The Impact of the COVID-19 Pandemic on People With Epilepsy. An Italian Survey and a Global Perspective

Navigating the waves: A systematic review of telemedicine interventions and health service access challenges in epilepsy during COVID-19

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.

The study of mental health status of people with epilepsy during the COVID-19 pandemic: A systematic review and meta-analysis study

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.

Exploring ncRNAs in epilepsy: From oxidative stress regulation to therapy

Epilepsy is a prevalent neurological illness which is linked with high worldwide burdens. Oxidative stress (OS) is recognized to be among the contributors that trigger the advancement of epilepsy, affecting neuronal excitability and synaptic transmission. Various types of non-coding RNAs (ncRNAs) are known to serve vital functions in many disease mechanisms, including epilepsy. The current review sought to understand better the mechanisms through which these ncRNAs regulate epilepsy's OS-related pathways. We investigated the functions of microRNAs in controlling gene expression at the post-translatory stage and their involvement in OS and neuroinflammation. We also looked at the different regulatory roles of long ncRNAs, including molecular scaffolding, enhancer, and transcriptional activator, during OS. Circular RNAs and their capability to act as miRNA decoys and their consequential impact on epilepsy development were also explored. Our review aimed to improve the current understanding of novel therapies for epilepsy based on the role of ncRNAs in OS pathways. We also demonstrated the roles of ncRNAs in epilepsy treatment and diagnosis, explaining that these molecules play vital roles that could be used in therapy as biomarkers.

Trends in outpatient and inpatient visits for separate ambulatory-care-sensitive conditions during the first year of the COVID-19 pandemic: a province-based study

Background

The COVID-19 pandemic led to global disruptions in non-urgent health services, affecting health outcomes of individuals with ambulatory-care-sensitive conditions (ACSCs).

Methods

We conducted a province-based study using Ontario health administrative data (Canada) to determine trends in outpatient visits and hospitalization rates (per 100,000 people) in the general adult population for seven ACSCs during the first pandemic year (March 2020-March 2021) compared to previous years (2016-2019), and how disruption in outpatient visits related to acute care use. ACSCs considered were chronic obstructive pulmonary disease (COPD), asthma, angina, congestive heart failure (CHF), hypertension, diabetes, and epilepsy. We used time series auto-regressive integrated moving-average models to compare observed versus projected rates.

Results

Following an initial reduction (March-May 2020) in all types of visits, primary care outpatient visits (combined in-person and virtual) returned to pre-pandemic levels for asthma, angina, hypertension, and diabetes, remained below pre-pandemic levels for COPD, and rose above pre-pandemic levels for CHF (104.8 vs. 96.4, 95% CI: 89.4-104.0) and epilepsy (29.6 vs. 24.7, 95% CI: 22.1-27.5) by the end of the first pandemic year. Specialty visits returned to pre-pandemic levels for COPD, angina, CHF, hypertension, and diabetes, but remained above pre-pandemic levels for asthma (95.4 vs. 79.5, 95% CI: 70.7-89.5) and epilepsy (53.3 vs. 45.6, 95% CI: 41.2-50.5), by the end of the year. Virtual visit rates increased for all ACSCs. Among ACSCs, reductions in hospitalizations were most pronounced for COPD and asthma. CHF-related hospitalizations also decreased, albeit to a lesser extent. For angina, hypertension, diabetes, and epilepsy, hospitalization rates reduced initially, but returned to pre-pandemic levels by the end of the year.

Conclusion

This study demonstrated variation in outpatient visit trends for different ACSCs in the first pandemic year. No outpatient visit trends resulted in increased hospitalizations for any ACSC; however, reductions in rates of asthma, COPD, and CHF hospitalizations persisted.

Changes in sleep quality of children with epilepsy and anxiety of their caregivers after COVID-19 infection: a case-series report

Objective

To study the changes in epileptic seizures and sleep quality in children with epilepsy (CWE) and the changes in anxiety of their caregivers after infection with COVID-19.

