Delta, Omicron Infections: Seizures, Brain Fog, Dementia Risk Still High After 2 Years

Article published by Medical News Today

A recent study published in The Lancet sought to examine some long-term psychiatric and neurological problems related to SARS-CoV-2 compared to risks from other respiratory infections.

The researchers first identified nearly 1.2 million patients who had become infected with SARS-CoV-2 between January 20, 2020, and April 13, 2022, and pair matched them with others who had the same vaccination status, age, demographic and risk factors, who had not had COVID-19 but had experienced other respiratory infections.

Next, the authors analyzed the participants’ risk for 14 psychiatric and neurological diagnoses and compared the risk for these disorders to the control cohort. They also looked at how these risks differed before and after waves of infection that were dominated by the Alpha, Delta, and Omicron variants, respectively.

Among adults, there was an increased risk for brain fog, dementia, psychotic disorders, and epilepsy or seizures at the end of the 2-year follow-up.

The researchers further discovered that participants who had been infected with the Delta variant had an increased risk for ischaemic stroke, cognitive deficit, insomnia, anxiety disorders, and epilepsy or seizures when compared to participants who had been infected with the Alpha variant.

These findings emphasize there is a need for further research into the long-term impact of COVID-19.

Epilepsy Research News: August 2022

This issue of Epilepsy Research News includes summaries of articles on:

Impact of the COVID-19 Pandemic on People with Epilepsy: Findings From the US Arm of the COV-E Study

A recent survey of people with epilepsy and their caregivers showed that the COVID-19 pandemic has had negative effects on self-management and mental health for those with epilepsy. Some of the topics covered in the study include timeliness of taking medications, mental health, stress, and discussions with a healthcare provider about sleep, antiseizure medications, and potential side effects. The findings highlight the need for healthcare providers to be more aware of the increased emotional distress in people with epilepsy.
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Ketamine: An Effective Treatment for Neonatal, Pediatric Epilepsy

Treatment with a prescription medication called ketamine significantly reduced seizure occurrence related to refractory status epilepticus in neonates and children, according to results of a new study. In the study, researchers sought to determine the safety and efficacy of ketamine in young patients for this difficult to treat form of epilepsy. Results showed that after ketamine infusion, 32 patients experienced seizure cessation, 19 patients experienced seizure reduction, while there was no change in 18 patients. Three patients had adverse events requiring intervention during or within 12 hours of ketamine administration, including hypertension in two patients and delirium in one patient. “Many children with status epilepticus have persistent seizures despite administration of at least two appropriately dosed antiseizure medications,” stated the study authors. “Ketamine… may be a beneficial alternative.”
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Seizures in Young Stroke Survivors Doubles Dementia Risk

For young stroke survivors, the subsequent development of seizures more than doubles their risk of developing dementia, according to a recently published study. Researchers used the IBM Watson Health MarketScan Commercial Claims and Encounters database to identify 23,680 patients (aged 18 to 60 years) with ischemic strokes or hemorrhagic strokes from 2006 through 2009. The researchers found that young patients with stroke who developed seizures had a greater risk for dementia than those without seizures. The authors noted that “since strokes are occurring in younger people and survival rates are increasing, it is important to understand the long-term effects and determine who is at greatest risk for severe complications like dementia.”
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Age at Epilepsy Diagnosis and EEG can Help Predict Returning Seizures After Stopping Antiseizure Medication

Recent research has identified characteristics that can help predict the likelihood of seizures returning in children who have stopped taking antiseizure medication (ASM) after becoming seizure free. Among the characteristics studied, three were associated with a higher chance of having returning seizures after stopping ASM and included adolescent age at diagnosis, unusual EEG findings after the medication was stopped, and having a high number of seizures while taking medication. This information may be useful to doctors as they consider discontinuing antiseizure medication in their patients.
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A New Technique to Understand Temporal Lobe Epilepsy

A team of researchers used a new technique to find a link between a specific protein in the brain and increased vulnerability to neurodegeneration for individuals with temporal lobe epilepsy. The technique used by the researchers made it possible to study small amounts of tissue from hard-to-reach regions within the brain. Using this new technique, the researchers identified changes in a protein called GluN3 that is associated with cellular damage. The technique allowed the researchers to narrow the focus to specific areas of the brain where neurons are dying. The study author has applied to patent the technique, known as ‘area-specific tissue analysis’. This advanced technique may lead to a new understanding of the causes of epilepsy and therapies to help patients, stated the study author.
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Impact of the COVID-19 Pandemic on People with Epilepsy: Findings From the US Arm of the COV-E Study

Abstract found on Wiley Online Library

Objectives: As part of the COVID-19 and Epilepsy (COV-E) global study, we aimed to understand the impact of COVID-19 on the medical care and well-being of people with epilepsy (PWE) in the United States, based on their perspectives and those of their caregivers.

