Survey examines impact of COVID-19 pandemic among patients with epilepsy

For patients with epilepsy, negative effects of the COVID-19 pandemic include heightened seizure frequency and an increase in comorbid psychiatric disorders, among other concerns, according to survey results from Spain.

The outcomes of the survey, which was conducted via telephone among patients from a specialized epilepsy unit, also found that most patients (83.9%) considered telemedicine to be satisfactory. Researchers published the survey findings in Acta Neurologica Scandinavica.

“Chronic health conditions such as hypertension, diabetes and cardiovascular disease have been identified as risk factors for developing severe COVID-19. However, the relationship between epilepsy and COVID-19, and the effects of the pandemic on epilepsy patients, have been scarcely investigated to date,” the researchers wrote. “Patients with epilepsy face a unique situation at this time, and some may be at risk of breakthrough seizures not only due to COVID-19 itself, but also to the effects of home confinement and collapse of the healthcare services.”

Elena Fonseca, MD, of the epilepsy unit in the department of neurology at Vall d'Hebron University Hospital, Autonomous University of Barcelona, and colleagues conducted the cross-sectional study in consecutive patients via telephone during the first month of confinement. They obtained demographic and clinical information, including the effects of confinement, economic ramifications of the pandemic and subjective perceptions of telemedicine, and administered a 19-item questionnaire. The researchers collected additional clinical data among patients diagnosed with COVID-19.

Fonseca and colleagues recruited 255 patients (mean age, 48.2 ± 19.8 years), including 121 women (47.5%). Slightly less than 10% of patients reported an uptick in the number of seizures they were experiencing (9.8%).

Respondents also described confinement-related anxiety (26.7%), depression (8.6%), both anxiety and depression (12.2%) and insomnia (28.2%). More than a quarter of participants noted a decrease in income (28.6%).

Logistic regression analysis demonstrated an increased risk for greater seizure frequency in the following scenarios: tumor-related epilepsy etiology (OR = 7.36; 95% CI, 2.17-24.96), drug-resistant epilepsy (OR = 3.44; 95% CI, 1.19-9.95), insomnia (OR = 3.25; 95% CI, 1.18-8.96), fear of epilepsy (OR = 3.26; 95% CI, 1.09-9.74) and income reduction (OR = 3.65; 95% CI, 1.21-10.95).

Five patients diagnosed with COVID-19 reported no differences in seizure frequency, according to Fonseca and colleagues.

The researchers found a delay in epilepsy-related tests among 15% of patients, but note that the value may be underestimated, because patients who had an initial unprovoked seizure but had not yet formally received a diagnosis of epilepsy were not included in the final analysis.

“It is likely that examinations were delayed in new-onset seizures during the lockdown,” Fonseca and colleagues wrote.

Further, few patients described difficulties with their medication supply, according to the survey results.

“The COVID-19 pandemic and the confinement measures to control it can have an impact on patients with epilepsy,” the researchers wrote. “Tumor-related and drug-resistant epilepsy, the presence of insomnia, and a reduction in economic income were found to be risk factors for increased seizure frequency. Telemedicine emerged as a useful tool that was well accepted by patients to offer clinical assessment and mitigate the effects of physical distancing during confinement.”