statistics methodologies, decision-tree approaches could provide a first-step tool for the prognosis of the abnormal outcome in newborns with encephalopathy.


Subject(s)
Brain Injuries , Epilepsy , Apgar Score , Electroencephalography , Female , Humans , Infant , Infant, Newborn , Pregnancy , Retrospective Studies , Seizures/epidemiology
10.
Epilepsy Res ; 174: 106650, 2021 08.
Article in English | MEDLINE | ID: covidwho-1213222

ABSTRACT

BACKGROUND AND PURPOSE: Post COVID-19 seizures are relatively rare. The aim of the present study was to estimate the frequency of acute symptomatic seizures among patients with COVID-19 and to discuss possible pathophysiological mechanisms. MATERIAL AND METHODS: Out of 439 cases with COVID-19 that were admitted to Assiut and Aswan University hospitals during the period from 1 June to 10 August 2020, 19 patients (4.3 %) presented with acute symptomatic seizures. Each patient underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the brain and conventional electroencephalography (EEG). Laboratory investigations included: blood gases, complete blood picture, serum D-Dimer, Ferritin, C-reactive protein, renal and liver functions, and coagulation profile. RESULTS: Of the 19 patients, 3 had new onset seizures without underlying pathology (0.68 % out of the total 439 patients); 2 others (0.46 %) had previously diagnosed controlled epilepsy with breakthrough seizures. The majority of cases (14 patients, 3.19 %) had primary pathology that could explain the occurrence of seizures: 5 suffered a post COVID-19 stroke (3 ischemic and 2 hemorrhagic stroke); 6 patients had COVID-related encephalitis; 2 patients were old ischemic stroke patients; 1 patient had a brain tumor and developed seizures post COVID-19. CONCLUSION: acute symptomatic seizure is not a rare complication of post COVID-19 infection. Both new onset seizures and seizures secondary to primary brain insult (post COVID encephalitis or recent stroke) were observed.


Subject(s)
COVID-19/epidemiology , Encephalitis, Viral/epidemiology , Epilepsy/epidemiology , Seizures/epidemiology , Stroke/epidemiology , Adult , Aged , Anticonvulsants/therapeutic use , Brain/diagnostic imaging , COVID-19/physiopathology , Egypt/epidemiology , Electroencephalography , Epilepsy/drug therapy , Female , Hospitalization , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Seizures/physiopathology , Stroke/diagnostic imaging , Tomography, X-Ray Computed
11.
Epileptic Disord ; 23(2): 268-273, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1177866

ABSTRACT

The current study screened major depression in people with epilepsy (PWE) during the epidemic of the novel coronavirus-related disease COVID-19, in order to identify whether the outbreak generated negative psychological impact on PWE. A Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E), a self-reporting depression inventory, was applied for rapid detection of major depression. Assessment was carried out online during three different periods (prior to, during, and after the outbreak of COVID-19), with the aim of identifying changes in prevalence of depression and associated risk factors. A total of 158 PWE were recruited into the study (48.7% female). The questionnaire completion rates were 94.3% and 70.9% during and after the outbreak, respectively. The prevalence of depression prior to the epidemic, as the baseline, was 34.8% and increased to 42.3% during the period of the epidemic. Towards the end of the outbreak, the prevalence declined towards the baseline (36.6%). Factors such as living alone (OR = 4.022, 95% CI: 1.158-13.971, P = 0.028) and active seizures before the epidemic (OR = 2.993, 95% CI: 1.197-7.486, P = 0.019) were associated with depression during the epidemic. Monotherapy appeared to be protective against depression (OR = 0. 105, 95% CI: 0.047-0.235, P <0.001). Our results suggest that the pandemic exerts negative influence on PWE's mental health. Depression is one of the common psychological disorders that needs greater attention during this extraordinary period.


Subject(s)
COVID-19 , Depression/complications , Depression/epidemiology , Epilepsy/complications , Epilepsy/epidemiology , Pandemics , Adult , Anticonvulsants/therapeutic use , China/epidemiology , Female , Humans , Longitudinal Studies , Male , Prevalence , Risk Factors , Seizures/drug therapy , Seizures/epidemiology , Self Report , Socioeconomic Factors , Surveys and Questionnaires , Young Adult
12.
Seizure ; 88: 102-108, 2021 May.
Article in English | MEDLINE | ID: covidwho-1164463

