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Debate continues as to whether epilepsy increases the severity of coronavirus

People with epilepsy do not appear to be at a greater risk of getting coronavirus (COVID-19) than anyone else. That said, experts suggest that as many as one in four people with epilepsy experienced more seizures during the height of the pandemic, suggesting that the virus may play a part.

It’s a fair assumption, given that COVID-19 is known to cause neurological (nervous system-related) symptoms in some, including headaches, brain inflammation, delirium, and the loss of taste or smell.

Other studies suggest that epilepsy may increase the risk of severe complications of COVID-19, although the exact cause of this is unclear.

This article will describe the possible risks of COVID-19 in people with epilepsy as well as the impact of COVID-19 on epilepsy and epilepsy treatment. It will also explain how to stay safe from COVID-19 and what to do if you contract the virus.

Epilepsy and COVID-19 Risk

Epilepsy is a group of non-contagious neurological disorders that trigger recurrent seizures. It is caused by the misfiring of nerve cells of the brain due mainly to a genetic abnormality or an injury to the central nervous system (such as from a stroke or head trauma).

COVID-19, in turn, is a contagious disease caused by a virus known as severe acute respiratory syndrome coronavirus (SARS-CoV-2). It is primarily transmitted when people breathe in respiratory droplets or small airborne particles containing the virus.

Though some early studies suggested that people with epilepsy are at greater risk of getting COVID-19, they could not explain how a non-communicable neurological disorder might place a person at greater risk of a communicable respiratory infection.

Much of the evidence gathered since then suggests that it cannot.

One of the largest studies, conducted by researchers in Sweden in 2022, could find no evidence of an association between epilepsy and the risk of getting COVID-19 based on an analysis of 1,221,801 people with a confirmed COVID diagnosis.

A similar study in Korea involving 212,678 participants concluded that epilepsy was neither linked to an increased risk of COVID-19 nor an increased risk of death from COVID-19.

This is not to say that certain individuals with epilepsy might not be at an increased risk. In the end, epilepsy is not a single disease but a neurological abnormality with many possible causes, some of which may predispose you to infection.

By way of example, older age independently increases the risk of getting COVID-19. Adults over 60 account for a high proportion of epilepsy cases due to their higher incidence of strokes. As such, the underlying cause of epilepsy may be related to age, and older age increases the risk of COVID-19.

Epilepsy and COVID-19 Complications

Despite evidence that epilepsy does not increase the risk of getting COVID-19, there are conflicting opinions as to whether epilepsy increases the risk of severe illness if you contract the virus.

The same analysis from Korea concluded that having epilepsy more than doubles your risk of severe complications of COVID-19 (defined as needing mechanical ventilation or an intensive care unit or dying within two months of the diagnosis).

Similar findings were reported in a 2021 review of studies in which epilepsy was said to independently increase the severity of COVID symptoms (although the researchers could not explain why). The study also concluded that epilepsy increases the risk of COVID-related death by around 170%.

But not everyone is convinced. Some public health experts contend there are multiple explanations for these findings and that the risk of severe COVID generally involves multiple overlapping factors.

For instance, certain medications used to treat epilepsy can suppress the immune system, including corticosteroids, adrenocorticotropic hormone (ACTH), and Afinitor (everolimus). These could potentially contribute to susceptibility by undermining a person’s immune defenses.

Statistically, epilepsy is not linked to an increased risk of severe COVID complications compared to other underlying medical conditions such as high blood pressure, obesity, diabetes, and heart disease. Though people with epilepsy may have these conditions, none are inherently linked to epilepsy in any of its forms.

The nonprofit Epilepsy Foundation states that “people with epilepsy are not at a higher risk of getting COVID-19, getting a severe case, or dying of COVID-19” based on the available research.

Changes in CDC Recommendations

 

Early in the pandemic, the Centers for Disease Control and Prevention (CDC) suggested that neurological conditions, including epilepsy, may be risk factors for COVID-19 despite a lack of robust evidence. Epilepsy has since been removed from the CDC advisement.

Epilepsy Complications and COVID-19

Though there remains debate as to whether epilepsy makes COVID worse, the current body of evidence does not suggest that COVID makes epilepsy worse.

Some studies have reported an increase in the frequency of seizures among people with epilepsy during the height of the pandemic. This includes a study from India in which 30.3% of people with epilepsy reported an increase in seizures during the lockdown.

Though other studies have reported similar increases, ranging from 8–35%, it is largely acknowledged that external factors account for a large proportion of these increases.

These include risk factors such as:

  • Anxiety and stress
  • Depression
  • Poor sleep quality
  • Gaps in access to medical care or medication refills
  • Increased alcohol or drug use

It is well known that stress, illness, fatigue, and/or the overuse of alcohol and drugs are common triggers for epileptic seizures. During the COVID lockdowns, all of these were common in people with epilepsy as well as those without.

That said, it is also possible for a seizure to be induced by fever. These types of seizures, known as febrile seizures, are commonly associated with viral infections like COVID-19 and are frequently seen in children with or without epilepsy.

