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Zhang N, Niu C, Li P, Du X, Zhao M, Li M, Jing W. The impact of the COVID-19 pandemic on people with epilepsy and epilepsy specialists. Epilepsy Behav 2023; 147:109389. [PMID: 37619465 DOI: 10.1016/j.yebeh.2023.109389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES During the coronavirus disease 2019 (COVID-19) pandemic, the global population experienced changes in diagnosis and treatment patterns. The aim of this study was to evaluate the influence of the COVID-19 pandemic on people with epilepsy (PWE) and epilepsy specialists in China. METHODS We retrospectively evaluated newly diagnosed PWE from January 2018 to January 2022 at Shanxi Bethune Hospital. The clinical characteristics of PWE and the prescription habits of epilepsy specialists were analyzed. We also explored changes in seizure control among PWE as a result of the COVID-19 pandemic and assessed the possible causes. RESULTS After excluding 49 PWE who were lost to follow-up, 421 PWE were included in the study. They were divided into a prepandemic group and a pandemic group, with December 2019 as the boundary. By comparing the two groups, we found that the duration between first symptom detection and diagnosis was longer in the pandemic group than in the prepandemic group. Epilepsy specialists preferred prescribing the fast-acting antiepileptic drug levetiracetam (LEV) in the pandemic group. During the COVID-19 pandemic, 49.57% of PWE reported difficulties in accessing their epilepsy healthcare provider, and 26.96% reported that appointments with their providers occurred as usual. A lack of anti-seizure medication (ASM) availability was reported by 32.17% of subjects. An increase in seizure frequency was noted in 25.22% of the PWE during the pandemic. The factors increasing seizure frequency during the pandemic were fear of COVID-19, exacerbation of mental states, sleep deprivation, cancelation of regular medical visits, difficulties accessing epilepsy healthcare providers, and a lack of ASM availability. CONCLUSION The COVID-19 pandemic exposed PWE to harmful consequences mainly due to medical shortages and worse life states. During the pandemic, there were delays in the diagnosis of PWE, and doctors' prescription habits changed. We must consider the lessons learned during this period of social restrictions and employ recent technological advances to improve treatment for PWE.
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Affiliation(s)
- Ning Zhang
- Department of Neurology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China; Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China.
| | - Cailang Niu
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, 030032, Taiyuan, China
| | - Penghong Li
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, 030032, Taiyuan, China
| | - Xueqing Du
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, 030032, Taiyuan, China
| | - Mina Zhao
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, 030032, Taiyuan, China
| | - Mao Li
- Department of Neurology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China; Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Wei Jing
- Department of Neurology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China; Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China.
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Kuroda N, Gajera PK, Yu H, Kubota T. Seizure Control in Patients with Epilepsy during the COVID-19 Pandemic: A Systematic Review and Meta-analysis. Intern Med 2022; 61:2287-2293. [PMID: 35650127 PMCID: PMC9424088 DOI: 10.2169/internalmedicine.9321-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate seizure control in patients with epilepsy during the coronavirus disease 2019 (COVID-19) pandemic. Method A systematic review and meta-analysis was conducted, and the MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov databases were comprehensively searched for relevant studies. Studies that reported seizure control in patients with epilepsy during the COVID-19 pandemic were included. Pooled proportions with 95% confidence intervals (CIs) of patients with epilepsy who experienced seizure worsening during the COVID-19 pandemic were assessed using a random-effects model. The quality of the assessment for each study, heterogeneity between the studies, and publication bias were also evaluated. Subgroup analyses were performed, excluding studies with reports of seizures worsening from caregivers. Results A total of 24 studies with 6,492 patients/caregivers were included in the meta-analysis. The pooled proportion of seizure worsening was 18.5% (95% CI: 13.9-23.6; I2=96%; p<0.01). The pooled proportion of seizure worsening in the subgroup analysis was 18.9% (95% CI: 13.5-25.0; I2=96%; p<0.01). Conclusion Although the heterogeneity was high, our results showed a relatively high incidence of seizure worsening during the COVID-19 pandemic. During the COVID-19 pandemic, physicians should be aware of the likelihood of worsening seizures in patients with epilepsy.
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Affiliation(s)
- Naoto Kuroda
- Department of Pediatrics, Wayne State University, USA
- Department of Epileptology, Tohoku University Graduate School of Medicine, Japan
| | | | - Hongxuyang Yu
- Department of Neurology, West Virginia University, USA
| | - Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
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Wang S, Yang J, Wei N, Lv W, Jiang Z, Huang H, Zhang J, Xu P, Yu CY, Xu Z. Anxiety and depression among epilepsy patients in low-risk areas for COVID-19 in the northern part of Guizhou Province, China, during the COVID-19 pandemic. ACTA EPILEPTOLOGICA 2022. [PMCID: PMC9084936 DOI: 10.1186/s42494-022-00092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study was aimed to investigate whether patients with epilepsy (PWE) have higher depression and anxiety levels than the normal population in low-risk areas for coronavirus disease 2019 (COVID-19) in the northern part of Guizhou Province, China, during the COVID-19 epidemic, to evaluate their knowledge on COVID-19, and to analyze related factors for the psychological distress of PWE at this special time.
Methods
The survey was conducted online from February 28, 2020 to March 7, 2020 via a questionnaire. PWE from the outpatient clinic of epilepsy of the Affiliated Hospital of Zunyi Medical University, and healthy people matched for age and sex, participated in this study. Mental health was assessed via a generalized anxiety self-rating scale (GAD-7) and the self-rating depression scale (PHQ-9). The knowledge of COVID-19 in both groups was investigated.
Results
There were no significant differences in the general demographics between the PWE and healthy control groups. The scores of PHQ-9 (P < 0.01) and GAD-7 (P < 0.001) were higher in the PWE group than in the healthy group. There was a significant difference in the proportions of respondents with different severities of depression and anxiety, between the two groups, which revealed significantly higher degree of depression and anxiety in PWE than in healthy people (P = 0, P = 0). Overwhelming awareness and stressful concerns for the pandemic and female patients with epilepsy were key factors that affect the level of anxiety and depression in PWE. Further, the PWE had less accurate knowledge of COVID-19 than healthy people (P < 0.001). There was no statistically significant difference between the two groups in the knowledge of virus transmission route, incubation period, susceptible population, transmission speed, clinical characteristics, and isolation measures on COVID-19 (P > 0.05). PWE knew less about some of the prevention and control measures of COVID-19 than healthy people.
Conclusions
During the COVID-19 epidemic, excessive attention to the epidemic and the female sex are factors associated with anxiety and depression in PWE, even in low-risk areas.
