Incidence and case fatality rate of COVID-19 in patients with active epilepsy

Cabezudo‐García, Pablo; Ciano-Petersen, Nicolás Lundahl; Mena-Vázquez, Natalia; Pons-Pons, Gracia; Castro-Sánchez, María Victoria; Serrano-Castro, Pedro J.

doi:10.1212/wnl.0000000000010033

Cited by 91 publications

(118 citation statements)

References 25 publications

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“…Epilepsy related papers (Table 2): One cross-sectional study of 21 patients with active epilepsy and COVID-19 out of 1537 patients (1.4%) with level 2 of evidence showed that the cumulative incidence of COVID-19 in people with epilepsy was higher compared with the population without epilepsy (1.2% vs. 0.5%) [9]. Furthermore, the total case fatality rate was higher in PWE compared to patients without active epilepsy (23.8% vs. 3.6%; p < 0.001) [9]. However, these results were obtained based on a small number of PWE (21 persons) and should be interpreted with caution.…”

Section: Resultsmentioning

confidence: 99%

COVID-19, de novo seizures, and epilepsy: a systematic review

et al. 2020

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Objective We discuss the evidence on the occurrence of de novo seizures in patients with COVID-19, the consequences of this catastrophic disease in people with epilepsy (PWE), and the electroencephalographic (EEG) findings in patients with COVID-19. Methods This systematic review was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Scopus, and Embase from inception to August 15, 2020 were systematically searched. These key words were used: "COVID" AND "seizure" OR "epilepsy" OR "EEG" OR "status epilepticus" OR "electroencephalography". Results We could identify 62 related manuscripts. Many studies were case reports or case series of patients with COVID-19 and seizures. PWE showed more psychological distress than healthy controls. Many cases with new-onset focal seizures, serial seizures, and status epilepticus have been reported in the literature. EEG studies have been significantly ignored and underused globally. Conclusion Many PWE perceived significant disruption in the quality of care to them, and some people reported increase in their seizure frequency since the onset of the pandemic. Telemedicine is a helpful technology that may improve access to the needed care for PWE in these difficult times. De novo seizures may occur in people with COVID-19 and they may happen in a variety of forms. In addition to prolonged EEG monitoring, performing a through metabolic investigation, electrocardiogram, brain imaging, and a careful review of all medications are necessary steps. The susceptibility of PWE to contracting COVID-19 should be investigated further.

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Section: Resultsmentioning

confidence: 99%

COVID-19, de novo seizures, and epilepsy: a systematic review

et al. 2020

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“…However, there is a paucity of data on its impact on chronic neurologic conditions, including epilepsy. One study found that patients with epilepsy were not at significantly higher risk for COVID‐19–associated mortality 8 . Two small cross‐sectional questionnaire studies explored epilepsy patients’ seizure control and neurologic care; one study reported that one‐third of patients noted increased seizure frequency, but neither examined variables associated with worsened seizure control 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Seizure control, stress, and access to care during the COVID‐19 pandemic in New York City: The patient perspective

et al. 2020

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Objective Our epilepsy population recently experienced the acute effects of the COVID‐19 pandemic in New York City. Herein, we aimed to determine patient‐perceived seizure control during the surge, specific variables associated with worsened seizures, the prevalence of specific barriers to care, and patient‐perceived efficacy of epilepsy care delivered via telephone and live video visits during the pandemic. Methods We performed a cross‐sectional questionnaire study of adult epilepsy patients who had a scheduled appointment at a single urban Comprehensive Epilepsy Center (Montefiore Medical Center) between March 1, 2020 and May 31, 2020 during the peak of the COVID‐19 pandemic in the Bronx. Subjects able to answer the questionnaire themselves in English or Spanish were eligible to complete a one‐time survey via telephone or secure online platform (REDCap). Results Of 1212 subjects screened, 675 were eligible, and 177 adequately completed the questionnaire. During the COVID‐19 pandemic, 75.1% of patients reported no change in seizure control, whereas 17.5% reported that their seizure control had worsened, and 7.3% reported improvement. Subjects who reported worsened seizure control had more frequent seizures at baseline, were more likely to identify stress and headaches/migraines as their typical seizure precipitants, and were significantly more likely to report increased stress related to the pandemic. Subjects with confirmed or suspected COVID‐19 did not report worsened seizure control. Nearly 17% of subjects reported poorer epilepsy care, and 9.6% had difficulty obtaining their antiseizure medications; these subjects were significantly more likely to report worse seizure control. Significance Of the nearly 20% of subjects who reported worsened seizure control during the COVID‐19 pandemic, stress and barriers to care appear to have posed the greatest challenge. This unprecedented pandemic exacerbated existing and created new barriers to epilepsy care, which must be addressed.

