An international group of epilepsy specialists outlined recommendations for healthcare professionals to provide optimal care for patients with epilepsy during the coronvavirus disease 2019 (COVID-19) pandemic. The recommendations were published in Neurology and focus on providing care at-home settings, improving adherence to treatment and maintaining the medications supply.
In light of the COVID-19 pandemic, the experts summarized the available data on the effects of the viral infection on patients with epilepsy and provide some guidance for the patients and for health care providers.
Based on the limited evidence regarding the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the central nervous system, there is some suggestion that the virus may penetrate the blood-brain barrier, worsen respiratory symptoms, and cause neurological complications including seizures.
To date, there are no data indicating that patients with epilepsy are at increased risk for SARS-CoV-2 infection or have more severe forms of COVID-19. However, some patients with autoimmune disorders and epilepsy may be treated with immunosuppressant therapy and may theoretically have a greater complication risk.
The experts provided several recommendations for treating epilepsy during the COVID-19 pandemic. First, it is recommended to administer as much care as possible in at-home setting to reduce the need to visit health care facilities, while establishing an emergency care plan. It is important to educate the patients and their families/caregivers that most tonic-clonic seizures last <3 minutes and do not require emergency medical services or hospital care. Emergency visits are necessary if seizures last >5 minutes or clusters, occur in water, or are followed by abnormal recovery.
Second, it is advised to postpone changes to the medical treatment and ensure a regular supply of antiseizure medications. Third, telehealth services may be used, especially for patients who struggle with significant anxiety.
For newly diagnosed patients, the evaluation is based on careful history and home video, while medical examination, laboratory tests, imaging and diagnostic EEG should be postponed in most cases.
The experts also provided suggestions to people with epilepsy during this pandemic, including reducing the risk for seizure, forming a comprehensive care plan with a potential solution if families or caregivers are not available to assist in an emergency situation. It is important to stress the importance of adherence and maintaining regular medication supply. Furthermore, adequate sleep, routine exercise, healthy eating, and avoiding alcohol and recreational drugs are recommended. Access to telephone advice may alleviate anxiety and concerns.
When fever control is important, such as patients with Dravet syndrome, acetaminophen can be used. There were previous reports suggesting that nonsteroidal anti-inflammatory drugs may be associated with worse outcomes in patients with COVID-19, but the data are limited. Other medications such as pseudoephedrine or diphenhydramine may worsen seizure in those with epilepsy. It is also important to address potential interactions between epilepsy medications and other agents to treat COVID-19.
Potential challenges to epilepsy care providers associated with the pandemic include the inadequacy of health care systems to manage a massive rise in number of COVID-19 patients and the results of lockdown; limited access to telemedicine; and difficulties ensuring appropriate supply of antiseizure medications.
The experts also provide links to useful information for patients and for physicians on the matter.
“These recommendations may help health care professionals provide optimal care to people with epilepsy during the coronavirus pandemic,” wrote the experts.
French JA, Brodie MJ, Caraballo R, et al. Keeping people with epilepsy safe during the COVID-19 pandemic. Neurology. 2020;94(23):1032‐1037. doi:10.1212/WNL.0000000000009632