ABSTRACT

OBJECTIVES: To investigate the impact of the COVID-19 outbreak on the behaviours, mental health and seizure control of adult patients with epilepsy (PWE) and to identify the correlation of seizure increase and the COVID-19 outbreak to guide the medical care of individuals with epilepsy during a public health crisis. METHODS: This study was conducted at 28 centres from February 2020 to April 2020. Participants filled out a 62-item online survey including sociodemographic, COVID-19-related, epilepsy-related and psychological variables and were divided into two groups based on whether their seizure frequency increased during the COVID-19 pandemic. Chi-square tests and t-tests were used to test differences in significant characteristics. Multiple logistic regression analyses were used to identify risk factors for seizure worsening. RESULTS: A total of 1,237 adult PWE were enrolled for analysis. Of this sample, 31 (8.33%) patients experienced an increase in seizures during the pandemic. Multivariate logistic regression suggested that feeling nervous about the pandemic (P < 0.05), poor quality of life (P = 0.001), drug reduction/withdrawal (P = 0.032), moderate anxiety during the COVID-19 outbreak (P = 0.046) and non-seizure free before the COVID-19 outbreak (P < 0.05) were independently related to seizure increase during the pandemic. CONCLUSIONS: During the COVID-19 pandemic, PWE with poor quality of life and mental status, as well as AED reduction/withdrawal, were more likely to experience seizure increase. This observation highlights the importance of early identification of the population at high risk of seizure worsening and implementation of preventive strategies during the pandemic.


Subject(s)
COVID-19/psychology , Epilepsy/epidemiology , Quality of Life/psychology , Seizures/epidemiology , Adult , COVID-19/epidemiology , China/epidemiology , Disease Outbreaks , Female , Humans , Male , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
13.
Epileptic Disord ; 23(2): 257-267, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1154136

ABSTRACT

OBJECTIVE: This study sought to understand issues facing people with epilepsy (PWE) during the lockdown period of the COVID-19 pandemic in the United States. METHODS: We conducted a cross-sectional study using a 20-question survey that used SeziureTracker.com, sent to eligible PWE and their caregivers on May 6th, 2020. Questions about demographics and medical history were used to calculate COVID mortality risk odds ratios (OR) compared to a low baseline risk group. RESULTS: In total, 505 responses were collected. Of these, 71% reported no change in seizure rates and 25% reported an increase in seizures, which they attributed primarily to disrupted sleep (63%) and decreased exercise (42%). Mortality risks from COVID-19 had median OR of 1.67, ranging 1.00-906.98. Fear about hospitalization (53%) and concern for loved ones (52%) were prominent concerns. Of the respondents, 5% reported stopping or reducing anti-seizure medications due to problems communicating with doctors, access or cost. Lower-risk COVID patients reported more fear of hospitalization (55% versus 38%, p<0.001) and anxiety about medication access (43% versus 28%, p=0.03) compared with higher-risk COVID patients. Increased anxiety was reported in 47%, and increased depression in 28%. Ten percent without generalized convulsions and 8% with did not know anything about epilepsy devices (VNS, RNS, DBS). SIGNIFICANCE: The COVID-19 pandemic presents unique challenges to PWE, including increased seizure rates, problems with access and cost of life-saving medications. Those with lower COVID-19 risk may have been marginalized more than those with higher risk. Efforts to protect PWE during major public health emergencies should take these findings into account.


Subject(s)
COVID-19 , Epilepsy/complications , Pandemics , Quarantine , Adolescent , Adult , Aged , Aged, 80 and over , Anticonvulsants/administration & dosage , Anticonvulsants/therapeutic use , Caregivers , Child , Child, Preschool , Cross-Sectional Studies , Depression/epidemiology , Epilepsy/mortality , Epilepsy/psychology , Fear , Health Services Accessibility , Hospitalization , Humans , Infant , Middle Aged , Risk Factors , Seizures/epidemiology , Socioeconomic Factors , Surveys and Questionnaires , United States/epidemiology , Young Adult
14.
Ann Neurol ; 89(5): 872-883, 2021 05.
Article in English | MEDLINE | ID: covidwho-1148790

