Psychogenic nonepileptic seizures during the COVID-19 pandemic in New York City – A distinct response from the epilepsy experience

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.

An international study of the effects of the COVID-19 pandemic on characteristics of functional seizures

“…In a survey of 54 patients with FS, 15 people (28%) reported increased frequency of FS during the pandemic in Brazil [22] . In contrast, in a survey of 18 people with FS, 22.2% reported an improvement in seizure control during the peak of the COVID-19 pandemic in New York City [23] . The nature of these studies (survey) and the risk of recall bias associated with their methodology may explain their contradictory results.…”

SARS-CoV-2 alters neural synchronies in the brain with more severe effects in younger individuals

“…According to a systematic review and meta-analysis, the proportion of abnormal EEG in C19 subjects is as high as 96% 16 . Non-specific, generalized background or diffuse slowing has been reported in several studies as the most common finding 10 , 11 , 18 , whereby EEG abnormalities correlate with encephalopathy, disease severity 8 , 9 , 17 , and risk for novel seizures 13 , including psychogenic non-epileptic seizures 5 . In particular, delta waves with absence of epileptic activity have been documented 12 , as well as alpha coma patterns suggestive of SARS-CoV-2 neurotropism for the brainstem ascending reticular system 15 .…”

“…Although some studies suggested that SARS-CoV-2 could preferentially and directly target the frontal lobes 19 , with EEG abnormalities localized to frontal electrodes 8 , 12 , our results did not confirm these qualitative observations. The mechanisms underlying these observations are largely unknown; however, it has been suggested that metabolic hypoxia 18 , immune-mediated neuro-inflammation 3 , as well as severe stress and sleep disturbances 5 , are likely contributing factors.…”

“…Neurological symptoms of C19 include loss of smell and seizures 4 , 5 , and more broadly defined symptoms such as brain ‘fogginess’, dizziness, extreme fatigue, and sleepiness 6 , 7 . In cases where electroencephalography (EEG) has been performed on C19 patients, predominant observations converge on generalized slowing and diffuse encephalopathy 8 – 19 .…”

New-onset functional seizures during the COVID-19 pandemic

“…In three previous studies, it was observed that the COVID-19 pandemic may have associations with some of the characteristics of FS at diagnosis [6] , [7] , [8] . However, in FS, often there is a significant delay between the onset of functional seizures and the diagnosis of the condition.…”