Methods: Separate surveys designed for PWE and their caregivers were circulated from April 2020 to July 2021; modifications in March 2021 included a question about COVID-19 vaccination status.

Results: We received 788 responses, 71% from PWE (n = 559) and 29% (n=229) from caregivers of persons with epilepsy. A third (n = 308) of respondents reported a change in their health or in the health of the person they care for. Twenty-seven percent (n = 210) reported issues related to worsening mental health. Of respondents taking ASMs (n = 769), 10% (n=?78) reported difficulty taking medications on time, mostly due to stress causing forgetfulness. Less than half of respondents received counseling on mental health and stress. Less than half of the PWE reported having discussions with their healthcare providers about sleep, ASMs and potential side effects, while a larger proportion of caregivers (81%) reported having had discussions with their healthcare providers on the same topics. More PWE and caregivers reported that COVID-19 related measures caused adverse impact on their health in the post-vaccine period than during the pre-vaccine period, citing mental health issues as the primary reason.

Significance: Our findings indicate that the impact of the COVID-19 pandemic in the US on people with epilepsy is multifaceted. Apart from the increased risk of poor COVID-19 outcomes, the pandemic has also had negative effects on mental health and self-management. Healthcare providers must be vigilant for increased emotional distress in PWE during the pandemic and consider the importance of effective counseling to diminish risks related to exacerbated treatment gaps.

Epilepsy Management During Difficult Times

Abstract found on John Libbey Eurotext

Major disruption in the delivery of healthcare services can occur in exceptional situations such as natural disasters, conflicts, periods of severe economic hardship, and epidemics. These disruptions typically affect to the greatest extent the most vulnerable segments of the population, including people with epilepsy. Inability to access healthcare services can lead to failure to undergo necessary diagnostic investigations, or to receive needed therapeutic interventions, including epilepsy surgery. Stress and other factors associated with the nature or the cause of the disruption can adversely affect seizure control status, or precipitate the occurrence of psychiatric disorders and other comorbid conditions. Failure to access antiseizure medications is a common occurrence in these situations and can result in loss of seizure control, withdrawal seizures, and status epilepticus. In this article, we provide examples of recent disruptions in healthcare and their implications for people with epilepsy. We discuss the consequences of natural disasters, conflicts, economic sanctions, and focus in greater detail on lessons learnt during the COVID-19 pandemic. We also discuss possible mitigation procedures, focusing in particular on the application of telemedicine to epilepsy care. Finally, we underline the need for governments, healthcare authorities, and international organizations to improve their preparedness to deal with exceptional situations that may arise in the future.

A Cross-Sectional Study of COVID-19 Vaccination Patterns Among Patients with Epilepsy in Hong Kong

Abstract found on Wiley Online Library

Objective: As Hong Kong faced the 5^th wave of the COVID-19 pandemic, the facilitators and hurdles towards effective vaccination is important for healthcare professionals to understand the vaccination gap among patients with epilepsy.

Methods: A cross-sectional, pragmatic study of COVID-19 vaccination was performed at a tertiary epilepsy centre with regards to patterns of vaccination and any unusually high rate of adverse events. Patients having recent visits at the epilepsy centre (4 months) had their anonymized electronic linkage records examined 12 months after the inception of vaccination program for types of vaccines, seizure demographics, and adverse events following immunization(AEFI).

Results: 200 patients with epilepsy and their anonymized data were analyzed. The vaccine uptake was approximately 60% of that of the general population. Twice as many patients with epilepsy chose to receive mRNA vaccine as compared with inactivated vaccine. The proportion of patients who kept up-to-date with all available dosing was 7%. Patients with epilepsy with genetic aetiology were least likely to receive vaccination (13/38, 34%, p=0.02). There was no unreasonably high rate of unacceptable side effects after vaccination among patients with epilepsy. Only 3 patients reported worsening of seizures without meeting the criteria for AEFI. Refractory epilepsy, allergy to antiseizure medications and elder age (>=65) did not confer any significant difference in vaccination patterns or adverse effects.