Methods

Outpatients and inpatients of CWEs were selected as subjects and a questionnaire survey was used to carry out this case-series study. The demographic information of the CWEs and their caregivers, information about epilepsy, and information about the vaccination, infection, and treatment of COVID-19 were collected. The changes in sleep quality of CWEs and the changes in anxiety of their caregivers were assessed by the Child Sleep Habits Questionnaire (CSHQ) and Caregiver Anxiety Scale (CAS). Risk factors affecting sleep habits in CWEs and caregiver anxiety were further analyzed by one-way analysis of variance.

Results

A total of 312 children were included in the study. Among them, 134 patients (42.9%) were female. The average age of the children was 9.30 ± 3.88 years, and the duration of epilepsy was 4.59 ± 3.36 years. A total of 221 of the 312 children were infected with COVID-19, and all the infected children developed fever, which lasted for 1.71 ± 1.13 days. 10 children were satisfied with controlled seizures for more than 1 year and relapsed after COVID-19 infection (4.2%), 4 cases (3.6%) with increased seizures, and 8 children with reduced seizures (7.7%), 17 children (7.7%) had no change in seizures, and 182 children (82.3%) remained seizure-free after the COVID-19 infection. The average sleep time of the CWEs was 9.25 ± 1.04 h and the average total score of the CSHQ was 37.25 ± 5.19, among which 44 cases (14.1%) had more than 41 points. As the result of the CAS, 16 of them (5.13%) scored above 50 and the average total score was 31.49 ± 8.09. The control of seizures, age of onset, types of anti-seizure medicines (ASMs), and seizure duration were risk factors affecting sleep quality. Accordingly, the score of CAS was significantly lower when there was more than one caregiver who cared for the CWE.

Conclusions

COVID-19 infection did not cause an increase in seizures in CWEs, nor did it worsen their sleep quality of them or aggravate the anxiety of their caregivers.

Global landscape of COVID-19 and epilepsy research: A bibliometric analysis

Background

A large number of papers regarding coronavirus disease 2019 (COVID-19) and epilepsy have been published since the declaration of the COVID-19 pandemic. However, there is no bibliometric analysis on these papers. In this study, we aimed to analyze the bibliometric characteristics of these papers, thus identifying the trends and future directions of COVID-19 and epilepsy research.

Methods

Scientific papers regarding COVID-19 and epilepsy were retrieved through searches of the Web of Science Core Collection database. Title, authors, contributing institute, country, source journal, times cited, and additional information were extracted from each selected paper. Microsoft Excel 2019 and GraphPad Prism 8 were used to analyze the extracted data and export the bar charts and tables whilst VOSviewer software was used to perform and visualize co-authorship analysis and co-occurrence analysis of keywords.

Results

A total of 317 papers regarding COVID-19 and epilepsy were included in the final analysis. Epilepsy & Behavior published the largest number of papers (n = 84). J. Helen Cross and Naoto Kuroda were the most prolific authors (n = 13 each). The United States (n = 88) and the University of London (n = 23) were the country and organization with the most contributions, respectively. The strongest authors' collaborations were between Giovanni Assenza and Jacopo Lanzone and between J. Helen Cross and Nathalie Jette. Selected author keywords were organized into seven clusters, and the keywords in clusters 1 and cluster 4 had the largest average appearing year of any clusters.

Conclusion

This is the first bibliometric analysis of papers regarding COVID-19 and epilepsy. Our results showed that the United States was the leading country whilst J. Helen Cross was the most influential scholar in COVID-19 and epilepsy research. psychological consequences of COVID-19, and the safety of COVID-19 vaccines for people with epilepsy, are possible areas for future research on COVID-19 and epilepsy.

Challenges for low middle-income people with epilepsy during the COVID-19 pandemic: Lessons learnt, call for action

OBJECTIVE

The COVID-19 pandemic impacted the care of people with epilepsy (PWE). Several online surveys were conducted but there is limited data regarding the impact on low-income PWE from lower-middle income countries (LMICs) who have no access or ability to answer online surveys. The purpose of this interview was to understand the challenges faced by low-income PWE during the lockdown phase of the pandemic.

