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Vasey MJ, Tai XY, Thorpe J, Jones GD, Ashby S, Hallab A, Ding D, Andraus M, Dugan P, Perucca P, Costello DJ, French JA, O'Brien TJ, Depondt C, Andrade DM, Sengupta R, Datta A, Delanty N, Jette N, Newton CR, Brodie MJ, Devinsky O, Cross JH, Sander JW, Hanna J, Besag FMC, Sen A. The impact of COVID-19 on people with epilepsy: Global results from the coronavirus and epilepsy study. Epilepsia Open 2024; 9:1931-1947. [PMID: 39225433 PMCID: PMC11450608 DOI: 10.1002/epi4.13035] [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: 05/18/2024] [Revised: 07/25/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE To characterize the experience of people with epilepsy and aligned healthcare workers (HCWs) during the first 18 months of the COVID-19 pandemic and compare experiences in high-income countries (HICs) with non-HICs. METHODS Separate surveys for people with epilepsy and HCWs were distributed online in April 2020. Responses were collected to September 2021. Data were collected for COVID-19 infections, the effect of COVID-related restrictions, access to specialist help for epilepsy (people with epilepsy), and the impact of the pandemic on work productivity (HCWs). The frequency of responses for non-HICs and HICs were compared using non-parametric Chi-square tests. RESULTS Two thousand one hundred and five individuals with epilepsy from 53 countries and 392 HCWs from 26 countries provided data. The same proportion of people with epilepsy in non-HICs and HICs reported COVID-19 infection (7%). Those in HICs were more likely to report that COVID-19 measures had affected their health (32% vs. 23%; p < 0.001). There was no difference between non-HICs and HICs in the proportion who reported difficulty in obtaining help for epilepsy. HCWs in non-HICs were more likely to report COVID-19 infection than those in HICs (18% vs 6%; p = 0.001) and that their clinical work had been affected by concerns about contracting COVID-19, lack of personal protective equipment, and the impact of the pandemic on mental health (all p < 0.001). Compared to pre-pandemic practices, there was a significant shift to remote consultations in both non-HICs and HICs (p < 0.001). SIGNIFICANCE While the frequency of COVID-19 infection was relatively low in these data from early in the pandemic, our findings suggest broader health consequences and an increased psychosocial burden, particularly among HCWs in non-HICs. Planning for future pandemics should prioritize mental healthcare alongside ensuring access to essential epilepsy services and expanding and enhancing access to remote consultations. PLAIN LANGUAGE SUMMARY We asked people with epilepsy about the effects of COVID-19 on their health and healthcare. We wanted to compare responses from people in high-income countries and other countries. We found that people in high-income countries and other countries had similar levels of difficulty in getting help for their epilepsy. People in high-income countries were more likely to say that their general health had been affected. Healthcare workers in non-high-income settings were more likely to have contracted COVID-19 and have the care they deliver affected by the pandemic. Across all settings, COVID-19 associated with a large shift to remote consultations.
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Affiliation(s)
| | - Xin You Tai
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
| | - Jennifer Thorpe
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
| | - Gabriel Davis Jones
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
| | | | - Asma Hallab
- Charité—Universitätsmedizin BerlinCorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Biologie Intégrative et Physiologie – Neurosciences Cellulaires et Intégrées, Faculté des Sciences et IngénierieSorbonne UniversitéParisFrance
| | - Ding Ding
- Institute of NeurologyFudan University Huashan HospitalShanghaiChina
| | - Maria Andraus
- Department of Internal Medicine, Faculty of Medicine & Neurology and Neurophysiology Services, Deolindo Couto Institute of NeurologyUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrazil
| | - Patricia Dugan
- Department of NeurologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Piero Perucca
- Department of Medicine (Austin Health), Epilepsy Research CentreThe University of MelbourneMelbourneVictoriaAustralia
- Department of Neurology, Bladin‐Berkovic Comprehensive Epilepsy ProgramAustin HealthMelbourneVictoriaAustralia
- Department of Neuroscience, School of Translational Medicine, The Alfred HospitalMonash UniversityMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe Royal Melbourne Hospital, The University of MelbourneMelbourneVictoriaAustralia
