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Leung WC, Ho RWH, Leung AKL, Chu FHN, Lo CNR, Chan AA, Chan CYC, Chan DYH, Chui JHY, Li WTV, Yeung EHL, Teo KC, Lau GKK, Chang RSK. Risk of Seizure Aggravation after COVID-19 Vaccinations in Patients with Epilepsy. Vaccines (Basel) 2024; 12:593. [PMID: 38932322 PMCID: PMC11209536 DOI: 10.3390/vaccines12060593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Although Coronavirus disease 2019 (COVID-19) vaccinations are generally recommended for persons with epilepsy (PwE), a significant vaccination gap remains due to patient concerns over the risk of post-vaccination seizure aggravation (PVSA). In this single-centre, retrospective cohort study, we aimed to determine the early (7-day) and delayed (30-day) risk of PVSA, and to identify clinical predictors of PVSA among PwE. Adult epilepsy patients aged ≥18 years without a history of COVID-19 infection were recruited from a specialty epilepsy clinic in early 2022. Demographic, epilepsy characteristics, and vaccination data were extracted from a centralized electronic patient record. Seizure frequency before and after vaccination, vaccination-related adverse effects, and reasons for or against vaccination were obtained by a structured questionnaire. A total of 786 PwEs were included, of which 27.0% were drug-resistant. At the time of recruitment, 74.6% had at least 1 dose of the COVID-19 vaccine. Subjects with higher seizure frequency (p < 0.0005), on more anti-seizure medications (p = 0.004), or had drug-resistant epilepsy (p = 0.001) were less likely to be vaccinated. No significant increase in seizure frequency was observed in the early (7 days) and delayed phases (30 days) after vaccination in our cohort. On the contrary, there was an overall significant reduction in seizure frequency 30 days after vaccination (1.31 vs. 1.89, t = 3.436; p = 0.001). This difference was seen in both types of vaccine (BNT162b2 and CoronaVac) and drug-resistant epilepsy, but just missed significance for the second dose (1.13 vs. 1.87, t = 1.921; p = 0.055). Only 5.3% had PVSA after either dose of vaccine. Higher pre-vaccination seizure frequency of ≥1 per week (OR 3.01, 95% CI 1.05-8.62; p = 0.04) and drug-resistant status (OR 3.32, 95% CI 1.45-249 7.61; p = 0.005) were predictive of PVSA. Meanwhile, seizure freedom for 3 months before vaccination was independently associated with a lower risk of PVSA (OR 0.11, 95% CI 0.04-0.28; p < 0.0005). This may guide epilepsy treatment strategies to achieve better seizure control for at least 3 months prior to vaccination. As COVID-19 shifts to an endemic phase, this study provides important data demonstrating the overall safety of COVID-19 vaccinations among PwE. Identification of high-risk patients with subsequent individualized approaches in treatment and monitoring strategies may alleviate vaccination hesitancy among PwE.
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Affiliation(s)
- William C.Y. Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Ryan Wui-Hang Ho
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Anthony Ka-Long Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Florinda Hui-Ning Chu
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Cheuk Nam Rachel Lo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Andrian A. Chan
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Cheuk Yan Claudia Chan
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Desmond Yin Hei Chan
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Jacklyn Hoi Ying Chui
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Wai Tak Victor Li
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Elton Hau Lam Yeung
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Kay Cheong Teo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Gary Kui-Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
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Doron A, Eviatar-Ribak T, Vituri A, Shahar S, Fahoum F, Goldstein L. The COVID-19 pfizer BioNTech mRNA vaccine and the frequency of seizures. Clin Neurol Neurosurg 2023; 233:107952. [PMID: 37690190 DOI: 10.1016/j.clineuro.2023.107952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE A nationwide vaccination operation against Coronavirus disease 2019 (COVID-19) using the BNT162b2 mRNA vaccine commenced in Israel in December 2020. People older than 60 were prioritized, and most were vaccinated shortly after. Seizures are not infrequently attributed to the vaccine despite a lack of supporting evidence. People with epilepsy (PWE) are often reluctant to get the vaccine due to concerns of seizure aggravation. We aim to examine the effect of the vaccine effort on the frequency of both new-onset seizures and recurrent seizures in PWE. METHODS All adults who presented to the emergency department (ED) of Tel Aviv Sourasky Medical Center between January 1st and May 31st, 2017-2021, and were diagnosed with seizures were included. Demographic, clinical, and vaccination status parameters were collected using MDClone, a data acquisition tool. Vaccination rates in the general population were obtained from official governmental publications. Statistics included a sub-analysis of patients with the highest vaccination rate, people older than 60. RESULTS 1675 cases were included. The numbers of ED visits and hospital admissions due to seizures in 2021 were comparable to preceding years after adjusting for the total number of ED visits at the same time. Out of 339 cases in 2021, 134 patients older than 60 years old presented to the ED (39.5%) compared to 124-151 in 2017-2019 (37-44%) and 103 in 2020 (33%). The vaccination rate among patients hospitalized due to seizures was similar to the general population of the same age group during the same period in Israel. There was no temporal relation between vaccination and hospitalization due to a seizure. SIGNIFICANCE Despite very high vaccination rates in the general population in Israel and especially among people older than 60 years, no increase was observed in ED presentations due to seizures. No temporal relation was observed between vaccination and hospitalization due to a seizure. We conclude that the mass vaccination with the Pfizer BioNTech mRNA vaccine is not associated with increased seizure propensity.