METHOD

PWE visiting the epilepsy specialty outpatient department of a tertiary referral government hospital to avail of subsidized services were interviewed. In the interview, they discussed challenges in obtaining medical care, the impact on wellbeing, employment, and vaccination status during the lockdown phase of the pandemic.

RESULTS

Out of the 214 PWE interviewed, 20.6% had increased seizure frequency, 28.9% did not have access to medication mainly due to travel restrictions, 30.5% reported lack of availability of medication and 50% were not able to afford the medication mainly due to loss of income. 51% were unable to have follow-up consultations. 36% reported worsening of mood and some reported impact on other aspects of wellbeing. The impact on wellbeing was significantly associated with an increase in seizure frequency (P < .05). The study revealed hesitation related to vaccines in the majority and expectations of financial support by the government and assistance for procuring medication. There was a lack of awareness about telemedicine services and the same was not adequately offered by government hospitals.

SIGNIFICANCE

The study underscores the need to learn lessons from the challenging experiences of low-income PWE and create an action plan for the future to address the issues of lack of affordability of medical care and access to telemedicine. It is critical that the care of the marginalized, underrepresented PWE from lower-middle income countries is not neglected during a pandemic.

Seizure Control in Patients with Epilepsy during the COVID-19 Pandemic: A Systematic Review and Meta-analysis

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.

Risk of hospitalization and death for COVID-19 in persons with epilepsy over a 20-month period: the EpiLink Bologna cohort, Italy

Objective

Data on COVID‐19 outcomes in persons with epilepsy (PWE) are scarce and inconclusive. We aimed to study the risk of hospitalization and death for COVID‐19 in a large cohort of PWE from March 1, 2020 to October 31, 2021.

Methods

The historical cohort design (EpiLink Bologna) compared adult PWE grouped into people with focal epilepsy (PFE), idiopathic generalized epilepsy (PIGE), and developmental and/or epileptic encephalopathy (PDEE), and a population cohort matched (ratio 1:10) for age, sex, residence, and comorbidity (assessed with the multisource comorbidity score), living in the local health trust of Bologna (approximately 800 000 residents). Clinical data were linked to health administrative data.

Results

In both cohorts (EpiLink: n = 1575 subjects, 1128 PFE, 267 PIGE, 148 PDEE, 32 other; controls: n = 15 326 subjects), 52% were females, and the mean age was 50 years (SD = 18). Hospital admissions for COVID‐19 in the whole period were 49 (3.1%) in PWE and 225 (1.5%) in controls. The adjusted hazard ratio (aHR) in PWE was 1.9 (95% confidence interval [CI] = 1.4–2.7). The subgroups at higher risk were PFE (aHR = 1.9, 95% CI = 1.3–2.8) and PDEE (aHR = 3.9, 95% CI = 1.7–8.7), whereas PIGE had a risk comparable to the controls (aHR = 1.1, 95% CI = .3–3.5). Stratified analyses of the two main epidemic waves (March–May 2020, October 2020–May 2021) disclosed a higher risk of COVID‐19‐related hospitalization during the first epidemic wave (March–May 2020; aHR = 3.8, 95% CI = 2.2–6.7). Polytherapy with antiseizure medications contributed to a higher risk of hospital admission. Thirty‐day risk of death after hospitalization was 14% in both PWE and controls.

Significance

During the first 20 months since the outbreak of COVID‐19 in Bologna, PWE had a doubled risk of COVID‐19 hospital admission compared to a matched control population. Conversely, epilepsy did not represent a risk factor for COVID‐19‐related death.

Impact of COVID-19 pandemic on epilepsy care in Japan: A national-level multicenter retrospective cohort study

OBJECTIVE

The impact of the coronavirus disease 2019 (COVID-19) pandemic on epilepsy care across Japan was investigated by conducting a multicenter retrospective cohort study.

METHODS

This study included monthly data on the frequency of (1) visits by outpatients with epilepsy, (2) outpatient electroencephalography (EEG) studies, (3) telemedicine for epilepsy, (4) admissions for epilepsy, (5) EEG monitoring, and (6) epilepsy surgery in epilepsy centers and clinics across Japan between January 2019 and December 2020. We defined the primary outcome as epilepsy-center-specific monthly data divided by the 12-month average in 2019 for each facility. We determined whether the COVID-19 pandemic-related factors (such as year [2019 or 2020], COVID-19 cases in each prefecture in the previous month, and the state of emergency) were independently associated with these outcomes.