| | - Daniel J. Costello
- Epilepsy Service, Cork University Hospital & College of Medicine and HealthUniversity College CorkCorkIreland
| | | | - Terence J. O'Brien
- Department of Neuroscience, School of Translational Medicine, The Alfred HospitalMonash UniversityMelbourneVictoriaAustralia
| | - Chantal Depondt
- Department of Neurology, CUB Erasme HospitalHôpital Universitaire de Bruxelles—Université Libre de BruxellesBrusselsBelgium
| | - Danielle M. Andrade
- Division of Neurology, Adult Epilepsy Genetics Program, Toronto Western HospitalUniversity of TorontoTorontoOntarioCanada
| | | | | | - Norman Delanty
- School of Pharmacy and Biomolecular Sciences, Beaumont Hospital, FutureNeuro Research CentreRoyal College of Surgeons in IrelandDublinIreland
| | - Nathalie Jette
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Charles R. Newton
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | | | - Orrin Devinsky
- Department of NeurologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - J. Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child HealthLondonUK
- Young EpilepsyLingfieldUK
| | - Josemir W. Sander
- UCL Queen Square Institute of NeurologyLondonUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | | | - Frank M. C. Besag
- East London NHS Foundation TrustBedfordUK
- UCL School of PharmacyLondonUK
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
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Panahi P, Mirzohreh ST, Zafardoust H, Khamnian Z, Alizadeh M. Navigating the waves: A systematic review of telemedicine interventions and health service access challenges in epilepsy during COVID-19. Epilepsy Behav 2024; 158:109934. [PMID: 39079379 DOI: 10.1016/j.yebeh.2024.109934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/13/2024] [Accepted: 06/30/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has dramatically reshaped the landscape of healthcare delivery, prompting a surge in the adoption of telemedicine as a means to ensure continuity of care. During the pandemic, patients with epilepsy experienced difficulties accessing healthcare and obtaining necessary medications, with a substantial percentage facing obstacles in acquiring anti-seizure medication and reaching healthcare professionals. Disruptions in the supply and distribution of medication, due to COVID-19-related actions, further caused more problems for people with epilepsy and their caregivers like increasing seizure frequency. The pandemic has also accelerated the adoption of telemedicine, with evidence suggesting its potential benefits in various medical fields. In this systematic review and meta-analysis, we aim to investigate the challenges faced by patients with epilepsy during the COVID-19 pandemic, including healthcare access and medication acquisition, as well as evaluate changes in seizure frequency. Additionally, we will synthesize existing evidence on the use of telemedicine to address the healthcare needs of these patients, exploring its advantages and limitations. METHODS This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using Joanna Briggs Institute (JBI). Following rigorous application of eligibility criteria, relevant data, covering both telemedicine-related and health service access information, were methodically extracted and organized using Microsoft Excel spreadsheets. The analytical procedures were executed through the utilization of Comprehensive Meta-Analysis (CMA) software. RESULTS A total of 70 articles included in this review. Regarding difficulties in accessing healthcare, 34% of PWE and 41% of caregivers experienced cancelled, changed or postponed appointments. Following issues with obtaining medicine, 13% of patients and 16% of caregivers had difficulties in medicine availability and 11% of patients and 10% of caregivers in medicine accessibility. A very high rate of 90% satisfaction with telemedicine was reported by PWE. 17.6% of PWE experienced an escalation, 9% a decrease and 67% no changes in seizure frequency. CONCLUSION This review and meta-analysis revealed that telemedicine and virtual communications have been helpful but not sufficient for meeting healthcare needs for PWE during the COVID-19 pandemic. Additionally, there was a significant increase in seizure frequency among PWE who had difficulty obtaining medicine and access to healthcare.
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Affiliation(s)
| | | | | | - Zhila Khamnian
- Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahasti Alizadeh
- Faculty of Medicine, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Iran.
