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

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.

Does SARS-CoV-2 Cause Seizures and Epilepsy in COVID-19 via Inflammation or by Direct Infection?

“…1 Early studies on whether SARS-CoV-2 infection could cause seizures and resultant epilepsy and whether COVID-19 and its sequelae were more prevalent or severe in persons with preexisting epilepsy were difficult to interpret because SARS-CoV-2 antigen tests had not yet been developed or widely deployed. [1][2][3] In 2020 and 2021, it was observed that COVID-19 patients hospitalized with severe pulmonary signs sometimes had encephalopathy, but acute seizures and status epilepticus appeared to be relatively uncommon. [4][5][6] Taquet et al questioned whether patients with COVID-19 were more likely than controls to develop seizures or epilepsy.…”

Manifestaciones neurológicas en pacientes con diagnóstico de COVID-19

“…Estos pacientes nunca tuvieron un episodio convulsivo definido antes de la infección. La electroencefalografía se realizó a los pacientes porque tenían encefalopatía o había tenido algún (30) episodio similar a una convulsión con el cual se valoró la actividad epileptiforme .…”

Epilepsy and the risk of COVID‐19‐related hospitalization and death: A population study

“…SARS‐CoV‐2 is known to directly affect the central nervous system, with high rates of neurological and psychiatric complications 11,12 . There is some evidence that people with epilepsy are at increased risk of COVID‐19 hospitalization and COVID‐19 death 13–16 . This may be in part due to the increased proportion of people with epilepsy with comorbidities, such as dementia and intellectual disability, that increase the risk of severe COVID‐19 13,16 …”

“…11,12 There is some evidence that people with epilepsy are at increased risk of COVID-19 hospitalization and COVID-19 death. [13][14][15][16] This may be in part due to the increased proportion of people with epilepsy with comorbidities, such as dementia and intellectual disability, that increase the risk of severe COVID-19. 13,16 SARS-CoV-2 vaccines have significantly improved COVID-19 outcomes.…”