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Individuals with epilepsy were not at an increased risk of COVID-19 susceptibility or death, but COVID-19 patients with epilepsy were at higher risk for severe complications, according to a study published in Neurology on March 25.

“Mortality in epileptic patients is higher than in the general population, which may be due to comorbidities such as head trauma or stroke,” wrote lead investigator Joonsang Yoo, MD, of the department of neurology at Yongin Severance Hospital and Yongsei University College of Medicine, Yongin-si, Korea, and colleagues. “Furthermore, infectious diseases like pneumonia are associated with poor prognosis and mortality in patients with epilepsy…However, studies on epilepsy and COVID-19 remain still limited.”

To determine the risks for those with epilepsy, the researchers analyzed data from a nationwide COVID-19 dataset in South Korea. The study cohort consisted of 212,678 participants over 20 years old with at least one SARS-CoV-2 test done between January 1 and June 4, 2020. Of these participants, 3,919 were diagnosed with epilepsy prior to the pandemic and 7,713 were positive for COVID-19. Seventy-two of those diagnosed with a confirmed COVID-19 infection had a history of epilepsy.

The researchers defined severe complications with COVID-19 as the use of mechanical ventilation, intensive care unit admission, and death within two months after COVID-19 diagnosis.

Overall, the researchers found no significant difference in COVID-19 positivity or mortality of those with epilepsy compared to those without epilepsy.

Severe complications occurred in 5.8 percent of those with COVID-19, however. Propensity  score matching (PSM) showed that epilepsy was associated with occurrence of severe complications after COVID-19 infection (odds ratio: 2.05).

In a secondary outcome analysis for individual complications after COVID-19 diagnosis with the PSM cohort, having epilepsy was associated with mechanical ventilation (odd ratio: 3.22) and ICU admission (odds ratio: 3.51).

In the unmatched cohort, severe complications and mortality following COVID-19 were more frequently noted in individuals with epilepsy (p< 0.001 for severe complications and p= 0.001 for mortality).

“The causes of more serious complications in patients with epilepsy who are infected with COVID-19 are yet to be elucidated,” the study authors wrote. “One possibility is an association with epilepsy comorbidities. Many patients with epilepsy have one or more other medical problems. Although our study adjusted for some comorbidities using PSM, unknown comorbidities may contribute to worsening symptoms when patients become infected with COVID-19.”

The researchers noted that, among other factors accounting for this association, antiseizure drugs could interact with COVID-19 treatment and reduce its effectiveness, or the status epilepticus may increase due to more systemic inflammation from COVID-19 infection.

In addition, they added, when complications related to epilepsy occurred, it is possible the appropriate treatment was not administered in a timely manner due to limited medical resources, or the pandemic affected overall access to care for epilepsy patients.

The study authors concluded that the increased risk of severe complications for those with epilepsy indicated the need for careful management and monitoring.

Limitations of the study include the lack of detailed information on the severity of epilepsy within the study cohort, the study was conducted in the early stages of the pandemic, and the ethnicity of the dataset only included the Korean general population.

 

SOURCE: journals.lww.com, Stephanie Specht

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