RESULTS

In 2020, the frequency of outpatient EEG studies (-10.7%, p<0.001) and cases with telemedicine (+2,608%, p=0.031) were affected. The number of COVID-19 cases was an independent associated factor for epilepsy admission (-3.75*10-3 % per case, p<0.001) and EEG monitoring (-3.81*10-3 % per case, p = 0.004). Further, the state of emergency was an independent factor associated with outpatient with epilepsy (-11.9%, p<0.001), outpatient EEG (-32.3%, p<0.001), telemedicine for epilepsy (+12,915%, p<0.001), epilepsy admissions (-35.3%; p<0.001), EEG monitoring (-24.7%: p<0.001), and epilepsy surgery (-50.3%, p<0.001).

SIGNIFICANCE

We demonstrated the significant impact that the COVID-19 pandemic had on epilepsy care. These results support those of previous studies and clarify the effect size of each pandemic-related factor on epilepsy care.

The effects of COVID-19 measures on the hospitalization of patients with epilepsy and status epilepticus in Thailand: An interrupted time series analysis

Objective

To investigate the effect of Coronavirus disease 2019 (COVID‐19) measures on the hospitalization of patients with epilepsy and status epilepticus (SE).

Methods

This interrupted time series design included data from the Thai Universal Coverage Scheme electronic database between January 2017 and September 2020. The monthly hospitalization rate of epilepsy and SE was calculated by the number of hospitalizations divided by the midyear population. Segmented regression fitted by ordinary least squares (OLS) was used to detect the immediate and overtime effects of COVID‐19 measures on the hospitalization rate.

Results

During January 2017 and September 2020, the numbers of epilepsy and SE patients admitted to the hospital were 129 402 and 15 547 episodes, respectively. The monthly trend of the hospitalization rate in epilepsy decreased immediately after the COVID‐19 measure (0.739 per 100 000 population [95% CI: 0.219 to 1.260]). In particular, the number of children declined to 1.178 per 100 000 population, and the number of elderly individuals dropped to 0.467 per 100 000 population, while there was a nonstatistically significant change in SE.

Significance

COVID‐19 measures reduced the hospital rate in epilepsy, particularly in children and adults. However, there was no change in SE patients.

The impact of one-year COVID-19 containment measures in patients with mesial temporal lobe epilepsy: A longitudinal survey-based study

BACKGROUND

We assessed levels of depression, anxiety, stress, anhedonia, somatization, psychological distress, sleep, and life quality in patients with mesial temporal lobe epilepsy (MTLE) after one year of containment measures started in Italy to stem the COVID-19 pandemic.

METHODS

We consecutively enrolled 51 patients with MTLE, administering an online survey that compared the year before and after the COVID-19 propagation. We analyzed clinical data (e.g., seizure frequency, life quality) and neuropsychological assessment through Somatic Symptom Scale-8 (SSS-8), Beck Depression Inventory (BDI-2), State-Trait Anxiety Inventory (STAI-Y), Depression, Anxiety and Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI), Snaith-Hamilton Pleasure Scale (SHAPS), Impact of Event Scale-Revised (IES-R). The BDI-2 and STAI-Y scores were compared to those acquired in the same patients before the COVID-19 outbreak.

RESULTS

Comparing our population with MTLE before and after COVID-19 outbreak, we found a significant worsening in life quality (p = 0.03), SSS-8 (p = 0.001), BDI-2 (p = 0.032), and STAI-Y scores (p < 0.001). After one year of pandemic, 88.2% of patients obtained pathological scores at PSQI, 19.6% at SHAPS, 29.4% at IES-R. Reduction of life quality correlated with anxiety, depression, stress, and somatization. Higher levels of anhedonia correlated with stress, depression, and anxiety. Somatization correlated with depression, anxiety, and sleep quality. Distress levels correlated with anxiety, somatization, and depression.