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3
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Moreno-Pérez O, Merino E, Manuel Ramos J, Carlos Rodríguez J, Diaz C, Mas P, Reus S, Sánchez-Martínez R, Boix V, Chico-Sánchez P, Sánchez-Payá J, Portilla J. Valproic acid could help in the fight against COVID-19: A case-control study. Neurologia 2024; 39:549-554. [PMID: 39232592 DOI: 10.1016/j.nrleng.2023.12.009] [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: 11/12/2021] [Accepted: 01/22/2022] [Indexed: 09/06/2024] Open
Abstract
OBJECTIVE There is early evidence about Valproic acid (VPA) antiviral effect. Our aim was to investigate the incidence and severity of SARS-CoV-2 infection in VPA users as compared with the general population. MATERIAL AND METHODS A case-control study nested within a cohort, carried out between March 1 and December 17, 2020. Retrospectively, we identified confirmed SARS-CoV-2 infection patients exposed to VPA in our health department (defined as case). We ascertained VPA regimen (all the time (AT) (292 days) or at least 20% of the study period (notAT) (≥58 days) and if VPA levels were in therapeutic range (ATR) (50-100mcg/mL) in the last 24 months. We calculated the cumulative incidence of SARS-CoV-2 infection and hospital admission in the cases, comparing it with the general unexposed VPA population (controls). RESULTS During the study period, 6183 PCR+ were detected among 281,035 inhabitants, of these, 746 were hospitalized. 691 patients were on VPA notAT and 628 (90.1%) AT. The indication for VPA use was epilepsy in 54.9%. The incidence of PCR+ was 1.736% (OR 0.785 (95%CI 0.443-1.390) and 1.910% (OR 0.865 (95%CI 0.488-1.533), on VPA notAT and VPA AT patients, respectively vs. 2.201% in people without VPA regimen. Those patients with VPA ATR had a lower risk of PCR + (OR 0.233 (95%CI 0.057-0.951) notAT; OR 0.218 (95%CI 0.053-0.890) AT). Hospital admission incidence was lower in patient on VPA (OR was 0.543 (95% CI 0.076-3.871). CONCLUSION Patients with VPA within the therapeutic range had a reduction of SARS-Cov-2 infection incidence greater than 75%. There is a downward trend in the risk of COVID-19 admission by SARS-CoV-2 in patients on VPA therapy. These findings warrant further investigation.
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Affiliation(s)
- O Moreno-Pérez
- Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - E Merino
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - J Manuel Ramos
- Internal Medicine Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - J Carlos Rodríguez
- Microbiology Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Miguel Hernández University, Elche, Spain
| | - C Diaz
- Neurology Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - P Mas
- Pharmacy Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - S Reus
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - R Sánchez-Martínez
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - V Boix
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - P Chico-Sánchez
- Preventive Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - J Sánchez-Payá
- Preventive Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - J Portilla
- Internal Medicine Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain
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Panahi P, Zafardoust H, Mirzohreh ST, Khamnian Z, Alizadeh M. The study of mental health status of people with epilepsy during the COVID-19 pandemic: A systematic review and meta-analysis study. Epilepsy Behav 2024; 157:109834. [PMID: 38852496 DOI: 10.1016/j.yebeh.2024.109834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has affected the lives of people with epilepsy (PWE) in various ways. This systematic review and meta-analysis aims to assess the mental health status and prevalence of mental disorders including depression, anxiety, stress, and psychological distress among PWE. Furthermore, this study evaluates changes in sleep patterns and presence of sleep disturbances among them. The findings of this systematic review can help health organizations, policymakers, and health workers to better prepare and respond to future health crises for PWE and other chronic disease patients. METHOD This systematic review was prepared using PRISMA reporting guidelines. We systematically searched PubMed, Web of Science, Scopus and Cochrane Library databases for studies that reported data on mental health parameters including depression, anxiety, stress, psychological distress, quality of life, and sleep quality, during the pandemic until May 2023. The analytical procedures were executed through the utilization of Comprehensive Meta-Analysis (CMA) software. RESULTS In our study, a total of 61 carefully selected studies were analyzed, yielding valuable insights into the prevalence and impact of various mental health indicators among PWE. The findings revealed that a significant proportion of PWE experienced distressing psychological symptoms, with depression being reported by 34% of participants. Additionally, anxiety was prevalent among 43% of individuals, while stress symptoms were reported by 49% of respondents. Moreover, a substantial portion of PWE, approximately 38%, reported experiencing poor sleep quality, further underscoring the multifaceted nature of the challenges faced by this population. These findings highlight the need for targeted interventions and comprehensive support systems to address the mental health concerns and sleep disturbances faced by individuals living with epilepsy. CONCLUSION The findings revealed that a substantial number of PWE experience symptoms of depression, anxiety, stress, and poor sleep quality. These results emphasize the importance of considering mental health and sleep assessments as integral components of care for individuals with epilepsy. The study underscores the need for further research and targeted interventions to address the mental health burden faced by this population. By prioritizing and addressing these challenges, healthcare providers can enhance the overall well-being and quality of life for individuals living with epilepsy.