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Pergolizzi JV, Raffa RB, Varrassi G, Magnusson P, LeQuang JA, Paladini A, Taylor R, Wollmuth C, Breve F, Chopra M, Nalamasu R, Christo PJ. Potential neurological manifestations of COVID-19: a narrative review. Postgrad Med 2022; 134:395-405. [PMID: 33089707 PMCID: PMC7799377 DOI: 10.1080/00325481.2020.1837503] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023]
Abstract
Neurological manifestations are increasingly reported in a subset of COVID-19 patients. Previous infections related to coronaviruses, namely Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS) also appeared to have neurological effects on some patients. The viruses associated with COVID-19 like that of SARS enters the body via the ACE-2 receptors in the central nervous system, which causes the body to balance an immune response against potential damage to nonrenewable cells. A few rare cases of neurological sequelae of SARS and MERS have been reported. A growing body of evidence is accumulating that COVID-19, particularly in severe cases, may have neurological consequences although respiratory symptoms nearly always develop prior to neurological ones. Patients with preexisting neurological conditions may be at elevated risk for COVID-19-associated neurological symptoms. Neurological reports in COVID-19 patients have described encephalopathy, Guillain-Barré syndrome, myopathy, neuromuscular disorders, encephalitis, cephalgia, delirium, critical illness polyneuropathy, and others. Treating neurological symptoms can pose clinical challenges as drugs that suppress immune response may be contraindicated in COVID-19 patients. It is possible that in some COVID-19 patients, neurological symptoms are being overlooked or misinterpreted. To date, neurological manifestations of COVID-19 have been described largely within the disease trajectory and the long-term effects of such manifestations remain unknown.
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Affiliation(s)
| | - Robert B. Raffa
- Temple University School of Pharmacy, Temple University, Philadelphia, PA, USA
- University of Arizona College of Pharmacy, Tucson, AZ, USA
| | | | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden
- Department of Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Frank Breve
- NEMA Research, Inc., Naples, FL, USA
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA
| | | | - Rohit Nalamasu
- Department of Physical Medicine and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul J. Christo
- Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Antonazzo IC, Fornari C, Maumus-Robert S, Cei E, Paoletti O, Conti S, Cortesi PA, Mantovani LG, Gini R, Mazzaglia G. Impact of COVID-19 Lockdown, during the Two Waves, on Drug Use and Emergency Department Access in People with Epilepsy: An Interrupted Time-Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413253. [PMID: 34948862 PMCID: PMC8701966 DOI: 10.3390/ijerph182413253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND In 2020, during the COVID-19 pandemic, Italy implemented two national lockdowns aimed at reducing virus transmission. We assessed whether these lockdowns affected anti-seizure medication (ASM) use and epilepsy-related access to emergency departments (ED) in the general population. METHODS We performed a population-based study using the healthcare administrative database of Tuscany. We defined the weekly time series of prevalence and incidence of ASM, along with the incidence of epilepsy-related ED access from 1 January 2018 to 27 December 2020 in the general population. An interrupted time-series analysis was used to assess the effect of lockdowns on the observed outcomes. RESULTS Compared to pre-lockdown, we observed a relevant reduction of ASM incidence (0.65; 95% Confidence Intervals: 0.59-0.72) and ED access (0.72; 0.64-0.82), and a slight decrease of ASM prevalence (0.95; 0.94-0.96). During the post-lockdown the ASM incidence reported higher values compared to pre-lockdown, whereas ASM prevalence and ED access remained lower. Results also indicate a lower impact of the second lockdown for both ASM prevalence (0.97; 0.96-0.98) and incidence (0.89; 0.80-0.99). CONCLUSION The lockdowns implemented during the COVID-19 outbreaks significantly affected ASM use and epilepsy-related ED access. The potential consequences of these phenomenon are still unknown, although an increased incidence of epilepsy-related symptoms after the first lockdown has been observed. These findings emphasize the need of ensuring continuous care of epileptic patients in stressful conditions such as the COVID-19 pandemic.
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Affiliation(s)
- Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
- Correspondence:
| | - Sandy Maumus-Robert
- Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, 33000 Bordeaux, France;
| | - Eleonora Cei
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
| | - Olga Paoletti
- Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, 50141 Florence, Italy; (O.P.); (R.G.)
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
- Value-Based Healthcare Unit, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
- Value-Based Healthcare Unit, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
| | - Rosa Gini
- Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, 50141 Florence, Italy; (O.P.); (R.G.)
| | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milan-Bicocca, 20900 Monza, Italy; (I.C.A.); (E.C.); (S.C.); (P.A.C.); (L.G.M.); (G.M.)
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Epilepsy and COVID-19: Management of Patients and Optimization of Antiepileptic Treatment in the Pandemic. ACTA ACUST UNITED AC 2021; 51:843-849. [PMID: 34754132 PMCID: PMC8569090 DOI: 10.1007/s11055-021-01142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022]
Abstract
There are as yet no data pointing to any increase in the incidence of the novel coronavirus infection (COVID-19) or a more severe course of illness in patients with epilepsy. However, considering the high prevalence of epilepsy in patients over 60 years of age, the high comorbidity of epilepsy and a whole series of somatic diseases, and the need to maintain the opportunity for constant access to antiepileptic medications and follow-up of epilepsy patients, we can expect a whole set of difficulties in the management of these patients in the conditions imposed by the COVID-19 pandemic. This article addresses the main principles of the management of epilepsy patients in the conditions of the COVID-19 pandemic: the need to follow regimes; preservation of regular and continuous taking of antiepileptic drugs, including consideration of interdrug interactions; and switching patients to i.v. forms of antiepileptic drugs where necessary.
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Menon S, Sander JW. Effects of the COVID-19 pandemic on medication adherence: In the case of antiseizure medications, A scoping review. Seizure 2021; 93:81-87. [PMID: 34717290 PMCID: PMC8526436 DOI: 10.1016/j.seizure.2021.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 12/25/2022] Open
Abstract
Since early 2020, an unprecedented public global health emergency caused by coronavirus (COVID-19) resulted in national governments' imposing confinement measures. Lockdowns and isolation during pandemics complicate disease management and medication adherence. Chronic conditions, such as epilepsy, require linear adherence patterns to prevent breakthrough seizures and to reduce the risk of sudden unexpected death. Limited access to health care facilities for routine care and medicines management further hampers this. Social isolation exacerbates stress, depression and decreases social support, which may combine to reduce adherence to antiseizure medication (ASM) during the pandemic. Methods We conducted a literature scoping review to explore ASM adherence among people with epilepsy, non-infected or infected SARS-CoV-2 or recovered from COVID-19 during the pandemic and explore risk factors for adherence. We search Pubmed for articles up to 16 September 2021. Search terms included the thematic of ASM adherence and COVID-19. We adhered to the PRISMA guidelines for reporting scoping reviews. Results Six articles were retained after the screening, which covered four overarching themes: change of ASM compliance and as risk factors, lack of follow-up, difficulties accessing ASM, and behavioural risk factors. Our review underscores the lack of evidence on ASM adherence among people with epilepsy infected or recovered from COVID-19. No study retrieved took place in a low-income setting, warranting a cautionary approach to be employed when extrapolating findings on a global scale. Recommendations for practice Missing information on past SARS-CoV2 infections impact people with epilepsy precludes exploring a direct effect of SARS-CoV2 on ASM adherence. A more comprehensive chronic disease model based on the burden of co-cardiovascular and neuro-behavioural comorbidities should be envisaged for this population in preparation for future pandemics. A monitoring algorithm needs to be in place to establish a telemedicine framework and community pharmacists' potential to contribute to the model recognised.
