Providing the best possible care for epilepsy patients and protecting them from the devastating effects of the COVID-19 pandemic is a health priority. Even though evidence supporting an association between SARS-COVID 2 virus infection and onset of seizures or aggravation of epilepsy is lacking, Kuroda draws our attention to the fact that some subgroups of people with epilepsy (PwE), (e.g. those with comorbidities, refractory syndromes such as Dravet syndrome or taking immunosuppressants) may be more vulnerable to contract the infection and develop a more severe disease course (Kuroda, 2020).
A number of solutions pointed out by a consensus statement (French et al., 2020) and a review (Kuroda, 2020) can be adopted to support PwE in these difficult times, and to avoid unnecessary hospital visits that could expose them to the risk of contracting SARS-COVID 2 virus infection. Dissemination of reliable information through multiple channels can help to overcome anxiety experienced by patients and carers. Strategies for increasing drug adherence, maintaining a regular supply of antiseizure medicine (ASMs), avoiding ASM withdrawal and changes, and avoiding recognised seizure triggers can minimize the seizure risk. In selected patients, a lower threshold for prescribing rescue medication as part of an emergency care plan may reduce avoidable hospital and ICU admissions. Elective procedures should be postponed, but patients with severe or progressive conditions should be evaluated on a case by case approach. If safe to do so, utilising telemedicine, and postponing medical examinations and laboratory tests is preferable in the short-term. Whenever clinical investigations, such as therapeutic drug levels, EEG or MRI studies cannot be deferred, using outpatient facilities and taking additional protective measures to avoid infection spread, especially in patients with suspected status epilepticus, is strongly recommended.
Kinney et al. provide thorough guidance on the management of status epilepticus (SE) during the COVID-19 pandemic (Kinney et al., 2020). Measures to prevent SE, to establish an accurate diagnosis in a timely manner and to prevent the need for ICU admission would reduce the volume of referrals to and time spent in ICU. Although most ICUs are overwhelmed with COVID-19 patients, SE cases should be considered for ICU care on an equal basis. Following admission to ICU, efforts to wean sedation should be initiated as soon as possible. If SE occurs in conjunction with COVID-19, ASMs and antiviral interactions should be taken into account, and appropriate monitoring initiated. Should the use of extracorporal membrane oxygenation (ECMO) and/or haemodialysis become inevitable, ASM levels should be monitored.
In conclusion, the effects of COVID-19 on PwE remains unclear, and further research and data collection are urgently needed.
Key points:
- Providing the best possible care for people with epilepsy (PwE) and protecting them from the devastating effects of COVID-19 pandemic is a health priority.
- There are no proven associations between COVID-19 and development of epilepsy, although some PwE may be more vulnerable to viral infection due to comorbidities, complex syndromes or immunosuppressant treatment regimens.
- Avoiding unnecessary hospital visits, maintaining good seizure control and administering epilepsy care at home or by telemedicine when appropriate is pivotal.
- Elective procedures may be postponed; patients affected by severe or progressive conditions should be evaluated with an individualised approach.
- Treatment of epilepsy and status epilepticus in PwE with COVID-19 should be tailored to the needs of each patient, with specific attention paid to drug-antiseizure medicine interactions and side effects.
References:
French JA, Brodie MJ, Caraballo R, Devinsky O, Ding D, Jehi L, et al. Keeping people with epilepsy safe during the Covid-19 pandemic. Neurology. 2020 Apr 23;10.1212/WNL.0000000000009632.
Kuroda N. Epilepsy and COVID-19: Associations and important considerations. Epilepsy Behav. 2020; 10.1016/j.yebeh.2020.107122
Kinney MO, Brigo F, Kaplan PW. Optimizing status Epilepticus care during the COVID-19 pandemic. Epilepsy Behav. 2020; 10.1016/j.yebeh.2020.107124