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Affiliation(s)
| | | | | | - Zhila Khamnian
- Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahasti Alizadeh
- Faculty of Medicine, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Iran.
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Zhao M, Liu FX, Wang XL, Gao YH, Li X. A Cross-Sectional Survey on Psychological Health and Influencing Factors Among 2628 Asymptomatic and Mild COVID-19 Patients in Fangcang Shelter Hospital. Neuropsychiatr Dis Treat 2024; 20:69-81. [PMID: 38249525 PMCID: PMC10799643 DOI: 10.2147/ndt.s446223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
Purpose The Coronavirus disease 2019 (COVID-19) remains a global public health concern. Many people have been forced to change their lifestyles, which has led to psychological and sleep problem. This study aims to investigate the psychological health problems and factors among patients in the Fangcang Shelter Hospital (FSH) during the COVID-19 pandemic. Patients and Methods A Cross-Sectional survey was conducted to investigate the sleep, anxiety, depression and stress disorders of 2628 asymptomatic and mild patients treated in FSH of Zhengzhou, Henan Province, from 30 October to 6 December 2022, by scanning a WeChat two-dimensional code. Sociodemographic data and influencing factors in FSH were collected, Insomnia Severity Index (ISI), 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Impact of Event Scale-Revised (IES-R) were administered. Descriptive statistics, t-tests or analysis of variance, Spearman or Pearson correlation analysis, and multivariate regression analysis were used to explore the relationships between different variables and their impact on psychological health indicators. Results The proportions of patients with insomnia, depressive disorder, anxiety, and stress disorders were 33.49%, 35.80%, 31.74%, and 43.57%, respectively. Spearman correlation analysis demonstrated that factors such as gender, higher education level, positive nucleic acid test results, longer illness duration, underlying diseases, and extended electronic device use were associated with elevated psychological distress scores. Notably, within FSH, extended exposure to light, a noisy environment, and sleep schedule management significantly impacted the prevalence of insomnia, depression, anxiety, and stress disorders (p<0.01). Multivariable binary logistic regression analysis identified higher education level, light exposure, noisy environment, sleep management, and electronic device usage as the primary risk factors for psychological distress. Conclusion Patients in FSH face psychological distress influenced by sociodemographic factors, environment, and lifestyle, highlighting the need for integrated psychological support in healthcare, particularly in temporary medical facilities during crises.
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Affiliation(s)
- Min Zhao
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan Province, People’s Republic of China
| | - Fei-xiang Liu
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan Province, People’s Republic of China
| | - Xiao-lin Wang
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, Henan Province, People’s Republic of China
| | - Ya-hui Gao
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou, Henan Province, People’s Republic of China
| | - Xiang Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Research Units of Infectious Disease and Microecology, Chinese Academy of Medical Sciences, Hangzhou, People’s Republic of China
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Singh M, Kaushik JS, Yadav A, Khanna A, Dabla S. Parent's Perspective of Problems Faced during the COVID-19 Pandemic Lockdown on the Care of Children with Epilepsy: A Qualitative Study. Indian J Public Health 2023; 67:382-386. [PMID: 37929379 DOI: 10.4103/ijph.ijph_1564_22] [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] [Indexed: 11/07/2023] Open
Abstract
Background COVID-19 has significantly impacted the care of children with chronic illness. There is a paucity of data on issues faced by parents of children with epilepsy (CWE) in an Indian setup. Objectives The objective was to describe the parental perspective of the problems faced by them on the care of their CWE during the first wave of the COVID-19 pandemic. Materials and Methods Parents of CWE who physically visited the clinic for their follow-up visit were asked to narrate their experiences about the problems they faced during the first lockdown due to COVID-19. The narratives were audio recorded, and transcripts were analyzed using thematic analysis to arrive at broad themes. Results Four broad themes were identified: transport-related issues, medication-related issues, issues related to doctor consultation, and diagnostic delay. Limited transportation facilities, lack of appropriate social distancing norms in public transport and outpatient units, rigorous frisking by personnel during travel, fear of viral transmission during outpatient visits, nonavailability of antiseizure medications (ASMs) in local markets, lack of discounts by pharmacy, change of brands of ASM, and inability to undergo scheduled diagnostic investigations were some of the major issues raised by parents of CWE. Conclusion Parents of CWE had trouble in transport to the hospital, inadequate access to ASMs, difficulties in doctor consultation, and delays in diagnostic investigations during the first COVID-19 pandemic lockdown.