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Affiliation(s)
- Sonia Menon
- Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), Inserm, F-75004, Paris, France; Cochrane France, F 75004 Paris, France.
| | - Josemir W Sander
- Department of Neurology, West of China Hospital, Sichuan University, Chengdu, China; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG; Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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Teng T, Sareidaki DE, Chemaly N, Bar C, Coste-Zeitoun D, Kuchenbuch M, Nabbout R. Physician and patient satisfaction with the switch to remote outpatient encounters in epilepsy clinics during the Covid-19 pandemic. Seizure 2021; 91:60-65. [PMID: 34098318 PMCID: PMC9525220 DOI: 10.1016/j.seizure.2021.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Analyzing parents' and physicians' opinions regarding phone-based encounters in emergency shifts of a French pediatric epilepsy center compared to traditional face-to-face encounters during the first lockdown of the COVID-19 pandemic METHODS: Prospective monocentric study on remote encounters at Necker rare epilepsy reference center from March 20th, 2020 to April 23rd, 2020 due to lockdown measures. This study was conducted with a survey based on 5-point Likert scales (LS-2/2) designed for both parents and physicians. We compared first versus follow-up encounters as well as physicians' and parents' opinions. RESULTS We had a total of 224 responses, among which 204 were completed by physicians (91%) and 173 (84,4%) by parents. Twenty five were first encounters (14,2%). Physicians pointed out the need for clinical examination (42.6%), mainly for first encounters (p=0.0004). Physicians rated the quality of communication lower (p=0.003) as their capacity to answer parents' questions (p=0.004). They were significantly less satisfied with remote encounters compared to parents (p<10-4). We identified six urgent (2.9%) and 50 semi-urgent (24%) situations requiring programming face-to-face encounter during or shortly after the lockdown. CONCLUSION Remote encounters could be a helpful practice for pediatric patients with epilepsy in emergency situations such as pandemics. It allowed the identification and prioritization of emergency situations. Physicians were less positive than parents. We raised the possible use of remote encounters in association to face-to-face encounters for routine follow-up of pediatric patients with epilepsy.
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Affiliation(s)
- T Teng
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - D E Sareidaki
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - N Chemaly
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - C Bar
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - D Coste-Zeitoun
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France
| | - M Kuchenbuch
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, France
| | - R Nabbout
- Reference center for rare epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, APHP, Member of the ERN EpiCARE, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, France.
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Olivo S, Cheli M, Dinoto A, Stokelj D, Tomaselli M, Manganotti P. Telemedicine during the SARS-Cov-2 pandemic lockdown: Monitoring stress and quality of sleep in patients with epilepsy. Epilepsy Behav 2021; 118:107864. [PMID: 33743345 PMCID: PMC7891095 DOI: 10.1016/j.yebeh.2021.107864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/13/2022]
Abstract
SARS-CoV-2 pandemic heavily hit the western healthcare system saturating the hospital beds in wards and clogging the emergency departments. To avoid the collapse of Italian hospitals, office visits to outpatients were limited to emergencies and the general population went in a lockdown state. Physicians had to approach new problems in the management of chronic patients who could not leave their homes. In our experience as epilepsy clinic, the use of telemedicine was of crucial importance for monitoring our patients: phone call during lockdown let us monitor the stability of our 38 patients and psychometric parameters and habits that could influence seizures frequency. In particular, we found that in our patients, sleep quality was low resulting in high daily sleepiness and associated high stress levels. Secondly, we found an increase in daily screen hours and an association with daily sleepiness. In conclusion, we report our experience in managing people with epilepsy during the lockdown, underlining the utility of telemedicine as a valid monitoring tool and the necessity of a psychometric and behavioral screening.
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Mueller TM, Kostev K, Gollwitzer S, Lang JD, Stritzelberger J, Westermayer V, Reindl C, Hamer HM. The impact of the coronavirus disease (COVID-19) pandemic on outpatient epilepsy care: An analysis of physician practices in Germany. Epilepsy Behav 2021; 117:107833. [PMID: 33618316 PMCID: PMC7895474 DOI: 10.1016/j.yebeh.2021.107833] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To gain insight into epilepsy care during coronavirus disease (COVID-19) pandemic, we analyzed prescription data of a large cohort of persons with epilepsy (PWE) during lockdown in Germany. METHODS Information was obtained from the Disease Analyzer database, which collects anonymous demographic and medical data from practice computer systems of general practitioners (GP) and neurologists (NL) throughout Germany. We retrospectively compared prescription data for anti-seizure medication (ASM) and physicians' notes of "known" and "new" PWE from January 2020 until May 2020 with the corresponding months in the three preceding years 2017-2019. Adherence was estimated by calculating the proportion of patients with follow-up prescriptions within 90 days after initial prescriptions in January or February. We additionally analyzed hospital referrals of PWE. The significance level was set to 0.01 to adjust for multiple comparisons. RESULTS A total of 52,844 PWE were included. Anti-seizure medication prescriptions for known PWE increased in March 2020 (GP + 36%, NL + 29%; P < 0.01). By contrast, a decrease in prescriptions to known and new PWE was observed in April and significantly in May 2020 ranging from -16% to -29% (P < 0.01). The proportion of PWE receiving follow-up prescriptions was slightly higher in 2020 (73.5%) than in 2017-2019 (70.7%, P = 0.001). General practitioners and NL referred fewer PWE to hospitals in March 2020 (GP: -30%, P < 0.01; NL: -12%), April 2020 (GP: -29%, P < 0.01; NL: -37%), and May 2020 (GP: -24%, P < 0.01; NL: -16%). CONCLUSION Adherence of known PWE to ASM treatment appeared to remain stable during lockdown in Germany. However, this study revealed findings which point to reduced care for newly diagnosed PWE as well as fewer hospital admissions. These elements may warrant consideration during future lockdown situations.