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“…Patients with high seizure frequencies, frequent generalized tonic–clonic seizures, those participating in ongoing pharmacological studies, those with therapeutic neuromodulation devices (e.g., vagal nerve stimulation (VNS)), and those with potentially surgically treatable focal epilepsy continued to rely on specialized epilepsy care, which has been shown to be associated with a reduction in mortality within this cohort [ 11 , 12 ]. At the onset of the COVID-19 pandemic, the influence on patients with epilepsy was unknown, and a recent study points toward a higher cumulative incidence in patients with active epilepsy and increased fatality in patients with hypertension and epilepsy [ 13 ]. To maintain at least a minimal version of specialized medical care for these often severely affected patients, many specialized departments in Germany, and all over the world, tried to rapidly convert face-to-face contacts during personal clinic appointments to telemedicine consultations by telephone or video-telephone [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2-related rapid reorganization of an epilepsy outpatient clinic from personal appointments to telemedicine services: A German single-center experience

Willems

Balcik

Noda

et al. 2020

Epilepsy & Behavior

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Introduction When the SARS-CoV-2 pandemic reached Europe in 2020, a German governmental order forced clinics to immediately suspend elective care, causing a problem for patients with chronic illnesses such as epilepsy. Here, we report the experience of one clinic that converted its outpatient care from personal appointments to telemedicine services. Methods Documentations of telephone contacts and telemedicine consultations at the Epilepsy Center Frankfurt Rhine-Main were recorded in detail between March and May 2020 and analyzed for acceptance, feasibility, and satisfaction of the conversion from personal to telemedicine appointments from both patients' and medical professionals' perspectives. Results Telephone contacts for 272 patients (mean age: 38.7 years, range: 17–79 years, 55.5% female) were analyzed. Patient-rated medical needs were either very urgent (6.6%, n = 18), urgent (23.5%, n = 64), less urgent (29.8%, n = 81), or nonurgent (39.3%, n = 107). Outpatient service cancelations resulted in a lack of understanding (9.6%, n = 26) or anger and aggression (2.9%, n = 8) in a minority of patients, while 88.6% (n = 241) reacted with understanding, or relief (3.3%, n = 9). Telemedicine consultations rather than a postponed face-to-face visit were requested by 109 patients (40.1%), and these requests were significantly associated with subjective threat by SARS-CoV-2 (p = 0.004), urgent or very urgent medical needs (p = 0.004), and female gender (p = 0.024). Telemedicine satisfaction by patients and physicians was high. Overall, 9.2% (n = 10) of patients reported general supply problems due to SARS-CoV-2, and 28.4% (n = 31) reported epilepsy-specific problems, most frequently related to prescriptions, or supply problems for antiseizure drugs (ASDs; 22.9%, n = 25). Conclusion Understanding and acceptance of elective ambulatory visit cancelations and the conversion to telemedicine consultations was high during the coronavirus disease 2019 (COVID-19) lockdown. Patients who engaged in telemedicine consultations were highly satisfied, supporting the feasibility and potential of telemedicine during the COVID-19 pandemic and beyond.

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Incidence and case fatality rate of COVID-19 in patients with active epilepsy

Cited by 91 publications

References 25 publications

COVID-19, de novo seizures, and epilepsy: a systematic review

COVID-19, de novo seizures, and epilepsy: a systematic review

Seizure control, stress, and access to care during the COVID‐19 pandemic in New York City: The patient perspective

SARS-CoV-2-related rapid reorganization of an epilepsy outpatient clinic from personal appointments to telemedicine services: A German single-center experience

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