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Affiliation(s)
- Manjeet Singh
- Medical Undergraduate Student, Department of Neurology, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Jaya Shankar Kaushik
- Additional Professor, Department of Pediatrics, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Alka Yadav
- Professor, Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Alok Khanna
- Professor, Department of Pediatrics, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Surekha Dabla
- Senior Professor, Department of Neurology, Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Freund BE, Feyissa AM. EEG as an indispensable tool during and after the COVID-19 pandemic: A review of tribulations and successes. Front Neurol 2022; 13:1087969. [PMID: 36530612 PMCID: PMC9755176 DOI: 10.3389/fneur.2022.1087969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 10/03/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, elective and non-emergent tests and procedures were delayed or suspended in lieu of diverting resources to more emergent treatment of critically ill patients and to avoid the spread and contraction of COVID-19. Further, the workforce was stretched thin, and healthcare facilities saw high turnover rates for full-time and contract employees, which strained the system and reduced the ability to provide clinical services. One of the casualties of these changes was electroencephalography (EEG) procedures, which have been performed less frequently throughout the world since the pandemic. Whether considered routine or emergent, the deferral of EEG studies can cause downstream effects, including a delay in diagnosis and initiation of treatment for epilepsy and non-epileptic seizures resulting in a higher risk of morbidity and mortality. Despite these limitations, the importance and utility of EEG and EEG technologists have been reinforced with the development of COVID-related neurological complications, including encephalopathy and seizures, which require EEG for diagnosis and treatment. Since the pandemic, reliance on remote telemonitoring has further highlighted the value and ease of using EEG. There has also been a heightened interest in rapid EEG devices that non-technologist professionals can attach quickly, allowing minimum patient contact to avoid exposure to COVID-19 and taking advantage of remote EEG monitoring. This review discusses the acute and potential long-term effects of the COVID-19 pandemic on the use and performance of EEG.
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Affiliation(s)
| | - Anteneh M. Feyissa
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, United States
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8
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Lavin B, Gray CL, Brodie M. Telemedicine and Epilepsy Care. Neurol Clin 2022; 40:717-727. [DOI: 10.1016/j.ncl.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Zöllner JP, Noda AH, McCoy J, Schulz J, Tsalouchidou PE, Langenbruch L, Kovac S, Knake S, von Podewils F, Hamacher M, Mann C, Leyer AC, van Alphen N, Schubert-Bast S, Rosenow F, Strzelczyk A. Use of Health-Related Apps and Telehealth in Adults with Epilepsy in Germany: A Multicenter Cohort Study. Telemed J E Health 2022; 29:540-550. [PMID: 35984859 DOI: 10.1089/tmj.2022.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Telehealth can improve the treatment of chronic disorders, such as epilepsy. Telehealth prevalence and use increased during the coronavirus disease 2019 (COVID-19) pandemic. However, familiarity with and use of telehealth and health-related mobile applications (apps) by persons with epilepsy remain unknown. Methods: We investigated telehealth use, demographics, and clinical variables within the multicenter Epi2020 cross-sectional study. Between October and December 2020, adults with epilepsy completed a validated questionnaire, including individual questions regarding knowledge and use of apps and telehealth. Results: Of 476 included individuals (58.2% women; mean age 40.2 ± 15.4 years), 41.6% reported using health-related apps. Health apps were used more frequently (pedometer 32.1%, exercise app 17.6%) than medical apps (health insurance 15.1%, menstrual apps 12.2%) or apps designed for epilepsy (medication reminders 10.3%, seizure calendars 4.6%). Few used seizure detectors (i.e., apps as medical devices 1.9%) or mobile health devices (fitness bracelet 11.3%). A majority (60.9%) had heard the term telehealth, 78.6% of whom had a positive view. However, only 28.6% had a concrete idea of telehealth, and only 16.6% reported personal experience with telehealth. A majority (55%) would attend a teleconsultation follow-up, and 41.2% would in a medical emergency. Data privacy and availability were considered equally important by 50.8%, 21.8% considered data privacy more important, and 20.2% considered data availability more important. Current health-related app use was independently associated with younger age (p = 0.003), higher education (p < 0.001), and subjective COVID-19-related challenges (p = 0.002). Persistent seizure occurrence (vs. seizure freedom ≥12 months) did not affect willingness to use teleconsultations on multivariable logistic regression analysis. Conclusions: Despite positive telehealth views, few persons with epilepsy in Germany are familiar with specific apps or services. Socioeconomic factors influence telehealth use more than baseline epilepsy characteristics. Telehealth education and services should target socioeconomically disadvantaged individuals to reduce the digital care gap. German Clinical Trials Register (DRKS00022024; Universal Trial Number: U1111-1252-5331).