CONCLUSIONS

We demonstrated a significant worsening of depression, anxiety, life quality, and somatization in patients with MTLE after one year of COVID-19 beginning. Concomitantly, results suggest that the pandemic had a negative impact on sleep quality, psychological distress, and anhedonia, but not on epilepsy itself.

Masking for School-Age Children With Epilepsy: We Do Have Consensus!

INTRODUCTION

This study was designed to assess current recommendations from child neurologists and epileptologists on masking for school-age children with epilepsy.

METHODS

A 7-item survey was created and sent out to members of the Child Neurology Society and Pediatric Epilepsy Research Consortium in August of 2021 to assess current practice and provider recommendations on masking.

RESULTS

One hundred four individuals participated with representation from all regions of the United States. Masking was recommended by 95.1%, with 63.4% (n = 66) noting exception of those with severe intellectual disability, autism, and behavioral problems. Of those who write exemption letters, 54% write these <5% of the time. Only 3% reported potential adverse events associated with masking.

CONCLUSION

Nearly all respondents recommended masking for school-age children with epilepsy. Potential risks of masking and adverse events were low. Improved guidance on masking is needed to ensure academic success of our patients with epilepsy.

Understanding and managing the impact of the COVID-19 pandemic and lockdown on patients with epilepsy

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic represented a relevant issue for people with epilepsy (PwE). Medical care and social restrictions exposed PwE to a high risk of seizure worsening. Medical institutions answered to the pandemic assuring only emergency care and implementing a remote assistance that highlighted the technological obsolescence of the medical care paradigms for PwE.

AREA COVERED

We reviewed the literature on the COVID-19-related factors influencing the epilepsy course, from the evidence of seizure risk in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected PwE to anti-Sars-Cov-2 drugs interactions with antiseizure medications and the perceived changes of seizures in PwE.

EXPERT OPINION

COVID-19 pandemic was a problematic experience for PwE. We must make treasure of the lessons learned during this period of social restrictions and employ the recent technological advances to improve PwE assistance, in particular telemedicine and electronic media for patients' education.

Telemedicine in epilepsy management during the coronavirus disease 2019 pandemic

BACKGROUND

Telemedicine has spread rapidly during the coronavirus disease 2019 (COVID-19) pandemic and shown its usefulness, particularly for patients with epilepsy, compared to face-to-face visits. We sought to evaluate the clinical features of patients with childhood onset epilepsy associated with consultations by telephone call during the COVID-19 pandemic.

METHODS

We retrospectively investigated the medical records of patients with childhood onset epilepsy who visited an outpatient clinic in Saitama Children's Medical Center, Saitama, Japan, from 1 March 2020 to 30 September 2020. To find the clinical features of patients who utilized telemedicine consultation (by telephone call), we divided the patients into the telemedicine group and the face-to-face group. We then reviewed the clinical features. Telemedicine consultation was not implemented for new patients.

RESULTS

We enrolled 776 outpatients in total, and 294 patients (37.9%) utilized telemedicine consultations. The total number of visits was 2,299 and the total number of telemedicine consultations was 373 (16.2%). No clinical feature was associated with telemedicine consultations except for age at onset of epilepsy. The number of oral antiepileptic drugs prescriptions decreased in 23 of 776 (3.0%) of the patients who did not experience seizure deterioration, including status epilepticus, or who visited the emergency room.

CONCLUSION

Telemedicine consultations were successfully utilized for epilepsy treatment at our outpatient clinic, regardless of epilepsy type, etiology, seizure frequency, comorbidities, and patients' residential areas. Thus, telemedicine by telephone call may be a useful resource in the management of patients with childhood onset epilepsy during the pandemic.

Resilience of adolescents and teenagers with self-limited and genetic-generalized epilepsy during the COVID-19 pandemic

•

There were no significant differences in anxiety and depression before and during the pandemic.

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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.

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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.

