A longitudinal seizure outcome following the COVID-19 pandemic in 2020 and 2021: Transient exacerbation or sustainable mitigation

Abstract

Objective To study the longitudinal seizure outcomes of people with epilepsy (PWE) following the acute and chronic phases of the coronavirus disease 2019 (COVID-19) pandemic. Methods Consecutive PWE who were treated at the epilepsy center of Hiroshima University Hospital between 2018 and 2021 were enrolled. We evaluated the incidence of seizure frequency increase or decrease following the pandemic during observational periods in 2020 and 2021. Data between 2018 and 2019 were used as a control set. The sustainability of the altered seizure frequency condition was evaluated throughout the study period. We analyzed the clinical, psychological, and social factors associated with PWE with seizure exacerbation or amelioration. Results Among the 223 PWE who were evaluated (mean age 37.8 ± 16.3 years), seizure frequency increased for 40 (16.8%) and decreased for 34 (15.2%) after the pandemic began. While seizure exacerbation tended to be a transient episode during 2020, seizure amelioration was likely to maintain excellent status over the observation periods; the sustainability of the altered seizure frequency condition was more prominent for amelioration than exacerbation ( p < 0.001). Seizure exacerbation was significantly associated with “no housemate” (odds ratio [OR] 3.37; p = 0.045) and “comorbidity of insomnia” (OR 5.80; p = 0.004). Conversely, “structural abnormality of MRI” (OR 2.57; p = 0.039) and “two-generation householding” (OR 3.70; p = 0.004) were independently associated with seizure amelioration. Conclusion This longitudinal observation confirmed that seizure exacerbation and amelioration emerged during the COVID-19 pandemic. The COVID-19 pandemic has shed light on the stark difference that social support systems can make on outcomes for PWE.

Risk of hospitalization and death for COVID‐19 in persons with epilepsy over a 20‐month period: The EpiLink Bologna cohort, Italy

“…19,20 Some studies have reported risk factors for seizure exacerbation during the pandemic, regardless of SARS-CoV-2 infection, including epilepsy severity and ASM polytherapy, sleep disorders, social factors, and mental stress in general. [21][22][23][24] Notably, in a surveybased study performed at our epilepsy center between May and July 2020, a clinical worsening was reported in 27 of 222 PWE (12%) and was associated with limited access to health care, among other factors. 23 Epilepsy care was negatively impacted during the pandemic for several reasons, including restricted access to out-and inpatient clinics and routine electroencephalograms, in addition to difficulties related to ASM prescription and testing of blood levels.…”

“…Accordingly, in a recently published Korean study, PWE underwent a transient seizure exacerbation in 2020, which was followed by a trend toward seizure amelioration in 2021. 24 Additionally, the propensity of emergency department operators to hospitalize PWE with COVID-19 might have been more pronounced during the first epidemic wave, when the clinical features of COVID-19 and its impact on epilepsy were largely unknown. 17 PDEE were the population at highest risk of hospitalization, likely because among PWE they represent the most vulnerable patients, are more frequently institutionalized, and might not be compliant with the use of personal protective equipment, resulting in a higher risk of infection.…”

“…Accordingly, in a recently published Korean study, PWE underwent a transient seizure exacerbation in 2020, which was followed by a trend toward seizure amelioration in 2021. 24 Additionally, the propensity of emergency department operators to hospitalize PWE with COVID‐19 might have been more pronounced during the first epidemic wave, when the clinical features of COVID‐19 and its impact on epilepsy were largely unknown. 17 Finally, PWE and other vulnerable populations were prioritized to receive SARS‐CoV‐2 vaccination starting in January 2021, and this may have contributed to lowering the hospitalization risk during the second wave.…”

“…First, although the risk of seizure worsening for most PWE who develop COVID‐19 is low, 17,18 acute symptomatic seizures may occur during COVID‐19, as in other febrile infections 19,20 . Some studies have reported risk factors for seizure exacerbation during the pandemic, regardless of SARS‐CoV‐2 infection, including epilepsy severity and ASM polytherapy, sleep disorders, social factors, and mental stress in general 21–24 . Notably, in a survey‐based study performed at our epilepsy center between May and July 2020, a clinical worsening was reported in 27 of 222 PWE (12%) and was associated with limited access to health care, among other factors 23 .…”

“…An explanation for this difference may be that, during the first wave, the abovementioned psychological, social, and health care‐related issues were more prominent, thus facilitating seizures and epilepsy‐related admissions. Accordingly, in a recently published Korean study, PWE underwent a transient seizure exacerbation in 2020, which was followed by a trend toward seizure amelioration in 2021 24 . Additionally, the propensity of emergency department operators to hospitalize PWE with COVID‐19 might have been more pronounced during the first epidemic wave, when the clinical features of COVID‐19 and its impact on epilepsy were largely unknown 17 .…”