Significance: A vaccination gap exists among epilepsy patients which calls for actionable strategies for improving vaccine uptake, including education and outreach programs.

Risk of Hospitalization and Death for COVID-19 in Persons with Epilepsy Over a 20-Month Period: the EpiLink Bologna Cohort, Italy

Abstract found on Wiley Online Libary

Objective: Data on COVID-19 outcomes in persons with epilepsy (PWE) are scarce and inconclusive. We aimed to study the risk of hospitalization and death for COVID-19 in a large cohort of PWE from 01 March 2020 to 31 October 2021.

Methods: Historical cohort design (EpiLink Bologna), comparing adult PWE grouped in people with focal epilepsy (PFE), idiopathic generalized epilepsy (PIGE), developmental and/or epileptic encephalopathy (PDEE), and a matched population cohort (ratio 1:10) for age, sex, residence, and comorbidity (assessed with the multisource comorbidity score), living in the local health trust of Bologna (about 800,000 residents). Clinical data were linked to health administrative data.

Results: In both cohorts (EpiLink N=1,576 subjects, 1128 PFE, 267 PIGE, 148 PDEE, 32 other, controls N=15,326 subjects), 52% were females, and the mean age was 50?years (SD 18). Hospital admissions for COVID-19 in the whole period were 49 (3.1%) in PWE and 225 (1.5%) in controls. The adjusted hazard ratio (aHR) in PWE was 1.9 (95% CI 1.4-2.7). The subgroups at higher risk were PFE (aHR 1.9, 95% CI 1.3-2.8) and PDEE (aHR 3.9, 95% CI 1.7- 8.7), while PIGE had a risk comparable to the controls (aHR 1.1, 95% CI 0.3-3.5). Stratified analyses of the two main epidemic waves (March-May 2020, October 2020–May 2021) disclosed a higher risk of COVID-19-related hospitalization during the first epidemic wave (March-May 2020) (aHR 3.8, 95% CI 2.2-6.7). Polytherapy with antiseizure medications contributed to a higher risk of hospital admission. 30-day risk of death after hospitalization was 14% both in PWE and controls.

Significance: During the first 20 months since the outbreak of COVID-19 in Bologna, PWE had a doubled risk of COVID-19 hospital admission compared to a matched control population. Conversely, epilepsy did not represent a risk factor for COVID-19-related death.

Impact of COVID-19 Pandemic on Epilepsy Care in Japan: A National-Level Multicenter Retrospective Cohort Study

Abstract found on Wiley Online Library

Objective: The impact of the coronavirus disease 2019 (COVID-19) pandemic on epilepsy care across Japan was investigated by conducting a multicenter retrospective cohort study.

Methods: This study included monthly data on the frequency of (1) visits by outpatients with epilepsy, (2) outpatient electroencephalography (EEG) studies, (3) telemedicine for epilepsy, (4) admissions for epilepsy, (5) EEG monitoring, and (6) epilepsy surgery in epilepsy centers and clinics across Japan between January 2019 and December 2020. We defined the primary outcome as epilepsy-center-specific monthly data divided by the 12-month average in 2019 for each facility. We determined whether the COVID-19 pandemic-related factors (such as year [2019 or 2020], COVID-19 cases in each prefecture in the previous month, and the state of emergency) were independently associated with these outcomes.

Results: In 2020, the frequency of outpatient EEG studies (-10.7%, p<0.001) and cases with telemedicine (+2,608%, p=0.031) were affected. The number of COVID-19 cases was an independent associated factor for epilepsy admission (-3.75*10-3% per case, p<0.001) and EEG monitoring (-3.81*10-3% per case, p = 0.004). Further, the state of emergency was an independent factor associated with outpatient with epilepsy (-11.9%, p<0.001), outpatient EEG (-32.3%, p<0.001), telemedicine for epilepsy (+12,915%, p<0.001), epilepsy admissions (-35.3%; p<0.001), EEG monitoring (-24.7%: p<0.001), and epilepsy surgery (-50.3%, p<0.001).

Significance: We demonstrated the significant impact that the COVID-19 pandemic had on epilepsy care. These results support those of previous studies and clarify the effect size of each pandemic-related factor on epilepsy care.

ED Visits for Seizures, Epilepsy Decreased During Pandemic, Especially in Young Children

Article published in Healio

Seizure- and epilepsy-related emergency department visits decreased during the COVID-19 pandemic compared with pre-pandemic levels, with the largest drop seen among young children, per a study in MMWR.