A longitudinal seizure outcome following the COVID-19 pandemic in 2020 and 2021: Transient exacerbation or sustainable mitigation

Objective

To study the longitudinal seizure outcomes of people with epilepsy (PWE) following the acute and chronic phases of the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Consecutive PWE who were treated at the epilepsy center of Hiroshima University Hospital between 2018 and 2021 were enrolled. We evaluated the incidence of seizure frequency increase or decrease following the pandemic during observational periods in 2020 and 2021. Data between 2018 and 2019 were used as a control set. The sustainability of the altered seizure frequency condition was evaluated throughout the study period. We analyzed the clinical, psychological, and social factors associated with PWE with seizure exacerbation or amelioration.

Results

Among the 223 PWE who were evaluated (mean age 37.8 ± 16.3 years), seizure frequency increased for 40 (16.8%) and decreased for 34 (15.2%) after the pandemic began. While seizure exacerbation tended to be a transient episode during 2020, seizure amelioration was likely to maintain excellent status over the observation periods; the sustainability of the altered seizure frequency condition was more prominent for amelioration than exacerbation (p < 0.001). Seizure exacerbation was significantly associated with “no housemate” (odds ratio [OR] 3.37; p = 0.045) and “comorbidity of insomnia” (OR 5.80; p = 0.004). Conversely, “structural abnormality of MRI” (OR 2.57; p = 0.039) and “two-generation householding” (OR 3.70; p = 0.004) were independently associated with seizure amelioration.

Conclusion

This longitudinal observation confirmed that seizure exacerbation and amelioration emerged during the COVID-19 pandemic. The COVID-19 pandemic has shed light on the stark difference that social support systems can make on outcomes for PWE.

Prevalence of depression, anxiety, and psychological distress in patients with epilepsy during COVID-19: A systematic review

OBJECTIVE

COVID-19 pandemic disease has profound consequences for physical and mental health. In this regard, health care for chronic diseases, especially epilepsy is neglected The purpose of this systematic review study was to investigate the epidemic effect of COVID-19 on increasing the prevalence of mental disorders such as depression, anxiety, and sleep disorders in people with epilepsy (PWE).

METHODS

We systematically searched MEDLINE, Cochrane, Embase, Web of science, Scopus, and Psych info databases for studies that estimate the prevalence of mental disorders in PWE during the COVID-19 until December 2020. Inclusion criteria included samples of population, with a confirmed diagnosis of epilepsy.

RESULTS

Irrespective of PWE or people without epilepsy (PWOE), all experienced stress and anxiety during COVID-19 pandemic. Most of the studies showed that PWE and even PWOE during the pandemic, suffer from depression. The highest rate of depression was attributed to female PWE with financial problems (66.7%) and the lowest rate of depression in PWE was reported in 8.6%. 7.1-71.2% and 28.2% of patients reported sleep disorders and insomnia, respectively. Less than 2% experienced a sleep improvement.

LIMITATIONS

Due to a large amount of heterogeneities across the results, we could not evaluate the exact rate of prevalence in spite of using effective measures.

CONCLUSIONS

People with epilepsy were considered as a susceptible group to the impact of the pandemic. Therefore, great attention should be paid to PWE and adequate psychological supports provided in this period to relieve or inhibit risks to mental health in PWE.

The impact of the Covid-19 pandemic on a Greek cohort of patients with epilepsy

BACKGROUND

The Covid-19 pandemic, the subsequent lockdown, and the measures of social distancing may have had adverse effects on patients with epilepsy (PWE). This study was designed to assess the pandemic's psychological impact on the Greek non-infected PWE and possible changes in their seizure control.

METHOD

The patients were evaluated utilizing a semi-structured interview consisting of open questions regarding their demographic, social, and clinical characteristics, followed by five questions (on a scale of 0-10) related to the Covid-19 pandemic, lockdown, and social distancing measures. Anxiety and depression of PWE were screened using the Hospital Anxiety and Depression Scale (HADS), which consists of HADS-Anxiety and HADS-Depression subscales.