Seizures may also be triggered by COVID-related meningoencephalitis (inflammation of the brain and surrounding tissue), although this is considered rare.

Despite suggestions of an increased risk, seizures are still considered uncommon compared to other possible complications of COVID-19.

Treatments and COVID-19

It is possible that certain COVID-19 medications can interact with certain anti-epileptic drugs (AEDs) that treat epilepsy.

By way of example, Paxlovid (nirmatrelvir/ritonavir), an antiviral drug granted emergency use authorization for the treatment of COVID-19, is one such medication whose action may be reduced if taken with the following AEDs:

  • Aptiom (eslicarbazepine)
  • Banzel (rufinamide)
  • Depakote (valproate)
  • Dilantin (phenytoin)
  • Luminal (phenobarbital)
  • Nembutal (pentobarbital)
  • Sympazan (clobazam)
  • Trileptal (oxcarbazepine)
  • Tegretol (carbamazepine)

Other frontline drugs for treating COVID-19 may also interact with these same AEDs, including Veklury (remdesivir), an intravenous (IV) drug approved for treating hospitalized people with COVID-19.

Dose Adjustment

If you are prescribed treatment for COVID-19, advise your healthcare provider of any drugs you take for epilepsy. In some cases, the dose of the anti-epilepsy drug will need to be temporarily reduced to avoid an interaction.

As previously mentioned, there have also been suggestions that certain immunosuppressant drugs, like corticosteroids and ACTH, may lower your immunity and make you more vulnerable to COVID complications. Even so, there is not much evidence to support the hypothesis.

Discontinuing these drugs may be unnecessary and increase your risk of seizures. Never stop or adjust the dose of your AEDS without first speaking with your healthcare provider.

How to Stay Safe

If you have epilepsy, your need to avoid COVID-19 is no different than anyone else’s. Even if epilepsy doesn’t inherently increase your risk of severe illness or worsening seizures, you may have other underlying medical conditions that do. This includes older age.

Regardless of whether you have epilepsy or not, the first step to avoiding infection is to get the COVID-19 vaccine along with booster shots as recommended by your healthcare provider.

Among the other preventive strategies:

  • Avoid close contact with anyone who is sick.
  • Wash your hands frequently with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains at least 60% alcohol.
  • Wear a face mask if you are at high risk of COVID-19 and the community infection level is medium. When levels are high, everyone should wear a face mask.
  • Cover your mouth and nose with your elbow or a tissue when you cough or sneeze.
  • Avoid touching your eyes, nose, and mouth.

If exposed to COVID-19, the CDC recommends that you wear a high-quality face mask for 10 days and get tested on the fifth day.

If you test positive, stay home for at least five days and isolate yourself from others. You should stay away from work or school until you are free of fever and other symptoms for at least 24 hours without the use of fever-reducing drugs.

Be sure to refill your prescription on time so that you never run out of your anti-epilepsy drugs. If you are feeling stressed or depressed while in isolation, don’t reach for an alcoholic drink because this may increase your risk of seizures. Instead, talk with a friend, your healthcare provider, or an online epilepsy support group.

Summary

Epilepsy is not associated with an increased risk of getting COVID-19. Though some studies suggest that epilepsy may put you at risk of severe complications, the evidence is generally lacking and most research suggests that other factors (including older age and other underlying medical conditions) may play a more significant role.

The same applies to studies suggesting that COVID may lead to more seizures in people with epilepsy. Common triggers like stress, depression, alcohol use, or gaps in medical care are thought to contribute more than the virus itself.

A Word From Verywell

Any illness can potentially trigger a seizure in people with epilepsy, particularly when your immune system is down. If your seizures are more frequent or harder to control, speak with your healthcare provider.

It is possible that an adjustment in your medications or lifestyle can set you right again. And by feeling healthier and stronger, you may be more able to avoid COVID-19 or cope if you get it.

FREQUENTLY ASKED QUESTIONS

  • Can COVID-19 vaccines causes seizures?

    According to the Epilepsy Foundation, any vaccine can trigger a fever, which could theoretically cause a breakthrough seizure (meaning one that occurs while you are on anti-epilepsy drugs). Even so, the risk of this is small, and there is no evidence that the COVID vaccine causes the worsening of epilepsy.

  • Can COVID-19 cause epilepsy?

    COVID-19 has been known to cause new-onset seizures occasionally. Scientists are unsure why this is, although some believe it may be due to a “cytokine storm,” in which inflammatory chemicals overwhelm the body. Even so, these seizures tend to be one-time events. They are not technically considered epilepsy (because epilepsy is characterized by recurrent seizures).

  • COVID-19 has been known to cause neurological (nervous system-related) symptoms in some people, the most common of which include:

    • A loss of taste and smell
    • Headache
    • Fatigue
    • Loss of concentration
    • Nerve pain
    • Sleep problems
    • Dizziness or fainting when rising
    • Depression
      What are the neurological symptoms of COVID-19? 

 

Source: verywellhealth.com, James Myhre, Dennis Sifris, Geetika Gupta

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