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Affiliation(s)
- Alon Doron
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Eviatar-Ribak
- EEG and Epilepsy Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Aya Vituri
- Tel Aviv University Center for AI and Data Science (TAD), Israel
| | - Shimon Shahar
- Tel Aviv University Center for AI and Data Science (TAD), Israel
| | - Firas Fahoum
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; EEG and Epilepsy Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lilach Goldstein
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; EEG and Epilepsy Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Thomas Jefferson University, Philadelphia, USA.
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Rafati A, Jameie M, Amanollahi M, Jameie M, Pasebani Y, Sakhaei D, Ilkhani S, Rashedi S, Pasebani MY, Azadi M, Rahimlou M, Kwon CS. Association of seizure with COVID-19 vaccines in persons with epilepsy: A systematic review and meta-analysis. J Med Virol 2023; 95:e29118. [PMID: 37732629 DOI: 10.1002/jmv.29118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
Seizure aggravation following coronavirus disease 2019 (COVID-19) vaccines is a major cause behind vaccine hesitancy among persons with epilepsy (PwE), resulting in lower immunization rates. We systematically reviewed seizure-activity-related events in PwE following COVID-19 vaccination. We systematically searched PubMed, Web of Science, Scopus, and Cochrane Library, until January 31, 2023, and included articles reporting seizure activity-related events in PwE receiving COVID-19 vaccination. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. The protocol was registered with PROSPERO (CRD42022312475). Outcomes included pooled incidence proportions of (a) increased seizure frequency, (b) status epilepticus (SE), and (c) change in seizure type. Of the 2207 studies, 16 entered the meta-analysis. The pooled incidence proportion of increased seizure frequency (16 studies-3245 PwE) was 5% (95% CI: 3%-7%, I2 = 52%). Regarding increased seizure frequency, no significant difference was observed between mRNA and viral vector (OR: 1.11, 95% CI: 0.49-2.52, I2 = 0%), and between mRNA and inactivated virus (OR: 1.60, 95% CI: 0.27-9.37; I2 = 0%). The pooled incidence proportion of SE (15 studies-2387 PwE) was 0.08% (95% CI: 0.02%-0.33%, I2 = 0%). Ultimately, the pooled incidence proportion of change in seizure type (7 studies-1172 PwE) was 1% (95% CI: 1%-2%, I2 = 0%). The meta-analysis revealed post-COVID-19-vaccination increased seizure frequency in 5% of PwE, with no difference between mRNA and viral vector or inactivated virus vaccines. Furthermore, we found 0.08% and 1% incidence proportions for postvaccination SE and change in seizure type, respectively. While noteworthy, these values are far less than reports for COVID-19 infection, emphasizing vaccination importance in preventing COVID-19 consequences in PwE.
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Affiliation(s)
- Ali Rafati
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Melika Jameie
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mobina Amanollahi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mana Jameie
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Pasebani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Delaram Sakhaei
- School of Medicine, Sari Branch, Islamic Azad University, Sari, Iran
| | - Saba Ilkhani
- Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sina Rashedi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mehran Rahimlou
- Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Churl-Su Kwon
- Departments of Neurology, Epidemiology, Neurosurgery, The Gertrude H. Sergievsky Center, Columbia University, New York, New York, USA
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Fang X, Hu S, Han T, Yang T, Hu J, Song Y, Li C, Ma A, Li Y, Kong Q, Tang L, Chen W, Sun W, Fang C, Sun Y, Chen J, Sun W, Yan Y, Gao Y, Geng J, Li N, Li Q, Jiang Z, Lv S, Li W, Lang X, Wang S, Chen Y, Li B, Li L, Liu X, Liu Y, Zhan Y, Gao Z, Qu L, Fu Q, Liu X. Effect of inactivated COVID-19 vaccines on seizure frequency in patients with epilepsy: A multicenter, prospective study. Front Immunol 2022; 13:984789. [PMID: 36569941 PMCID: PMC9769399 DOI: 10.3389/fimmu.2022.984789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Several COVID-19 vaccines list "uncontrolled epilepsy" as a contraindication for vaccination. This consequently restricts vaccination against COVID-19 in patients with epilepsy (PWE). However, there is no strong evidence that COVID-19 vaccination can exacerbate conditions in PWE. This study aims to determine the impact of COVID-19 vaccination on PWE. Methods PWE were prospectively recruited from 25 epilepsy centers. We recorded the seizure frequency at three time periods (one month before the first vaccination and one month after the first and second vaccinations). A generalized linear mixed-effects model (GLMM) was used for analysis, and the adjusted incidence rate ratio (AIRR) with 95% CI was presented and interpreted accordingly. Results Overall, 859 PWE were included in the analysis. Thirty-one (3.6%) and 35 (4.1%) patients were found to have increased seizure frequency after the two doses, respectively. Age had an interaction with time. The seizure frequency in adults decreased by 81% after the first dose (AIRR=0.19, 95% CI:0.11-0.34) and 85% after the second dose (AIRR=0.16, 95% CI:0.08-0.30). In juveniles (<18), it was 25% (AIRR=0.75, 95% CI:0.42-1.34) and 51% (AIRR=0.49, 95% CI:0.25-0.95), respectively. Interval between the last seizure before vaccination and the first dose of vaccination (ILSFV) had a significant effect on seizure frequency after vaccination. Seizure frequency in PWE with hereditary epilepsy after vaccination was significantly higher than that in PWE with unknown etiology (AIRR=1.95, 95% CI: 1.17-3.24). Two hundred and seventeen (25.3%) patients experienced non-epileptic but not serious adverse reactions. Discussion The inactivated COVID-19 vaccine does not significantly increase seizure frequency in PWE. The limitations of vaccination in PWE should focus on aspects other than control status. Juvenile PWE should be of greater concern after vaccination because they have lower safety. Finally, PWE should not reduce the dosage of anti-seizure medication during the peri-vaccination period.
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Affiliation(s)
- Xiqin Fang
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, China,Institute of Epilepsy, Shandong University, Jinan, China
| | - Shimin Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China,Beijing Key Laboratory of Neuromodulation, Beijing, China,Institute of Sleep and Consciousness Disorders, Center of Epilepsy, Beijing institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Tao Han
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Tingting Yang
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, China,Institute of Epilepsy, Shandong University, Jinan, China
| | - Junji Hu
- Department of Neurology, Zibo Changguo Hospital, Zibo, China
| | - Yucheng Song
- Department of Neurology, Jining City Dai Zhuang Hospital, Jining, China
| | - Chunxiang Li
- Department of Pediatrics, Yantai Yuhuangding Hospital, Yantai, China
| | - Aihua Ma
- Department of Pediatrics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Yufeng Li
- Department of Pediatrics, Linyi People’s Hospital, Linyi, China
| | - Qingxia Kong
- Department of Neurology, Affiliated Hospital of Jining Medical, Jining, China
| | - Liou Tang
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Chen
- Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng, China
| | - Wenxiu Sun
- Department of Pediatrics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Chunyan Fang
- Department of Neurology, Zhucheng People’s Hospital, Zhucheng, China
| | - Yanping Sun
- Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Juan Chen
- Department of Neurology, Heze Third People’s Hospital, Heze, China
| | - Wenying Sun
- Department of Pediatrics, Liaocheng People’s Hospital, Liaocheng, China
| | - Yibing Yan
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yuxing Gao
- Department of Pediatrics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Jianhong Geng
- Department of Neurology, Affiliated Hospital of Weifang Medical College, Weifang, China
| | - Nan Li
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, China
| | - Qiubo Li
- Department of Pediatrics, Affiliated Hospital of Jining Medical, Jining, China
| | - Zhaolun Jiang
- Department of Pediatrics, Tengzhou Central People’s Hospital, Zaozhuang, China
| | - Shishen Lv
- Department of Pediatrics, Tengzhou Central People’s Hospital, Zaozhuang, China
| | - Wenke Li
- Department of Pediatrics, Tengzhou Central People’s Hospital, Zaozhuang, China
| | - Xiaoling Lang
- Department of Neurology, Laizhou People’s Hospital, Qingdao, China
| | - Suli Wang
- Department of Pediatrics, Weifang Maternal and Child Health Care Hospital, Weifang, China
| | - Yanxiu Chen
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, China
| | - Baomin Li
- Department of Pediatrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ling Li
- Department of Neurology, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Xinjie Liu
- Department of Pediatrics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yong Liu
- Department of Pediatrics, Qilu Children’s Hospital of Shandong University, Jinan, China
| | - Yan Zhan
- Department of Neurology, Affiliated Hospital of Binzhou Medical College, Yantai, China
| | - Zaifen Gao
- Department of Pediatrics, Qilu Children’s Hospital of Shandong University, Jinan, China
| | - Lixin Qu
- Department of Neurology, Dezhou People’s Hospital, Dezhou, China
| | - Qingxi Fu
- Department of Neurology, Linyi People’s Hospital, Linyi, China
| | - Xuewu Liu
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, China,Institute of Epilepsy, Shandong University, Jinan, China,*Correspondence: Xuewu Liu,
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