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Affiliation(s)
- Tamara M. Mueller
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany,Corresponding author at: Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Karel Kostev
- IQVIA, Epidemiology, Frankfurt am Main, Main Airport Center, Unterschweinstiege 2-14, 60549 Frankfurt am Main, Germany
| | - Stephanie Gollwitzer
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes D. Lang
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Jenny Stritzelberger
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Vivien Westermayer
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Caroline Reindl
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hajo M. Hamer
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
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Zeng C, Meng H, Zhu Y, Yao L, Lian Y, Zhu Y, Zhang M, Dai Y, Wang K, Han X, Li L, Zhang L, Xu H, Yao D, Luo X, Jiang W, Wang X, Zhao C, Chen Y, Deng X, Liu C, Feng L, Song Y, Wu Y, Liao W, Wang F, Zhu S, Xiao B, Wang Q, Long L. Correlation of Seizure Increase and COVID-19 Outbreak in Adult Patients with Epilepsy: Findings and Suggestions from a Nationwide Multi-centre Survey in China. Seizure 2021; 88:102-108. [PMID: 33839561 PMCID: PMC9056154 DOI: 10.1016/j.seizure.2021.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/22/2021] [Accepted: 03/27/2021] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To investigate the impact of the COVID-19 outbreak on the behaviours, mental health and seizure control of adult patients with epilepsy (PWE) and to identify the correlation of seizure increase and the COVID-19 outbreak to guide the medical care of individuals with epilepsy during a public health crisis. METHODS This study was conducted at 28 centres from February 2020 to April 2020. Participants filled out a 62-item online survey including sociodemographic, COVID-19-related, epilepsy-related and psychological variables and were divided into two groups based on whether their seizure frequency increased during the COVID-19 pandemic. Chi-square tests and t-tests were used to test differences in significant characteristics. Multiple logistic regression analyses were used to identify risk factors for seizure worsening. RESULTS A total of 1,237 adult PWE were enrolled for analysis. Of this sample, 31 (8.33%) patients experienced an increase in seizures during the pandemic. Multivariate logistic regression suggested that feeling nervous about the pandemic (P < 0.05), poor quality of life (P = 0.001), drug reduction/withdrawal (P = 0.032), moderate anxiety during the COVID-19 outbreak (P = 0.046) and non-seizure free before the COVID-19 outbreak (P < 0.05) were independently related to seizure increase during the pandemic. CONCLUSIONS During the COVID-19 pandemic, PWE with poor quality of life and mental status, as well as AED reduction/withdrawal, were more likely to experience seizure increase. This observation highlights the importance of early identification of the population at high risk of seizure worsening and implementation of preventive strategies during the pandemic.
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Affiliation(s)
- Chang Zeng
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Hongmei Meng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yulan Zhu
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lifen Yao
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanmei Zhu
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Min Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuwei Dai
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Kang Wang
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ling Li
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Lifang Zhang
- Department of Neurology, Changzhi People's Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Huiqing Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dongai Yao
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinmin Luo
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Xiahong Wang
- Department of Neurology, Zhengzhou Second Hospital, Zhengzhou, China
| | - Chuansheng Zhao
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuejun Deng
- Department of Neurology, Union Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chaorong Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yanmin Song
- Department of Emergency, Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Wu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Weiping Liao
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Institute, Department of Neurology of The Second Affiliated Hospital of Guangzhou Medical University, of Neuroscience, Province and the Ministry of Education of China, Guangzhou, China
| | - Furong Wang
- Department of Neurology, Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
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Shulman JG, Ford T, Cervantes-Arslanian AM. Neurologic Emergencies during the Coronavirus Disease 2019 Pandemic. Neurol Clin 2021; 39:671-687. [PMID: 33896538 PMCID: PMC7995638 DOI: 10.1016/j.ncl.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Julie G Shulman
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Suite C3, Boston, MA 02118, USA.
| | - Thomas Ford
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Suite C3, Boston, MA 02118, USA
| | - Anna M Cervantes-Arslanian
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Suite C3, Boston, MA 02118, USA; Department of Neurosurgery, Boston University School of Medicine, 725 Albany St, Suite 7C, Boston, MA 02118, USA; Department of Medicine (Infectious Diseases), Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown, 2nd floor, Boston MA 02118, USA
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13
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Conde Blanco E, Manzanares I, Centeno M, Khawaja M, Betrán O, Donaire A, Carreño M. Epilepsy and lockdown: A survey of patients normally attending a Spanish centre. Acta Neurol Scand 2021; 143:206-209. [PMID: 32990951 PMCID: PMC7646661 DOI: 10.1111/ane.13354] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 01/10/2023]
Abstract
Background Lockdown due to the SARS‐CoV‐2 pandemic became a challenge to maintain care for patients with epilepsy; we aimed to find out how the pandemic affected them. Methods We sent an online 22‐item questionnaire to patients from our outpatient clinic, a reference centre in Spain for drug‐resistant epilepsy, inquiring about the effects of lockdown, from March to May 2020. Results We sent the survey to 627 patients; 312 (58% women) sent a complete response and were included. Of all respondents, 57% took >2 antiseizure medications. One‐third of respondents (29%) declared an associated cognitive or motor disability. A minority had confirmed infection with SARS‐CoV‐2 (1.92%). Seizure frequency remained like usual in 56% of patients, while 31.2% reported an increase. Less than 10% needed emergent assistance. Almost half reported anxiety or depression, and 25% increased behavioural disorders. Mood (F: 5.40; p: 0.002) and sleep disorders (F = 2.67; p: 0.05) were associated with increase in seizure frequency. Patients were able to contact their physicians when needed and were open to a future telematic approach to follow‐up visits. Conclusions Seizure frequency and severity remained unchanged in most patients during the lockdown. Mood and sleep disorders were common and associated with seizure worsening. Patients were open to telematic care in the future.
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Affiliation(s)
- Estefanía Conde Blanco
- Hospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). EpiCARE Network Barcelona Spain
| | - Isabel Manzanares
- Hospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). EpiCARE Network Barcelona Spain
| | - María Centeno
- Hospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). EpiCARE Network Barcelona Spain
| | - Mariam Khawaja
- Hospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). EpiCARE Network Barcelona Spain
| | - Olga Betrán
- Hospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). EpiCARE Network Barcelona Spain
| | - Antonio Donaire
- Hospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). EpiCARE Network Barcelona Spain
| | - Mar Carreño
- Hospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). EpiCARE Network Barcelona Spain
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14
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Berlit P, Bösel J, Gahn G, Isenmann S, Meuth SG, Nolte CH, Pawlitzki M, Rosenow F, Schoser B, Thomalla G, Hummel T. "Neurological manifestations of COVID-19" - guideline of the German society of neurology. Neurol Res Pract 2020; 2:51. [PMID: 33283160 PMCID: PMC7708894 DOI: 10.1186/s42466-020-00097-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/28/2022] Open
Abstract
Infection with the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to a previously unknown clinical picture, which is known as COVID-19 (COrona VIrus Disease-2019) and was first described in the Hubei region of China. The SARS-CoV-2 pandemic has implications for all areas of medicine. It directly and indirectly affects the care of neurological diseases. SARS-CoV-2 infection may be associated with an increased incidence of neurological manifestations such as encephalopathy and encephalomyelitis, ischemic stroke and intracerebral hemorrhage, anosmia and neuromuscular diseases. In October 2020, the German Society of Neurology (DGN, Deutsche Gesellschaft für Neurologie) published the first guideline on the neurological manifestations of the new infection. This S1 guideline provides guidance for the care of patients with SARS-CoV-2 infection regarding neurological manifestations, patients with neurological disease with and without SARS-CoV-2 infection, and for the protection of healthcare workers. This is an abbreviated version of the guideline issued by the German Neurological society and published in the Guideline repository of the AWMF (Working Group of Scientific Medical Societies; Arbeitsgemeinschaft wissenschaftlicher Medizinischer Fachgesellschaften).