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Affiliation(s)
- Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Anna H Noda
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Jeannie McCoy
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Juliane Schulz
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Panagiota-Eleni Tsalouchidou
- Epilepsy Center Hessen, Department of Neurology, University Hospital Marburg-Philipps-University, Marburg (Lahn), Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, University Hospital Münster-Westfälische Wilhelms-University, Münster, Germany.,Department of Neurology, Osnabrück Hospital, Osnabrück, Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology, University Hospital Münster-Westfälische Wilhelms-University, Münster, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, University Hospital Marburg-Philipps-University, Marburg (Lahn), Germany
| | - Felix von Podewils
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Mario Hamacher
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Anne-Christine Leyer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany.,Department of Pediatrics and Neuropediatrics, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany
| | - Natascha van Alphen
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany.,Department of Pediatrics and Neuropediatrics, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt-Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe-University, Frankfurt am Main, Germany
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Milan A, Salles P, Pelayo C, Uribe-San-Martin R. Acute to Chronic Electro-Clinical Manifestations of Neuro-COVID and the Long-Haul Consequences in People With Epilepsy: A Review. Cureus 2022; 14:e26020. [PMID: 35865450 PMCID: PMC9293262 DOI: 10.7759/cureus.26020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/12/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection can involve the central nervous system (CNS). Acute symptomatic seizures or epileptiform discharges have not been commonly reported in patients with altered mental status related to coronavirus disease 2019 (COVID-19) infection. However, long-term neurological symptoms have been reported after COVID-19 infection (i.e., brain fog, cognitive complaints, and confusion), suggesting chronic encephalopathy. People with epilepsy (PWE) have been specifically affected by the COVID-19 pandemic, with changes in their seizure frequency, quality of life, health care accessibility, and medication interactions. This narrative review highlights possible pathophysiological mechanisms of COVID-19 on the brain, related to short- and long-term epileptiform activity and the impact of this infection on PWE.
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Moreno-Pérez O, Merino E, Ramos JM, Rodríguez JC, Diaz C, Mas P, Reus S, Sánchez-Martínez R, Boix V, Chico-Sánchez P, Sánchez-Payá J, Portilla J. [Valproic Acid Could Help in the Fight Against COVID-19: a case-control study]. Neurologia 2022:S0213-4853(22)00014-7. [PMID: 35185237 PMCID: PMC8841207 DOI: 10.1016/j.nrl.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE There is early evidence about Valproic acid (VPA) antiviral effect. Our aim was to investigate the incidence and severity of SARS-CoV-2 infection in VPA users as compared with the general population. MATERIAL AND METHODS A case-control study nested within a cohort, carried out between March 1 and December 17, 2020. Retrospectively, we identified confirmed SARS-CoV-2 infection patients exposed to VPA in our health department (defined as case). We ascertained VPA regimen (all the time (AT)(292 days) or at least 20% of the study period (notAT)(≥58 days) and if VPA levels were in therapeutic range (ATR) (50-100 mcg/mL) in the last 24 months. We calculated the cumulative incidence of SARS-CoV-2 infection and hospital admission in the cases, comparing it with the general unexposed VPA population (controls). RESULTS During the study period, 6183 PCR+ were detected among 281035 inhabitants, of these, 746 were hospitalized. 691 patients were on VPA notAT and 628 (90.1%) AT. The indication for VPA use was epilepsy in 54.9%. The incidence of PCR+ was 1.736 % (OR 0.785 (95%CI 0.443-1.390) and 1.910 % (OR 0.865 (95%CI 0.488-1.533), on VPA notAT and VPA AT patients, respectively vs. 2.201% in people without VPA regimen. Those patients with VPA ATR had a lower risk of PCR + (OR 0.233 (95%CI 0.057-0.951) notAT; OR 0.218 (95%CI 0.053-0.890) AT). Hospital admission incidence was lower in patient on VPA (OR was 0.543 (95% CI 0.076 to 3.871). CONCLUSION Patients with VPA within the therapeutic range had a reduction of SARS-Cov-2 infection incidence greater than 75%. There is a downward trend in the risk of COVID-19 admission by SARS-CoV-2 in patients on VPA therapy. These findings warrant further investigation.