ABSTRACT

OBJECTIVE: The aim was to determine the prevalence and risk factors for electrographic seizures and other electroencephalographic (EEG) patterns in patients with Coronavirus disease 2019 (COVID-19) undergoing clinically indicated continuous electroencephalogram (cEEG) monitoring and to assess whether EEG findings are associated with outcomes. METHODS: We identified 197 patients with COVID-19 referred for cEEG at 9 participating centers. Medical records and EEG reports were reviewed retrospectively to determine the incidence of and clinical risk factors for seizures and other epileptiform patterns. Multivariate Cox proportional hazards analysis assessed the relationship between EEG patterns and clinical outcomes. RESULTS: Electrographic seizures were detected in 19 (9.6%) patients, including nonconvulsive status epilepticus (NCSE) in 11 (5.6%). Epileptiform abnormalities (either ictal or interictal) were present in 96 (48.7%). Preceding clinical seizures during hospitalization were associated with both electrographic seizures (36.4% in those with vs 8.1% in those without prior clinical seizures, odds ratio [OR] 6.51, p = 0.01) and NCSE (27.3% vs 4.3%, OR 8.34, p = 0.01). A pre-existing intracranial lesion on neuroimaging was associated with NCSE (14.3% vs 3.7%; OR 4.33, p = 0.02). In multivariate analysis of outcomes, electrographic seizures were an independent predictor of in-hospital mortality (hazard ratio [HR] 4.07 [1.44-11.51], p < 0.01). In competing risks analysis, hospital length of stay increased in the presence of NCSE (30 day proportion discharged with vs without NCSE: HR 0.21 [0.03-0.33] vs 0.43 [0.36-0.49]). INTERPRETATION: This multicenter retrospective cohort study demonstrates that seizures and other epileptiform abnormalities are common in patients with COVID-19 undergoing clinically indicated cEEG and are associated with adverse clinical outcomes. ANN NEUROL 2021;89:872-883.


Subject(s)
COVID-19/epidemiology , COVID-19/physiopathology , Electroencephalography/trends , Seizures/epidemiology , Seizures/physiopathology , Aged , COVID-19/diagnosis , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Seizures/diagnosis , Treatment Outcome
15.
Clin Neurol Neurosurg ; 203: 106592, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1116476

ABSTRACT

OBJECTIVE: following the COVID-19 pandemic, a quarantine was imposed to all of regions Italy by 9th March until 3rd May 2020. We investigated the effect of COVID-19 infection and quarantine on seizure frequency in adult people with epilepsy (PwE) of Apulia and Basilicata regions, Southern Italy. METHODS: This is an observational, retrospective study based on prospective data collection of 102 successive PWE. The frequency of seizures was evaluated during pre-quarantine (January- February), quarantine (March-April), and post-quarantine period (May-June), while PwE were divided into A) cases responding to treatment with ≤ 1 seizure per year; B) cases responding to treatment with 2-5 seizure per year; C) cases with drug-resistant epilepsy with ≤ 4 seizures per month; D) cases with drug-resistant epilepsy with 5-10 seizures per month. PwE underwent several self-report questionnaires regarding therapeutic compliance, mood, stress and sleep during quarantine period. RESULTS: Approximately 50 % of PwE showed seizure frequency changes (22.55 % an increase and 27.45 % a reduction) during quarantine. Seizure frequency significantly (p < 0.05) increased in PwE responding to treatment with ≤ 1 seizure per year, while significantly (p < 0.05) reduced in PwE with drug-resistant epilepsy with 5-10 seizures per month. The data was not influenced by therapeutic adherence, sleep and depression. The analysis of anxiety showed a moderate level of anxiety in PwE responding to treatment with < 1 seizure per year, while moderate stress was perceived by all PwE. Seizure frequency changes were related to quarantine, but not to COVID-19 infection. In fact, unlike other regions of Italy, particularly Northern Italy, Apulia and Basilicata regions were less affected by COVID-19 infection, and almost all PwE recognized the quarantine as a stressful event. Emotional distress and anxiety due to social isolation, but also the relative reduction of triggers for epileptic seizures were the most important factors for changes in seizure frequency. CONCLUSIONS: Our study adds to the growing concern that the indirect effects of COVID-19 pandemic will far outstrip the direct consequences of the infection.


Subject(s)
COVID-19/prevention & control , Epilepsy/complications , Quarantine/psychology , Seizures/epidemiology , Adolescent , Adult , Affect , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/transmission , Female , Humans , Italy , Male , Middle Aged , Physical Distancing , Psychological Distress , Retrospective Studies , Self Report , Sleep , Young Adult
16.
Epilepsy Behav ; 117: 107852, 2021 04.
Article in English | MEDLINE | ID: covidwho-1104328

ABSTRACT

OBJECTIVE: We aimed to assess frequency of functional seizures or psychogenic nonepileptic seizures (PNES) during the COVID-19 outbreak and to recognize possible factors associated with worsening in this population. METHODS: In this cross-sectional study conducted during the second phase of the pandemic, adult patients with PNES documented by video-EEG and followed up in two tertiary epilepsy centers responded to a structured telephone survey. Data were gathered on demographics, clinical features and frequency of PNES, history of psychiatric comorbidity, access to treatment, as well as on anxiety (GAD-7 items) and depressive symptoms (NDDI-E). RESULTS: Fifty-four patients (78% female; mean age of 31.36 years [SD = 10.6]) were contacted and 15 (28%) reported increased frequency of PNES during the pandemic. Higher scores of GAD-7 items (p < 0.001) and NDDI-E (p < 0.001) were associated with PNES worsening. There was strong evidence of a correlation between higher stress levels (p < 0.001) and poor sleep quality (p 0.005) with PNES aggravation. After regression, stress was the strongest predictor of PNES increased frequency. SIGNIFICANCE: Patients with functional neurological disorders are vulnerable during ubiquitously felt stressors. However, the atmosphere of uncertainty did not affect these patients equally. Patients with PNES showing symptoms of anxiety and depression are at higher risk of seizure worsening. Early identification of this subset of patients may prevent this detrimental outcome.


