Impact on Clinical Practice

Barriers to Providing Care
A range of barriers were reported in providing care during the pandemic. Most frequently noted were limited access to in-person visits and nonemergency testing reported by 74% and 66% of respondents, respectively. Provider fear related to the outbreak and concern for their own well-being was reported by nearly 30%, while lack of personal protective equipment (PPE) and financial considerations were reported by 25% of respondents. Technological problems for telehealth visits were noted in only 15% of respondents. Only 7% of respondents experienced no barriers in providing patient care during the pandemic. One respondent noted that between the pandemic and Centers for Medicare and Medicaid Services (CMS) cutbacks on EEG reimbursement, continuing practice appeared difficult.
Respondents also cited the following additional practice-related barriers to providing care: prioritization of COVID over nonurgent care; suspensions of epilepsy monitoring units (EMUs), vagus nerve stimulator implantations, and presurgical evaluation and surgery; reopening logistics; staff cuts; and clinic staffing (eg, childcare challenges and fear of exposure to COVID). Regarding when respondents expected to return services to pre-COVID-19 levels, the answers formed a normally distributed Bell-shaped curve between now and never, centered at approximately 6 months. Only 9% of respondents were not sure. Approximately 5% did not feel their practice would ever return to normal.

Neurophysiologic Evaluations
About half of respondents (47%) reported that EEGs were discouraged for patients admitted to the hospital with COVID-19 or those suspected of having the infection. Even without restrictions, nearly a quarter (22%) reported they were doing fewer studies than usual (Figure 4). About 9% responded they were no longer doing continuous video-EEG monitoring. In the write in comments, many respondents noted that their EMUs had closed. Very few respondents (2%) reported that they were doing more EEGs than usual; of this group, 5 were from institutions where there were no restrictions for performing EEGs during the COVID-19 pandemic.
Figure 4.  Inpatient EEG utilization during COVID-19 pandemic.

Medication Interactions or Shortages
Almost no respondents had seen unusual interactions between anti-seizure medications (ASM) and medications used to treat COVID-19. Medications shortages were noted by approximately 44% of respondents (Figure 5). In write-in comments, the most frequently noted shortages were of extended release levetiracetam and midazolam, and other shortages of several IV benzodiazepines were noted by some respondents. However, it appears some of these shortages existed from prior to the pandemic. By and large, there appeared to be no consistent pattern of shortages of conventional ASMs directly attributable to the pandemic. The majority of shortage reports originated from patients; IV anesthetic shortages were reported by inpatient pharmacies.
Figure 5.  Medication shortages during COVID-19 pandemic.

Impact on Trainees
Trainees (residents and fellows) responded in low numbers and noted that the pandemic has harmed their educational experience. They cited reduced patient volumes and canceled clinics as responsible factors. Furthermore, the cancelling of interprofessional conferences and educational meetings limited learning and networking opportunities outside the home institution as well as the opportunity to present academic work.