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Affiliation(s)
- Peter Berlit
- Secretary General of the German Society of Neurology, Berlin, Germany
| | - Julian Bösel
- Department of Neurology, Klinikum Kassel, DGNI, Kassel, Germany
| | - Georg Gahn
- Department of Neurology, Klinikum Karlsruhe, DGNI, Karlsruhe, Germany
| | - Stefan Isenmann
- Department of Neurology and Clinical Neurophysiology, St. Josef Hospital Moers, Moers, Germany
| | - Sven G. Meuth
- Department of Neurology, University Hospital Düsseldorf, Düsseldorf,, Germany
| | - Christian H. Nolte
- Department of Neurology with Experimental Neurology and Center for Stroke Research Berlin (CSB) Charité-University Berlin, Berlin, Germany
| | - Marc Pawlitzki
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhein-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Benedikt Schoser
- Friedrich Baur Institute at the Neurological Department, LM-University Munich, Munich, Germany
| | - Götz Thomalla
- Department of Neurology, Head and Neurocenter, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Hummel
- Interdisciplinary Center for Smelling and Tasting, University ENT Hospital Dresden, German Society for ENT Medicine, Dresden, Germany
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15
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Banerjee D, Viswanath B. Neuropsychiatric manifestations of COVID-19 and possible pathogenic mechanisms: Insights from other coronaviruses. Asian J Psychiatr 2020; 54:102350. [PMID: 33271682 PMCID: PMC7422836 DOI: 10.1016/j.ajp.2020.102350] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/11/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has emerged as a global public health threat. Though the fear, anxiety, and stress related to COVID-19 have been studied in depth, the direct effects of SARS-CoV-2 on the central nervous system (CNS) remain elusive. Research related to the earlier coronavirus (CoV) outbreaks (like Severe Acute Respiratory Syndrome, SARS and Middle East Respiratory Syndrome, MERS) shows the neurotropic nature of CoV and the plethora of neuropsychiatric effects that it can cause. Though the current health priorities in managing COVID-19 remain restricted to containment and targeting pulmonary symptoms, the potential acute and long-term neuropsychiatric sequelae of the infection can increase morbidity and worsen the quality of life. Emerging evidence shows neural spread of the novel coronavirus. Delirium, encephalopathy, olfactory disturbances, acute behavioral changes, headache and cerebrovascular accidents are its common neuropsychiatric complications. These are directly related to increase in peripheral immunological markers, severity of infection and case fatality rate. This narrative review synthesizes available evidence related to the neuropsychiatric manifestations of COVID-19. Also, as SARS-CoV-2 shares structural and functional similarities with its earlier congeners, this article proposes possible long-term neuropsychological sequelae and pathogenic mechanisms for the same, based on research in the other coronavirus outbreaks.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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16
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Asadi-Pooya AA, Simani L, Shahisavandi M, Barzegar Z. COVID-19, de novo seizures, and epilepsy: a systematic review. Neurol Sci 2020; 42:415-431. [PMID: 33237493 PMCID: PMC7686454 DOI: 10.1007/s10072-020-04932-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
Objective We discuss the evidence on the occurrence of de novo seizures in patients with COVID-19, the consequences of this catastrophic disease in people with epilepsy (PWE), and the electroencephalographic (EEG) findings in patients with COVID-19. Methods This systematic review was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Scopus, and Embase from inception to August 15, 2020 were systematically searched. These key words were used: “COVID” AND “seizure” OR “epilepsy” OR “EEG” OR “status epilepticus” OR “electroencephalography”. Results We could identify 62 related manuscripts. Many studies were case reports or case series of patients with COVID-19 and seizures. PWE showed more psychological distress than healthy controls. Many cases with new-onset focal seizures, serial seizures, and status epilepticus have been reported in the literature. EEG studies have been significantly ignored and underused globally. Conclusion Many PWE perceived significant disruption in the quality of care to them, and some people reported increase in their seizure frequency since the onset of the pandemic. Telemedicine is a helpful technology that may improve access to the needed care for PWE in these difficult times. De novo seizures may occur in people with COVID-19 and they may happen in a variety of forms. In addition to prolonged EEG monitoring, performing a through metabolic investigation, electrocardiogram, brain imaging, and a careful review of all medications are necessary steps. The susceptibility of PWE to contracting COVID-19 should be investigated further.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Leila Simani
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Shahisavandi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohreh Barzegar
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
The coronavirus SARS-CoV-2 disease (COVID-19) pandemic affects availability and performance of neurophysiological diagnostic methods, including EEG. Our objective was to outline the current situation regarding EEG-based investigations across Europe. A web-based survey was distributed to centres within the European Reference Network on rare and complex epilepsies (ERN EpiCARE). Responses were collected between April 9 and May 15, 2020. Results were analysed with Microsoft Excel, Python Pandas and SciPy. Representants from 47 EpiCARE centres from 22 countries completed the survey. At the time of completing the survey, inpatient video-EEGs had been stopped or restricted in most centres (61.7% vs. 36.2% for adults, and 38.3% vs. 53.2% for children). Invasive investigations and epilepsy surgery were similarly affected. Acute EEGs continued to be performed, while indications for outpatient EEGs were limited and COVID-19 triage put in place. The strictness of measures varied according to extent of the outbreak in a given country. The results indicate a profound impact of COVID-19 on neurophysiological diagnostics, especially inpatient video-EEGs, invasive investigations, and epilepsy surgery. The COVID-19 pandemic may hamper care for patients in need of EEG-based investigations, particularly patients with seizure disorders. ERN EpiCARE will work on recommendations on how to rapidly adapt to such situations in order to alleviate consequences for our patients.