Subject(s)
COVID-19 , Adult , Cross-Sectional Studies , Disease Outbreaks , Electroencephalography , Female , Humans , Male , Psychophysiologic Disorders/epidemiology , SARS-CoV-2 , Seizures/epidemiology
17.
Neuroepidemiology ; 55(2): 109-118, 2021.
Article in English | MEDLINE | ID: covidwho-1102234

ABSTRACT

BACKGROUND: COVID-19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study, we estimate the frequency of such complications among hospital inpatients with COVID-19 in Assiut and Aswan university hospitals. MATERIALS AND METHODS: We screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory tests, CT/MRI of the chest and brain, and neurophysiology study were performed for each patient if indicated. RESULTS: 439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these, 117 had acute neurological disease and the remainder had nonspecific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke and the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), relapse of multiple sclerosis (2), and meningoencephalitis (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia (31) and the others had Guillain-Barré syndrome (4), peripheral neuropathy (3), myasthenia gravis (MG, 2), or myositis (2). Fever, respiratory symptoms, and headache were the most common general symptoms. Hypertension, diabetes mellitus, and ischemic heart disease were the most common comorbidities in patients with CNS affection. CONCLUSION: In COVID-19, both the CNS and PNS are affected. Stroke was the most common complication for CNS, and anosmia and/or ageusia were common for PNS diseases. However, there were 6 cases of encephalitis, 2 cases of spinal cord myelopathy, 2 cases of MG, and 2 cases of myositis.


Subject(s)
Anosmia/physiopathology , COVID-19/physiopathology , Central Nervous System Diseases/physiopathology , Peripheral Nervous System Diseases/physiopathology , Stroke/physiopathology , Adult , Aged , Anosmia/epidemiology , Brain/diagnostic imaging , COVID-19/diagnosis , COVID-19/epidemiology , Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/epidemiology , Disease Progression , Egypt/epidemiology , Encephalitis/epidemiology , Encephalitis/physiopathology , Female , Guillain-Barre Syndrome/epidemiology , Guillain-Barre Syndrome/physiopathology , Hospitals, University , Humans , Hypoxia, Brain/epidemiology , Hypoxia, Brain/physiopathology , Lung/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Sclerosis, Relapsing-Remitting/epidemiology , Multiple Sclerosis, Relapsing-Remitting/physiopathology , Myasthenia Gravis/epidemiology , Myasthenia Gravis/physiopathology , Myositis/epidemiology , Myositis/physiopathology , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/epidemiology , SARS-CoV-2 , Seizures/epidemiology , Seizures/physiopathology , Spinal Cord/diagnostic imaging , Spinal Cord Diseases/epidemiology , Spinal Cord Diseases/physiopathology , Stroke/diagnosis , Stroke/epidemiology , Tomography, X-Ray Computed
18.
Epilepsy Behav ; 116: 107800, 2021 03.
Article in English | MEDLINE | ID: covidwho-1057514

