Impact on Patient Care

Seizures and COVID-19
About a third (30%) of the survey respondents reported a suspected cause for new onset seizures in COVID-19 patients. Most often the mechanism thought to be responsible for the seizures was lowered seizure threshold with preexisting risk factors. Some respondents suspected viral invasion of the central nervous system (CNS) and injury from SARS-CoV-2. Rarely, seizures were attributed to cardiac arrest or stroke that occurred during the illness. Most survey respondents (63%) indicated that the new-onset seizures were mostly focal-onset with or without evolution to bilateral tonic–clonic seizures. Other respondents identified seizures as generalized, electrographic only or unclassifiable almost equally.
One-third of respondents reported that they had PWE in their practice that had been diagnosed with COVID-19. A majority of these PWE had no change in seizure frequency. About 17% of the respondents noted worsening, while none noted an improvement in seizures in PWE with COVID-19.
In PWE who had not been infected with SARS-CoV-2, most respondents did not see a change in seizure frequency in their patients. However, 10% of respondents noted a worsening in seizure frequency, while 5% noted an improvement (Figure 2). Worsening of seizure frequency was attributed to increased stress, sleep deprivation, and reduced access to pharmacies and medications. However, when survey participants were specifically asked if PWE were reporting increased seizures as a result of emotional stress, more than 80% of respondents either disagreed or were neutral or unsure. Conversely, improved seizure control was attributed to better sleep and medication adherence.
Figure 2.  Effects of the COVID-19 pandemic on PWE.

Epilepsy Clinical Care
Concerns have been raised about the quality of care provided to PWE during the COVID-19 pandemic. Forty-three percent of the survey respondents thought that PWE received the expected standard of care during the pandemic, while 34% thought that care was compromised. The remaining 17% were either neutral or unsure.
The majority of respondents felt that there were at least some barriers for PWE in getting appropriate clinical care, testing (including EEG and video EEG monitoring) and elective surgery. The reasons for these barriers were thought to include loss of employment and financial stress, lack of access to health care service due to closure, transportation issues, lack of access to technology for telehealth, and reluctance to seek care due to fear of viral outbreak (Figure 3). Other barriers identified by some respondents were reduced access to specialty pharmacy services for patients with severe epilepsies, loss of insurance leading to lack of medication coverage, loss of behavioral health services, and increase in stress, anxiety, and depression due to the pandemic. Respondents noted that overall, the COVID-19 pandemic has not resulted in a significant change in phone calls from patients to clinics, although both increased and decreased calls were reported in some instances.
Figure 3.  Barriers to care of PWE during COVID-19 pandemic.