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S1-Leitlinie: Neurologische Manifestationen bei COVID-19. DGNEUROLOGIE 2020. [PMCID: PMC7550844 DOI: 10.1007/s42451-020-00254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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19
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Willems LM, Balcik Y, Noda AH, Siebenbrodt K, Leimeister S, McCoy J, Kienitz R, Kiyose M, Reinecke R, Schäfer JH, Zöllner JP, Bauer S, Rosenow F, Strzelczyk A. SARS-CoV-2-related rapid reorganization of an epilepsy outpatient clinic from personal appointments to telemedicine services: A German single-center experience. Epilepsy Behav 2020; 112:107483. [PMID: 33181898 PMCID: PMC7537633 DOI: 10.1016/j.yebeh.2020.107483] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION When the SARS-CoV-2 pandemic reached Europe in 2020, a German governmental order forced clinics to immediately suspend elective care, causing a problem for patients with chronic illnesses such as epilepsy. Here, we report the experience of one clinic that converted its outpatient care from personal appointments to telemedicine services. METHODS Documentations of telephone contacts and telemedicine consultations at the Epilepsy Center Frankfurt Rhine-Main were recorded in detail between March and May 2020 and analyzed for acceptance, feasibility, and satisfaction of the conversion from personal to telemedicine appointments from both patients' and medical professionals' perspectives. RESULTS Telephone contacts for 272 patients (mean age: 38.7 years, range: 17-79 years, 55.5% female) were analyzed. Patient-rated medical needs were either very urgent (6.6%, n = 18), urgent (23.5%, n = 64), less urgent (29.8%, n = 81), or nonurgent (39.3%, n = 107). Outpatient service cancelations resulted in a lack of understanding (9.6%, n = 26) or anger and aggression (2.9%, n = 8) in a minority of patients, while 88.6% (n = 241) reacted with understanding, or relief (3.3%, n = 9). Telemedicine consultations rather than a postponed face-to-face visit were requested by 109 patients (40.1%), and these requests were significantly associated with subjective threat by SARS-CoV-2 (p = 0.004), urgent or very urgent medical needs (p = 0.004), and female gender (p = 0.024). Telemedicine satisfaction by patients and physicians was high. Overall, 9.2% (n = 10) of patients reported general supply problems due to SARS-CoV-2, and 28.4% (n = 31) reported epilepsy-specific problems, most frequently related to prescriptions, or supply problems for antiseizure drugs (ASDs; 22.9%, n = 25). CONCLUSION Understanding and acceptance of elective ambulatory visit cancelations and the conversion to telemedicine consultations was high during the coronavirus disease 2019 (COVID-19) lockdown. Patients who engaged in telemedicine consultations were highly satisfied, supporting the feasibility and potential of telemedicine during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Yunus Balcik
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anna H Noda
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sina Leimeister
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jeannie McCoy
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ricardo Kienitz
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Makoto Kiyose
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Raphael Reinecke
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan-Hendrik Schäfer
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
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Sanchez-Larsen A, Gonzalez-Villar E, Díaz-Maroto I, Layos-Romero A, Martínez-Martín Á, Alcahut-Rodriguez C, Grande-Martin A, Sopelana-Garay D. Influence of the COVID-19 outbreak in people with epilepsy: Analysis of a Spanish population (EPICOVID registry). Epilepsy Behav 2020; 112:107396. [PMID: 32911299 PMCID: PMC7476448 DOI: 10.1016/j.yebeh.2020.107396] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this study was to have a better understanding of the influence of the coronavirus disease 2019 (COVID-19) pandemic in people with epilepsy (PWE) and to assess whether there have been changes in seizure control during the current COVID-19 outbreak, exploring the possible causes thereof. METHODS This is an observational, retrospective study based on prospective data collection of 100 successive patients who attended an epilepsy outpatient clinic either face-to-face or telephonically during the months of the COVID-19 outbreak and national state of emergency. RESULTS One hundred patients were included, 52% women, mean age 42.4 years. During the COVID-19 period, 27% of the patients presented an increase of >50% of seizure frequency. An increase of stress/anxiety (odds ratios (OR): 5.78; p = 0.008) and a prior higher seizure frequency (OR: 12.4; p = 0.001) were associated with worsening of seizures. Other risk factors were exacerbation of depression, sleep deprivation, less physical activity, and history of epilepsy surgery. Three patients had status epilepticus (SE) and one a cluster of seizures. Likewise, 9% of patients improved their seizure control. Reduction in stress/anxiety (OR: 0.05; p = 0.03) and recent adjustment of antiepileptics (OR: 0.07; p = 0.01) acted as protecting factors. CONCLUSIONS A high proportion of PWE suffered a significant worsening of their seizure control during the months of the COVID-19 pandemic. Emotional distress due to home confinement was the main factor for the change in seizure control. Promoting physical activity and adequate sleep may minimize the potential impact of the pandemic in PWE. Ensuring correct follow-up can prevent decompensation in those PWE at high risk.
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Affiliation(s)
- Alvaro Sanchez-Larsen
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain.
| | - Esther Gonzalez-Villar
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain
| | - Inmaculada Díaz-Maroto
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain
| | - Almudena Layos-Romero
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain
| | - Álvaro Martínez-Martín
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain
| | - Cristian Alcahut-Rodriguez
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain
| | - Alberto Grande-Martin
- Department of Clinical Neurophysiology Complejo, Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain
| | - David Sopelana-Garay
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Castilla-La Mancha, Spain
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Epilepsy course during COVID-19 pandemic in three Italian epilepsy centers. Epilepsy Behav 2020; 112:107375. [PMID: 32858368 PMCID: PMC7445187 DOI: 10.1016/j.yebeh.2020.107375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 01/30/2023]
Abstract
During epidemic outbreaks, epilepsy course can be modified by different physical and psychological stressors and, most importantly, by irregular therapy intake. The effect of COVID-19 and quarantine isolation on the course of epilepsy and on incidence of new-onset seizures is still unclear. With the aim of managing epilepsy in quarantined patients, three Italian Epilepsy Centers set up telephone consultations using a semistructured interview, allowing a prospective collection of data on seizure course and other seizure-related problems during pandemic. The collected data on seizure course were compared with the analogous period of 2019. The level of patients' concern relating to the COVID-19 pandemic was also assessed using a numeric rating scale. To address the effect of COVID-19 pandemic on seizure incidence, data collection included the number of consultations for first seizures, relapse seizures, and status epilepticus (SE) in the emergency department of one of the participating centers. Clinical telephone interviews suggest the absence of quarantine effect on epilepsy course in our cohort. No differences in incidence of emergency consultations for seizures over a two-month period were also observed compared with a control period. As demonstrated in other infective outbreaks, good antiepileptic drug (AED) supplying, precise information, and reassurance are the most important factors in chronic conditions to minimize psychological and physical stress, and to avoid unplanned treatment interruptions.
