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Population data, COVID-19 and epilepsy

People with epilepsy have good levels of COVID-19 vaccination and COVID-19 infection is unlikely to cause epilepsy.

Despite the abundance of COVID-19 literature, the interplay between epilepsy and SARS-CoV-2 remains poorly understood.  Recent studies of large population datasets try to shed some light on COVID-19 vaccination uptake rates among people with epilepsy (PWE) and the risk of incident epilepsy following COVID-19 infection. 

Strafford et al., (1) turned to a national healthcare database of 3.1 million people in Wales.  They looked at first, second and booster COVID-19 vaccinations for 25,404 PWE and 127,020 matched controls.  Rates for all three vaccinations were higher among PWE (92.3%, 89.9% and 70.1%) than controls (87.8%, 85.2% and 62.4%).  At odds with this, Kobau and colleagues (2) analysed representative data from the US National Health Interview Survey – estimated to cover almost 247 million people.  Of 241 PWE, 70.1% received a COVID-19 vaccination and 61.0% had two or more vaccinations.  For 21,138 controls without epilepsy, the corresponding figures of 75.3% and 66.5% did not yield statistically significant differences.

From the Swedish system for communicable disease surveillance, Westman et al., (3) identified 1,221,801 people with a positive SARS-CoV-2 lab test and 1,223,312 pre-COVID-19 pandemic controls.  Extracting data from linked national registries, they identified new cases of epilepsy between positive COVID-19 testing and follow-up.  0.05% COVID-19-positive individuals developed epilepsy (62 cases/100,000 patient years) compared to 0.1% COVID-19-negative subjects (56 cases/100,000 patient years).  A Cox regression model found that a positive COVID-19 test was not associated with an increased risk of incident epilepsy on a whole population level (hazard ratio 1.01, 95% CI 0.91-1.12).  When stratified by age group, results were subject to multiple confounders.

From a health records network covering 81 million people (mostly in the US), Taquet et al., (4) looked at data pertaining to 860,934 people and selected two matched cohorts of 152,754 – a primary cohort of lab-confirmed COVID-19 cases and a SARS-CoV-2-negative control group with influenza infection.  The incidence of seizures or epilepsy at six months post-infection was 0.81% for SARS-CoV-2 and 0.51% for influenza. 

Confounding factors and differences in methodological approach make it difficult to draw firm conclusions from these studies.  For example, populations living under different models of healthcare delivery and funding would not be expected to have equal access to SARS-CoV-2 vaccination.  Estimating epilepsy incidence among COVID-19-positive and -negative groups is complicated by variation in follow-up duration, SARS-CoV-2 vaccination status and virus mutations.  In addition, epilepsy misdiagnosis may be more prevalent following COVID-19 infection, as psychogenic non-epileptic seizures may be more likely in this clinical context.

Overall, PWE have broadly similar SARS-CoV-2 vaccination rates to the general population in Wales and the US, and SARS-CoV-2 infection does not appear to be highly pro-epileptogenic. 

Key Points:

  1. Confounding factors and different methodological approaches in population studies pertaining to COVID-19 and epilepsy make it difficult to draw firm conclusions to inform day-to-day clinical practice.
  2. In modern healthcare settings, people with epilepsy seem to have broadly similar COVID-19 vaccination rates as the general population.
  3. Among the general population, COVID-19 infection is unlikely to lead to the development of epilepsy.

References:

  1. COVID-19 vaccination uptake in people with epilepsy in Wales. Straford H, Lacey AS, Hollinghurst J et al. Seizure. 2023. Doi: 10.1016/j.seizure.2023.04.006.  PMID: 37080124.
  2. COVID-19 vaccination status and related process of care outcomes among U.S. adults with active epilepsy--National Health Interview Survey, United States, 2021. Kobau R, Luncheon C, Pastula DN et al. Epilepsy Behav. 2023. Doi: 10.1016/j.yebeh.2023.109223. PMID: 37119577.
  3. Epilepsy diagnosis after Covid-19--A population-wide study. Westman G and Zelano J. Seizure. 2022. Doi: 10.1016/j.seizure.2022.07.005. PMID: 35842976.
  4. Incidence of Epilepsy and Seizures Over the First 6 Months After a COVID19 Diagnosis--A Retrospective Cohort Study. Taquet M, Devinsky O, Cross JH et al. Neurology. 2022. Doi: 10.1212/WNL.0000000000201595. PMID: 36384658. "

Publish on behalf of the Scientific Panel Epilepsy

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