ABSTRACT

OBJECTIVE: To evaluate the impact of the coronavirus disease 2019 (COVID-19) measures on the lives and psychosocial well-being of persons with epilepsy (PWE) during the third trimester of the COVID-19 pandemic. METHODS: A structured questionnaire investigating different aspects of the lives and psychosocial well-being of PWE during the COVID-19 pandemic was developed. Persons with epilepsy were invited via social media to anonymously respond to a secure web-based online questionnaire (www.icpcovid.com). Responses were collected between July 26th and December 3rd, 2020. Hospital anxiety and depression scales (HADS) were used to screen respondents for depression (HADS-D) and anxiety (HADS-A). RESULTS: Responses of 407 PWE were included in the analysis; 304 (74.7%) respondents were female and 245 (60.2%) living in Europe, 157 (38.6%) in South America, and 5 (1.2%) in Canada. Seventy-six (18.7%) reported a decrease of income during the COVID-19 lockdown, and 122 (30.0%) experienced difficulties in obtaining anti-seizure medication (ASM), mostly (72/122, 59.0%) due to unavailability. Seizure frequency increased in 122 (30.0%); 295 (72.5%) screened positive for anxiety, and 159 (39.1%) for depression. Hundred eighty-eight (46.2%) reported reluctance to seek medical care; 27.3% believed that epilepsy was associated with an increased risk of COVID-19 disease. Forty-six (74.2%) of 62 PWE who were followed up by telephone or video consult were satisfied with this consult. Fifty-five respondents, most (89.1%) of whom were from Europe, had also participated in a previous survey during the early months of the pandemic. In this subgroup, although there was no difference in prevalence of a positive screening for depression or anxiety, mean scores on HADS-A and HADS-D increased from 6.65 ±â€¯3.99 to 7.27 ±â€¯4.01 (p = 0.418), and from 5.84 ±â€¯4.43 to 6.60 ±â€¯4.45 (p = 0.371), respectively. CONCLUSIONS: The COVID-19 pandemic continues to impact the psychosocial and somatic well-being of PWE. To minimize this impact, ensuring uninterrupted access to ASM is essential. Teleconsultations are valid alternatives for continued follow-up, but should include attention to psychosocial well-being. Persons with epilepsy should be more actively informed that epilepsy is not a risk factor for developing (more severe) COVID-19 disease.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Epilepsy/epidemiology , Epilepsy/psychology , Internationality , Surveys and Questionnaires , Adult , Anxiety/epidemiology , Anxiety/psychology , Anxiety/therapy , COVID-19/prevention & control , Communicable Disease Control/methods , Communicable Disease Control/trends , Delivery of Health Care/methods , Delivery of Health Care/trends , Epilepsy/therapy , Female , Humans , Male , Middle Aged , Pandemics/prevention & control , Remote Consultation/methods , Remote Consultation/trends , Risk Factors , Seizures/epidemiology , Seizures/psychology , Seizures/therapy
19.
Seizure ; 86: 16-18, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1046134

ABSTRACT

OBJECTIVE: The aim of the current study was to investigate whether seizure is among the presenting manifestations of COVID-19. METHODS: All patients referred to emergency rooms anywhere in Iran between 12 and 25 April 2020 and who were sufficiently ill to require hospital admission with COVID-19, confirmed by a positive COVID-19 test, were studied. Data on the presenting manifestations were collected. RESULTS: Of 5872 people, who were admitted to hospitals in Iran with COVID-19 during the study period, 45 came to the emergency room with seizures. This makes seizure as the presenting manifestation of COVID-19 in 0.8 % of all patients with a severe illness. 93 % of the patients were 15 years of age and older. Four of the individuals presenting with seizures (9%) had a past history of epilepsy. Fifteen of these individuals (33 %) had other chronic medical conditions (e.g., cancer, diabetes mellitus, heart disease, etc.). CONCLUSION: This case series provides evidence that seizures are among the presenting manifestations of COVID-19 in 0.8 % of the patients who are admitted to hospital due to a severe illness.


Subject(s)
COVID-19/complications , Seizures/etiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/therapy , Child , Child, Preschool , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Infant , Iran/epidemiology , Male , Middle Aged , Patient Admission/statistics & numerical data , Seizures/epidemiology , Seizures/therapy , Young Adult
20.
Epilepsy Behav ; 116: 107785, 2021 03.
Article in English | MEDLINE | ID: covidwho-1030926

ABSTRACT

The coronavirus disease 2019 (COVID-19) outbreak started in Wuhan, China, in late 2019 and rapidly spread globally. Vaccines have recently been developed and are being administered in some countries, but their widespread use is not yet sufficient; the battle against COVID-19 is protracted and people need to adapt to living under the influence of this disease. Epilepsy is a common chronic neurological condition characterized by spontaneous recurrence of unprovoked seizures. Various effects of COVID-19 on epilepsy have been studied in recent months. As clinicians, we need to keep up with daily updates in the evidence regarding interactions between COVID-19 and epilepsy. This review article summarizes the current evidence. Prospective studies on epilepsy and COVID-19 remain lacking. Most articles have comprised case reports, case series, retrospective studies, and recommendations/opinions that do not include data. However, summarizing these articles can identify the demands for research into COVID-19 and epilepsy by clarifying what is known and what remains unclear from current research.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/methods , Epilepsy/epidemiology , Seizures/epidemiology , Anticonvulsants/therapeutic use , COVID-19/prevention & control , Communicable Disease Control/trends , Epilepsy/drug therapy , Humans , Prospective Studies , Recurrence , Retrospective Studies , SARS-CoV-2/isolation & purification , Seizures/drug therapy
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