The effect of COVID-19 vaccination on epileptic seizures in patients with epilepsy: A clinical observation in China

Abstract

This observational retrospective study was conducted on patients with epilepsy (PWE) in China who had at least one dose of COVID-19 vaccine and it investigated the safety of vaccination by analyzing changes in epileptic seizures and their influencing factors. Consecutive PWE who were followed up in the epilepsy clinic between June 2021 and May 2022 were enrolled. Data on vaccine type, demographic information, clinical characteristics of epilepsy, and treatment were collected through a questionnaire survey and retrospectively analyzed. PWE were divided into a stable seizure group and a worsening seizure group based on seizure episodes at least 90 days after the first vaccine dose. A total of 79 PWE were included. After vaccination, 14 patients (17.7%) had worsening seizures, 92.9% of whom had an increased seizure frequency. Compared with patients in the stable seizure group, patients in the worsening seizure group had significant differences in baseline monthly seizure frequency (P = .012), improper antiseizure medication (ASM) administration (P = .003) and a disrupted sleep routine (P = .016). Multivariate logistic regression analysis showed that improper ASM administration (OR 6.186, 95% confidence interval [CI] 1.312–29.170; p = .021) and a disrupted sleep routine (OR 6.326, 95% CI 1.326–30.174; p = .021) were significantly associated with seizure worsening. In short, COVID-19 vaccination is safe for PWE, and only those with poor seizure control have the possibility of seizure exacerbation after COVID-19 vaccination. The vaccination per se does not represent a major influencing factor, but the improper use of ASMs and a disrupted sleep routine may be correlated with seizure aggravation after vaccination.

Association of seizure with COVID‐19 vaccines in persons with epilepsy: A systematic review and meta‐analysis

“…Although the exact etiology behind seizure-related events after COVID-19 vaccination remains unclear, fever, [36][37][38] ASM-related factors (nonadherence, not using bridge ASMs, number of ASMs, change in ASM type or dose), 22,[28][29][30]34,35,37,41 pre-vaccine baseline seizure status, 12,28,30,32,35 genetic factors, 32,36 immune-related factors, 37 hyponatremia, 44 metabolic disturbances, 12,30 infections, 30 tumors, 30 stress, 30 insomnia or disturbed sleep routine, 30,35 fatigue, 34 and stimulant drinks such as caffeine, 34 have been mentioned in the vaccination. Hence, not all postvaccination seizure activity-related events should necessarily be considered vaccine-induced.…”

“…Sixteen studies reporting the incidence of increased seizure frequency were pooled in this section. 12,22,[28][29][30][32][33][34][35][36][37][38][39][40][41]43 The metaanalysis was performed on three subgroups of vaccine platforms (Figure 1). The pooled incidence of increased seizure frequency per PwE was 4% (95% CI: 2%−7%, I 2 = 0%; Cochran Q p = 0.59) for viralvector (5 studies, 12,28,30,40,41 199 PwE), 5% (95% CI: 3%−8%, 12,28,30,[36][37][38]40,41,43 1462 PwE), and 7% (95% CI: 6%−8%,…”

“…for the inactivated virus (9 studies, 22,29,[32][33][34][35][36]38,39 1584 PwE) vaccines. All vaccines combined (16 studies, 12,22,[28][29][30][32][33][34][35][36][37][38][39][40][41]43 3245 PwE), the pooled increased seizure frequency was calculated at 5% (95% CI: 3%−7%, I 2 = 52%; Cochran Q p < 0.01).…”

“…SE was reported in 15 studies. 12,22,[28][29][30][33][34][35][36][37][38][39][40][41]43 The meta-analysis was carried out on three subgroups of vaccine platforms (Figure 4). The pooled SE incidence proportion per PwE was 0.1% (95% CI: 0.01% −0.68%, I 2 = 0%; Cochran Q p= 1.00) for mRNA (8 studies, 28,30,[36][37][38]40,41,43 1043 PwE), 0.00% (95% CI: 0.00%−1.00%, I 2 = 0%;…”

Reply to the letter on the effects of COVID-19 vaccination on epileptic seizures in patient with epilepsy

“…Dear editor, thanks for Dr Rujittika Mungunpuntipantip and Dr Viroj Wiwanitkit’s pertinent personal views on the contents of our publication “The effect of COVID-19 vaccination on epileptic seizures in patients with epilepsy: A clinical observation in China,” 1 and for their agreeing with the conclusions of the safety of COVID-19 vaccine for PWE. 2 …”