Seizure Exacerbation Not Observed in People With Epilepsy and COVID-19

Data from a recent study suggest that there is a low risk of seizure exacerbation in people with epilepsy infected with COVID-19.

Investigators did not identify any risk factors for contracting COVID-19 in their heterogenous population of people with epilepsy. All participants in the study had a mild or moderate course of infection. Fever, fatigue, headaches, muscle aches, and loss of smell and/or taste were the most common symptoms.

“Patients with chronic disorders seem to be at higher risk of COVID-19 and the severe course of the disease. Epilepsy is the one of the most prevalent chronic neurological conditions and PWE [people with epilepsy] are likely to have somatic and psychiatric comorbidities, thus subject with epilepsy may be more predisposed both to COVID-19 and its more severe course,” wrote first author Magdalena Bosak, MD, PhD, department of neurology, Jagiellonian University Medical College, Krakow, Poland, and colleagues.

Bosak and colleagues analyzed survey data from 252 people with epilepsy that were treated at the Jagiellonian University epilepsy clinic. Participants had a median age of 33 years (range, 27-42) and 154 (61.1%) were women. Most had focal epilepsy (n = 189; 75.0%), followed by generalized epilepsy (n = 46; 18.2%) or a mixed or unknown type of epilepsy (n = 17; 6.8%). Sixty six (26.2%) participants had physical and/or intellectual disability and one third of the cohort had at least 1 comorbid condition.

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The most commonly prescribed antiseizure medications (ASM) were levetiracetam (LEV), valproate, and lamotrigine. Most patients (n = 129; 51.2%) were treated by polytherapy, with 121 (48.0%) having 1 treatment failure, 83 patients (32.9%) having 2 treatment failures, 39 patients (15.5%) having 3, and 7 (2.8%) having 4 to 5 treatment failures. Only 2 patients had no history of treatment failure. 

Of these participants, 17 (6.7%) had definite COVID-19 and 14 (5.5%) had probable COVID-19. Notably, the proportion of people with epilepsy and definite COVID-19 was higher than the proportion of people with COVID-19 in the general population (3.65%).

COVID-19 symptoms continued for approximately 7 to 21 days, except for loss of smell/taste which usually lasted several weeks. Seizure exacerbation was noted in 1 pregnant patient with confirmed COVID-19 who was seizure-free until the 33rd week of pregnancy and then experienced 4 tonic-clonic seizures within 2 weeks after a positive reverse transcription polymerase chain reaction test. Investigators noted that it was likely related to decreased serum level of levetiracetam in the third trimester; levetiracetam dosage was increased with subsequent seizure-freedom and she delivered a healthy daughter at term.

“The results of our study are consistent with available reports suggesting that seizures in PWE are infrequently worsened by COVID-19. We noted seizure exacerbation in only 1 out of 17 patients with confirmed COVID-19... We were not able to identify any risk factors for contracting COVID-19. It may be related to a relatively small number of studied subjects... Similar to other studies, a majority of patients reported limited access to health care during the pandemic,” Bosak and colleagues wrote.

The researchers analyzed subgroups of age, sex, age at onset of epilepsy, epilepsy type, seizure frequency, pharmacotherapy, physical or intellectual disability, comorbidities, and employment status, but no significant differences were found. Regression models did not reveal any significant predictor of COVID-19 in the studied cohort.

Most participants (n = 178; 70.6%) reported limited access to health services during the pandemic. These issues pertained to difficulty in obtaining ASMs (n = 92; 36.5%), limited access to general practice services (n = 81; 32.1%), specialist consultations (n = 60; 23.8%), or diagnostic studies (n = 24; 9.5%)

“Patients with epilepsy may be at increased risk of COVID-19, but the risk of seizure exacerbation in PWE during the course of COVID-19 is low. Epilepsy characteristics are not likely to modify the risk of COVID-19. Future studies are needed to investigate the prevalence and risk factors for SARS-CoV-2 infection in PWE,” Bosak and colleagues concluded.

REFERENCE

Bosak M, Mazurkiewicz I, Wężyk K, Słowika A, Turaj W. COVID-19 among patients with epilepsy: Risk factors and course of the disease. Epilepsy Behav. 2021:120 (107996). doi: 10.1016/j.yebeh.2021.107996