“Seizures generally account for approximately 1% of all emergency department visits,” Sanjeeb Sapkota, MBBS, MPH, of the Center for Global Health at the CDC, and colleagues wrote. “Persons of any age can experience seizures, and outcomes might range from no complications for those with a single seizure to increased risk for injury, comorbidity, impaired quality of life and early mortality for those with epilepsy.”

Seeking to examine trends in weekly seizure- or epilepsy-related ED visits in the United States before and during the COVID-19 pandemic, CDC researchers analyzed data from January 2019 to December 2021 using the National Syndromic Surveillance Program (NSSP), which collects deidentified electronic health record data from EDs and other health care settings.

Results showed that all ED visits, including seizure-related ones, decreased among all age groups and sexes during the pandemic period from April 1 to Dec. 29, 2020, compared with the same period in 2019. The largest decline in seizure-related ED visits, noted as early as February 2020, was observed among children aged 0 to 9 years.

COVID-19 Vaccine in Patients with Dravet Syndrome: Observations and Real-World Experiences

Abstract found on Wiley Online Library

Objectives: Vaccination against SARS-CoV-2 virus is a primary tool to combat the COVID-19 pandemic. However, vaccination is a common seizure trigger in individuals with Dravet syndrome (DS). Information surrounding COVID-19 vaccines side-effects in patients with DS would aid caregivers and providers in decisions for and management of COVID-19 vaccination.

Methods: A survey was emailed to the Dravet Syndrome Foundation’s (DSF) Family Network and posted to the Dravet Parent & Caregiver Support Group on Facebook between May and August 2021. Deidentified information obtained included demographics and vaccination status for individuals with DS. Vaccine type, side effects, preventative measures, and changes in seizure activity following COVID-19 vaccination were recorded. For unvaccinated individuals, caregivers were asked about intent to vaccinate and reasons for their decision.

Results: Of 278 survey responses, 120 represented vaccinated individuals with DS (median age 19.5 years) with 50% reporting no side effects from COVID-19 vaccination. Increased seizures following COVID-19 vaccination were reported in 16 individuals, but none had status epilepticus. Of the 158 individuals who had not received a COVID-19 vaccination, 37 were over the age of 12 (i.e., eligible at time of study) and only six of these caregivers indicated intent to seek vaccination. The remaining 121 responses were caregivers to children under the age of 12, 60 of whom indicated they would not seek COVID-19 vaccination when their child with DS is eligible. Reasons for vaccine-hesitancy were fear of increased seizure activity and concerns about vaccine safety.

Significance: These results indicate COVID-19 vaccination is well-tolerated by individuals with DS. One main reason for vaccine hesitancy was fear of increased seizure activity, which only occurred in 13% of vaccinated individuals and none had status epilepticus. This study provides critical and reassuring insights for caregivers and healthcare providers making decisions about safety of COVID-19 vaccinations for individuals with DS.

A Near-Global Slowing of Background Activity and Epileptic Discharges in Children With Mild to Moderately Symptomatic COVID-19 Infection: An Electro-Neurophysiological Study

Abstract found in PubMed

Background: To assess the functional involvement of the central nervous system (CNS) via quantitative electroencephalography (EEG) analysis in children with mild to moderate COVID-19 infection who were otherwise previously healthy children.

Methods: This prospective, case-control study was conducted between June and September 2020. Sleep EEG records of at least 40 min were planned for children who tested positive for COVID-19 using real-time PCR analysis and within 4-6 months post-recovery. All of the EEG analyses in this study were performed on an Ubuntu 20.04.2 LTS Operating System with the developed software using Python 3.7.6. The quantitative analysis of the epileptic discharges within the EEG records was performed using random forest after elimination of the artifacts with a model training accuracy of 98% for each sample data point. The frequency analysis was performed using the Welch method.

Results: Among the age and sex-matched groups, the global mean frequency was significantly lower among the COVID-19 patients, with a P-value of 0.004. The spike slow-wave and sharp slow-wave indices were significantly higher in the patients when compared to the controls. The mean frequency values were significantly lower in almost all of the electrodes recording the frontal, central, and occipital areas. For the temporal and parietal areas, those significantly low mean frequencies were limited to the right hemisphere.

Conclusion: A near-global involvement of background activity with decreased frequency, in addition to epileptic discharges, was recorded in mild to moderately COVID-19 infected children post-infection.