RESULTS

We evaluated 65 PWE in the outpatient clinic (60 %) or via telephone interview (40 %). None of these patients experienced changes in seizure control. The mean scores of the Covid-19-related questions were 6.1 ± 2.7 (fear of getting infected), 4.7 ± 3.3 (fear of death), 7.1 ± 2.7 (fear of sickness for their relatives), 6.4 ± 3.1 (stress during lockdown), and 3.0 ± 2.9 (fear of antiepileptic drugs unavailability). Thirty-nine (60 %) patients screened positive for anxiety and thirty-three (50.8 %) for depression.

CONCLUSION

The psychological impact of the Covid-19 pandemic, lockdown, and social distancing measures on non-infected PWE was moderate without changes in their seizure control. HIPPOKRATIA 2021, 25 (4):145-150.

Psychological impact of the COVID-19 pandemic for patients with epilepsy: A systematic review and meta-analysis

OBJECTIVE

To investigate psychological comorbidities in patients with epilepsy during the coronavirus disease 2019 (COVID-19) pandemic.

METHOD

A systematic review and meta-analysis approach was used to comprehensively search MEDLINE, CENTRAL, EMBASE, and ClinicalTrials.gov databases for relevant studies. Studies that reported psychological stress in patients with epilepsy during the COVID-19 pandemic were included. Psychological comorbidities were defined as anxiety, depression, and sleep disturbance. Pooled proportions of psychological comorbidities with 95% confidence intervals (CIs) were assessed using a random-effects model. The quality of assessment for each study, heterogeneity between the studies, and publication bias were also evaluated.

RESULTS

A total of 28 studies with 7959 patients/caregivers were included in the meta-analysis. The pooled proportions of anxiety/worry, depression/bad mood, and sleep disturbance were 38.9% (95% CI: 31.3-46.7); I2 = 97%; p < 0.01, 30.9% (95% CI: 23.3-38.9), I2 = 97%; p < 0.01, and 36.5% (95% CI: 28.3-45.1), I2 = 97%, p < 0.01, respectively.

CONCLUSION

Although the heterogeneity was high, our results showed a relatively high incidence of psychological comorbidities. Therefore, clinicians need to intervene early in the stress of patients with epilepsy to prevent worsening of stress, which can result in seizure worsening.

COVID-19 and epilepsy: How are people with epilepsy in Brazil?

PURPOSE

During COVID-19 pandemic the global population is facing an important psychosocial distress. The aim of this study was to evaluate how people with epilepsy (PWE) in Brazil is dealing with the pandemic, in relation to seizure frequency, access to antiseizure medicines (ASM), medical follow-up, and well-being.

METHODS

An online questionnaire survey among PWE (group 1) and caregivers (group 2) was applied in the social networks of the Brazilian Association of Epilepsy, the official Brazilian chapter of the International Bureau for Epilepsy. The questionnaire was composed of 46 generic questions in four areas, namely, demographics and baseline clinical data as well as epilepsy and quality-of-life impact by COVID-19 pandemic based on the domains of the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) instrument.

RESULTS

The questionnaire was answered by 464 participants including 380 (81.9%) PWE (78.7% female; age 34.3 yrs.; ±9.76) and 84 (18.1%) caregivers (patients' age 14.1 yrs.; ±10.30). During the COVID-19 pandemic, 36.8% of PWE and 36.4% of caregivers reported difficulties in accessing the epilepsy healthcare provider, and visits occurred normally only in 29.7% of PWE and in 34.5% of the caregiveŕs group. Telehealth was not provided for 66.6% of group 1 and for 58.5% of group 2. Lack of availability of ASM was reported by 21.9% of PWE and 28.0% of caregivers in public dispensing units and by 19.2% and 17.8%, respectively, in private pharmacies. Increase in seizures during pandemic was mentioned by 26.3% and 27.9% of groups 1 and 2, respectively. Patients who had increase in seizure frequency had more frequently reported problems with treatment and in quality-of-life concepts. Fear of having a more severe COVID-19 presentation because of epilepsy was reported by 74.5% of PWE and by 89.8% of caregivers. Dissatisfaction with current health status was reported by 36.7% and 38.1% in groups 1 and 2, respectively, and that the support from others has decreased (56.1% and 66.1%, in groups 1 and 2) during the pandemic. The factors with higher Odds Ratio of increase in seizure frequency during pandemic were age >41 yrs., treatment in public healthcare system, drug-resistant epilepsy, adversities in getting ASM in public dispensing units, difficulties with prescription renewals, current financial problems and belief that epilepsy or ASM are risk factors for contracting COVID-19.