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22
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Kuchenbuch M, D'Onofrio G, Wirrell E, Jiang Y, Dupont S, Grinspan ZM, Auvin S, Wilmshurst JM, Arzimanoglou A, Cross JH, Specchio N, Nabbout R. An accelerated shift in the use of remote systems in epilepsy due to the COVID-19 pandemic. Epilepsy Behav 2020; 112:107376. [PMID: 32882627 PMCID: PMC7457939 DOI: 10.1016/j.yebeh.2020.107376] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of the study was to describe epileptologists' opinion on the increased use of remote systems implemented during the COVID-19 pandemic across clinics, education, and scientific meetings activities. METHODS Between April and May 2020, we conducted a cross-sectional, electronic survey on remote systems use before and during the COVID-19 pandemic through the European reference center for rare and complex epilepsies (EpiCARE) network, the International and the French Leagues Against Epilepsy, and the International and the French Child Neurology Associations. After descriptive statistical analysis, we compared the results of France, China, and Italy. RESULTS One hundred and seventy-two respondents from 35 countries completed the survey. Prior to the COVID-19 pandemic, 63.4% had experienced remote systems for clinical care. During the pandemic, the use of remote clinics, either institutional or personal, significantly increased (p < 10-4). Eighty-three percent used remote systems with video, either institutional (75%) or personal (25%). During the pandemic, 84.6% of respondents involved in academic activities transformed their courses to online teaching. From February to July 2020, few scientific meetings relevant to epileptologists and routinely attended was adapted to virtual meeting (median: 1 [25th-75th percentile: 0-2]). Responders were quite satisfied with remote systems in all three activity domains. Interestingly, before the COVID-19 pandemic, remote systems were significantly more frequently used in China for clinical activity compared with France or Italy. This difference became less marked during the pandemic. CONCLUSION The COVID-19 pandemic has dramatically altered how academic epileptologists carry out their core missions of clinical care, medical education, and scientific discovery and dissemination. Close attention to the impact of these changes is merited.
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Affiliation(s)
- Mathieu Kuchenbuch
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France,Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine institute, Université de Paris, France
| | - Gianluca D'Onofrio
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France,Pediatric Residency Program, Department of Women and Child Health, University of Padua, Italy
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yuwu Jiang
- Departments of Pediatrics and Pediatric Epilepsy Center, Peking, University First Hospital, Beijing, China
| | - Sophie Dupont
- Epilepsy Unit and Rehabilitation Unit, Hôpital de la Pitié-Salpêtrière, AP-HP; Centre de recherche de l'Institut du cerveau et de la moelle épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France,Université Paris Sorbonne, Paris, France
| | - Zachary M. Grinspan
- Departments of Population Health Sciences and Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Stephane Auvin
- APHP, Department of Pediatric Neurology, Hôpital Robert-Debré, Paris, France
| | - Jo M. Wilmshurst
- Paediatric Neurology Department, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa
| | - Alexis Arzimanoglou
- Department of Paediatric Epilepsy, Sleep Disorders and Functional Neurology, University Hospitals of Lyon, Member of the ERN EpiCARE, Lyon, France,Epilepsy Unit, San Juan de Dios Children's Hospital, Universitat de Barcelona, Member of the ERN EpiCARE, Barcelona, Spain
| | - J. Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, London WC1N 1EH, United Kingdom of Great Britain and Northern Ireland
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesu’ Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Rima Nabbout
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine institute, Université de Paris, France.
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23
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Verstrepen K, Baisier L, De Cauwer H. Neurological manifestations of COVID-19, SARS and MERS. Acta Neurol Belg 2020; 120:1051-1060. [PMID: 32562214 PMCID: PMC7303437 DOI: 10.1007/s13760-020-01412-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
Since December 2019, the world is affected by an outbreak of a new disease named COVID-19, which is an acronym of 'coronavirus disease 2019'. Coronaviruses (CoV) were assumed to be associated with mild upper respiratory tract infections, such as common cold. This perception changed in time due to occurrence of the Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV in 2002 and the Middle East Respiratory Syndrome (MERS) caused by MERS-CoV in 2012, both inducing an epidemic severe viral pneumonia with potentially respiratory failure and numerous extra-pulmonary manifestations. The novel coronavirus, SARS-CoV-2, is likewise a causative pathogen for severe viral pneumonia with the risk of progression to respiratory failure and systemic manifestations. In this review, we will give a summary of the neurological manifestations due to SARS and MERS, as those might predict the neurological outcome in the novel COVID-19. Additionally, we provide an overview of the current knowledge concerning neurological manifestations associated with COVID-19, to the extent that literature is already available as the pandemic is still ongoing.
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Affiliation(s)
- Kato Verstrepen
- Department of Neurology, Dimpna Regional Hospital, JB Stessenstraat 2, 2440, Geel, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Laure Baisier
- Department of Neurology, Dimpna Regional Hospital, JB Stessenstraat 2, 2440, Geel, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Harald De Cauwer
- Department of Neurology, Dimpna Regional Hospital, JB Stessenstraat 2, 2440, Geel, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
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24
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Asadi‐Pooya AA, Farazdaghi M, Bazrafshan M. Impacts of the COVID-19 pandemic on Iranian patients with epilepsy. Acta Neurol Scand 2020; 142:392-395. [PMID: 32632917 PMCID: PMC7362008 DOI: 10.1111/ane.13310] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the effects of COVID-19 pandemic on patients' perceptions of hardship in obtaining their drugs and if this pandemic and the social restrictions in response to that has resulted in any changes in their seizure control status. We also investigated factors potentially associated with the perceptions of difficulty in obtaining their drugs (eg, polytherapy vs monotherapy, taking imported drugs, and seizure status worsening). METHODS We surveyed a random sample of patients with epilepsy, who were registered in our database at Shiraz Epilepsy Center, Iran, on their perceptions on two issues: (a) What has been your experience on obtaining your antiseizure medications in the past 4 weeks (compared to before)? (b) Have you experienced any changes in your seizure control status in the past 4 weeks? RESULTS We included 100 patients (53 male and 47 female patients). In response to the question "Have you had any difficulties in the past 4 weeks to obtain your drugs?," 31 people (31%) expressed hardship obtaining their drugs. In response to the question "How has been your seizure control status compared with before?," six people (6%) expressed worsening of their seizure control status in the past 4 weeks. None of the patients reported symptoms of coronavirus infection. CONCLUSION About one-third of patients with epilepsy expressed significant hardship obtaining their drugs after the intensification of the COVID-19 outbreak in Iran. The current COVID-19 pandemic could be considered as a major shock to a nation that has already been under significant pressure (ie, Iran).