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Affiliation(s)
- Oscar Moreno-Pérez
- Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
- Clinical Medicine department, Miguel Hernández University, Elche, Spain
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Jose Manuel Ramos
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
- Clinical Medicine department, Miguel Hernández University, Elche, Spain
| | - Juan Carlos Rodríguez
- Microbiology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
- Miguel Hernández University, Elche, Spain
| | - Carmina Diaz
- Neurology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
- Clinical Medicine department, Miguel Hernández University, Elche, Spain
| | - Patricio Mas
- Pharmacy department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Sergio Reus
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
- Clinical Medicine department, Miguel Hernández University, Elche, Spain
| | - Rosario Sánchez-Martínez
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
- Clinical Medicine department, Miguel Hernández University, Elche, Spain
| | - Pablo Chico-Sánchez
- Preventive department, Alicante General University Hospital - - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Sánchez-Payá
- Preventive department, Alicante General University Hospital - - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
| | - Joaquín Portilla
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
- Clinical Medicine department, Miguel Hernández University, Elche, Spain
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Kwok S, Engle J, Datta AN. Resilience of adolescents and teenagers with self-limited and genetic-generalized epilepsy during the COVID-19 pandemic. Epilepsy Behav Rep 2021; 17:100520. [PMID: 34977525 PMCID: PMC8709791 DOI: 10.1016/j.ebr.2021.100520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/03/2021] [Accepted: 12/19/2021] [Indexed: 11/05/2022] Open
Abstract
There were no significant differences in anxiety and depression before and during the pandemic. Overall, there was no reported change in seizure frequency during the pandemic. On the Obsession with COVID-19 Scale, only 6% were in the dysfunctional range. A subgroup experienced pandemic-related disruptive changes. Some disruptive changes may be related to modifiable factors, such as sleep and exercise.
Introduction The study-objective was to determine the emotional impact of the COVID-19 pandemic on children with self-limited and genetic-generalized epilepsy. Methods Patients completed the Children’s Depression Inventory-2 (CDI-2) and Multidimensional Anxiety Scale for Children 2nd Edition (MASC-2) questionnaires before and during the pandemic. Via tele-visits, a pandemic-lifestyle survey and Obsession with COVID-19 Scale (OCS) was administered. Results Fifty subjects with a mean (SD) age of 14.44 (2.97) years and 4.85 (2.97) years of epilepsy were included. Overall, mood (62%), anxiety (61%), sleep (68%) and seizure frequency (88%) were unchanged/improved during the pandemic. There was no significant difference in pre-COVID-19 and during COVID-19 CDI-2 and MASC-2 total T-scores. In 24% with a worsening CDI-2 total T-score, associations included higher total OCS score (p = 0.001), poor sleep (p = 0.013) and pre-existing psychiatric history (p = 0.0450). In 28% with a worsening MASC-2 total T-score, associations included less exercise during the pandemic (p = 0.028) and lower maternal education history (p = 0.022). On OCS, 6% were in the dysfunctional range. Conclusions This cohort demonstrated emotional resilience during the COVID-19 pandemic. However, screening is important, as a subgroup experienced disruptive changes, possibly related to modifiable factors, such as sleep and exercise. Lay summary To determine the impact of the COVID-19 pandemic on children with epilepsy (CWE), 50 CWE completed a pandemic-lifestyle survey. Questionnaires for anxiety and depression completed before and during the COVID-19 pandemic were also compared. Overall, there was no worsening of seizures, anxiety, or depression during the pandemic. During the pandemic, 24% had more depressive symptoms (associations: poor sleep and psychiatric history) and 28% had more anxiety (associations: less exercise and lower maternal education).This cohort showed emotional resilience during the COVID-19 pandemic. Regular screening is important, as some CWE experienced disruptive changes, related to modifiable-factors, such as sleep and exercise.
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Affiliation(s)
- Stephanie Kwok
- Department of Pediatrics, Division of Neurology, BC Children's Hospital, University of British Columbia Vancouver, BC, Canada
| | - Jennifer Engle
- Department of Psychology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anita N Datta
- Department of Pediatrics, Division of Neurology, BC Children's Hospital, University of British Columbia Vancouver, BC, Canada
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