CONCLUSION

During COVID-19 pandemic in Brazil, PWE and caregivers reported increase in seizures in one-fourth of the patients and several difficulties, namely problems in accessing the healthcare system including ASM dispensation, telehealth, and fear of having a more severe COVID-19 because of epilepsy. There were also physical, psychological, and social concerns which affected quality-of-life-related aspects in this population. These facts may increase treatment gap in epilepsy in Brazil as well in other developing countries.

Patient-zu-Arzt-Anwendungen in der ambulanten Epilepsieversorgung

Die telemedizinische Behandlung von Patient*innen mit Epilepsie ist eine Erweiterung der bislang die ambulante Versorgungslandschaft im Wesentlichen prägenden klassischen persönlichen Arztbesuche. Unter administrativen, finanziellen und rechtlichen nun klareren Rahmenbedingungen konnten, durch die COVID-19-Pandemie katalysiert, rasch die zuvor langsameren Prozesse in der Umsetzung beschleunigt werden. Nationale und internationale Erfahrungen verweisen auf eine Noninferiorität im Vergleich zu Vor-Ort-Besuchen. Verbindliche Algorithmen der Zuordnung Vor-Ort-Besuch vs. telemedizinische Behandlung sind noch ausstehend und sollten zukünftig unter Berücksichtigung der Patientencharakteristika sowie Behandlungssituation erarbeitet werden.

Knowledge, attitudes, and impact of COVID-19 pandemic among neurology patients in Jordan: a cross-sectional study

Background

The impacts of the COVID-19 pandemic on health services offered to patients with non-communicable diseases, including chronic neurological illnesses, are diverse and universal. We used a self-reported questionnaire to investigate these impacts on neurology patients in Jordan and assess their knowledge and attitudes towards the pandemic.

Results

Most respondents had positive attitudes towards the COVID-19 pandemic, with 96% reporting they believed in the seriousness of the pandemic and adhered to prevention measures. Nearly 97% resorted to the internet and media outlets for medical information about the pandemic. About one in five clinic visitors had their appointments delayed due to interruption of health services. A similar portion of patients with MS, epilepsy, and migraine or tension headache reported medication interruptions during the pandemic. One in two patients reported new events or worsening illness since the start of the pandemic, and sleep disturbances were reported by nearly one in three patients who had epilepsy or headache.

Conclusion

The COVID-19 pandemic’s impacts on patients with neurological illnesses in Jordan were deep and diverse. Meanwhile, the majority of surveyed neurology patients demonstrated a positive attitude towards the pandemic.

The impact of COVID-19 pandemic on frail health systems of low- and middle-income countries: The case of epilepsy in the rural areas of the Bolivian Chaco

INTRODUCTION

The Coronavirus disease 2019 (COVID-19) has put some health systems under pressure, especially in low- and middle-income countries. We aimed at evaluating the impact of COVID-19 emergency on the management of people with epilepsy (PWE) living in the rural communities of the Gran Chaco area of the Plurinational State of Bolivia.

MATERIALS AND METHODS

We selected a sample of PWE living in the rural communities of the Bolivian Chaco. A standardized questionnaire was developed, consisting of six questions addressing drug availability, drug discontinuation, personnel responsible for drug retrieval during the lockdown, and the presence of seizures in the two months preceding the interview. Questionnaires were administered by community health workers of the rural health centers in September 2020.

RESULTS

Seventy PWE (38 men, 54.3%; mean age 26.9 ± 16.7) were interviewed. During the lockdown the large majority of them (n = 51, 73.9%) reported an irregular medication intake mainly due to the lack of antiseizure medications in the local health posts, leading to an increase in seizure frequency.

CONCLUSION

The COVID-19 pandemic has unmasked the frailty of the Bolivian health system, especially for the management of chronic diseases such as epilepsy in the rural communities.