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Affiliation(s)
- Ali A. Asadi‐Pooya
- Epilepsy Research CenterShiraz University of Medical SciencesShirazIran
- Department of NeurologyJefferson Comprehensive Epilepsy CenterThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Mohsen Farazdaghi
- Epilepsy Research CenterShiraz University of Medical SciencesShirazIran
| | - Mehdi Bazrafshan
- Epilepsy Research CenterShiraz University of Medical SciencesShirazIran
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25
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Asadi-Pooya AA. Seizures associated with coronavirus infections. Seizure 2020; 79:49-52. [PMID: 32416567 PMCID: PMC7212943 DOI: 10.1016/j.seizure.2020.05.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/22/2022] Open
Abstract
Neurotropic and neuroinvasive capabilities of coronaviruses have been described in humans. Neurological problems found in patients with coronavirus infection include: febrile seizures, convulsions, loss of consciousness, encephalomyelitis, and encephalitis. Coronavirus disease (COVID-19) is caused by SARS-CoV2. In severe cases, patients may develop severe pneumonia, acute respiratory distress syndrome, and acute cardiac injury. While seizures and status epilepticus have not been widely reported in the past five months since the onset of COVID-19 pandemic, patients with COVID-19 may have hypoxia, multiorgan failure, and severe metabolic and electrolyte disarrangements; hence, it is plausible to expect clinical or subclinical acute symptomatic seizures to happen in these patients. One should be prepared to treat seizures appropriately, if they happen in a patient who is already in a critical medical condition and suffers from organ failure.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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26
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Kuroda N. Epilepsy and COVID-19: Associations and important considerations. Epilepsy Behav 2020; 108:107122. [PMID: 32361677 PMCID: PMC7174174 DOI: 10.1016/j.yebeh.2020.107122] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Naoto Kuroda
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
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27
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Parihar J, Tripathi M, Dhamija RK. Seizures and Epilepsy in Times of Corona Virus Disease 2019 Pandemic. J Epilepsy Res 2020; 10:3-7. [PMID: 32983949 PMCID: PMC7494888 DOI: 10.14581/jer.20002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/22/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023] Open
Abstract
The end of the year 2019 was marked by novel coronavirus (severe acute respiratory syndrome coronavirus-2, SARS-CoV-2) outbreak in China that rapidly spread to the rest of the world. While the involvement of the lower respiratory system causing pneumonia is identified as the primary target of the virus, extra-pulmonary manifestations, especially of the central nervous system, are also being increasingly reported. Previous research on Middle East respiratory syndrome coronavirus and SARS-CoV have shown neurological involvement in human coronavirus infections. While several cases of seizures have been reported in patients with coronavirus disease 2019 (COVID-19) patients, there is no specific data to suggest an association of COVID-19 with epilepsy. Epilepsy patients on immunosuppressive medications may have a higher risk of contracting the viral infection. There can be an indirect relation of COVID-19 to epilepsy as the viral infection is associated with fever in most COVID-19 cases, which can lower seizure threshold. Additionally, inadequate sleep and stress due to ongoing pandemic of coronavirus can be another trigger for seizure precipitation in epilepsy patients. Drug compliance, availability of antiepileptic drugs, and drug interactions with COVID-19 experimental drugs are major concerns in epilepsy patients. Adopting telemedicine services and the use of epilepsy helplines may be important in assisting epilepsy patients and ensuring that treatment continues uninterrupted.
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Affiliation(s)
- Jasmine Parihar
- Department of Neurology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
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28
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Lu L, Xiong W, Liu D, Liu J, Yang D, Li N, Mu J, Guo J, Li W, Wang G, Gao H, Zhang Y, Lin M, Chen L, Shen S, Zhang H, Sander JW, Luo J, Chen S, Zhou D. New onset acute symptomatic seizure and risk factors in coronavirus disease 2019: A retrospective multicenter study. Epilepsia 2020; 61:e49-e53. [PMID: 32304092 PMCID: PMC7264627 DOI: 10.1111/epi.16524] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 02/05/2023]
Abstract
Our aim was to clarify the incidence and risk of acute symptomatic seizures in people with coronavirus disease 2019 (COVID‐19). This multicenter retrospective study enrolled people with COVID‐19 from January 18 to February 18, 2020 at 42 government‐designated hospitals in Hubei province, the epicenter of the epidemic in China; Sichuan province; and Chongqing municipality. Data were collected from medical records by 11 neurologists using a standard case report form. A total of 304 people were enrolled, of whom 108 had a severe condition. None in this cohort had a known history of epilepsy. Neither acute symptomatic seizures nor status epilepticus was observed. Two people had seizurelike symptoms during hospitalization due to acute stress reaction and hypocalcemia, and 84 (27%) had brain insults or metabolic imbalances during the disease course known to increase the risk of seizures. There was no evidence suggesting an additional risk of acute symptomatic seizures in people with COVID‐19. Neither the virus nor potential risk factors for seizures seem to be significant risks for the occurrence of acute symptomatic seizures in COVID‐19.
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Affiliation(s)
- Lu Lu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Weixi Xiong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liu
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Dan Yang
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Nian Li
- Department of Medical Affairs, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Mu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Gao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yingying Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Mintao Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Sisi Shen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hesheng Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Josemir W Sander
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands
| | - Jianfei Luo
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shengli Chen
- Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Hernando-Requejo V, Huertas-González N, Lapeña-Motilva J, Ogando-Durán G. The epilepsy unit during the COVID-19 epidemic: The role of telemedicine and the effects of confinement on patients with epilepsy. Neurologia 2020; 35:274-276. [PMID: 32364125 PMCID: PMC7183291 DOI: 10.1016/j.nrl.2020.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- V Hernando-Requejo
- Servicio de Neurología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España; Servicio de Neurología, Hospital Universitario HM Sanchinarro, Madrid, España; Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España.
| | - N Huertas-González
- Servicio de Neurología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - J Lapeña-Motilva
- Servicio de Neurología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - G Ogando-Durán
- Servicio de Neurología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
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30
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Hernando-Requejo V, Huertas-González N, Lapeña-Motilva J, Ogando-Durán G. The epilepsy unit during the COVID-19 epidemic: the role of telemedicine and the effects of confinement on patients with epilepsy. NEUROLOGÍA (ENGLISH EDITION) 2020. [PMCID: PMC7241325 DOI: 10.1016/j.nrleng.2020.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Rider F, Lebedeva A, Mkrtchyan V, Guekht A. Epilepsy and COVID-19: patient management and optimization of antiepileptic therapy during pandemic. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:100-107. [DOI: 10.17116/jnevro2020120101100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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33
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Predictors of early seizure recurrence in patients admitted for seizures in the Emergency Department. Eur J Emerg Med 2008; 15:261-7. [DOI: 10.1097/mej.0b013e3282fce63d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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