FAQs for Clinicians
In languages other than English
Are my patients with epilepsy at more risk for severe COVID-19 infection?
Limited information from countries with experience of the pandemic (e.g. China, Italy, United States) suggests that individuals with epilepsy are not more likely to be infected by the virus, nor are they more likely to have severe COVID-19 manifestations because they suffer from epilepsy.
High risk individuals remain those with diseases impacting mobility, chronic lung disease, diabetes mellitus, hypertension, severe heart disease, impaired immune function due to underlying conditions or drug treatment, and older age. People with epilepsy may also have any of these conditions.
Is there a risk of exacerbation of seizures in COVID-19 infection?
There may be a risk of worsening in a person with fever due to COVID-19 for certain epilepsy syndromes such as Dravet syndrome, as well as for other epilepsies where seizures are triggered by fever or illness. To date, there are no case reports of worsening of seizures in these groups.
Should any medications be avoided in patients with epilepsy and COVID-19 infection?
Though reports have been circulating about possible increased risk of severe infection associated with use of non-steroidal anti-inflammatory medications. There is little data to support this assertion.
Certain medications used to treat severe infection may be considered contraindicated in epilepsy. This needs to be considered on a case by case basis. Consideration also needs to be given to possible drug interactions with anti-seizure medicines.
See: Antiseizure medication interactions with PaxlovidTM, used in oral treatment of COVID-19
Cokley JA, Gidal BE, Keller JA, Vossler DG. PaxlovidTM Information From U.S. Food & Drug Administration (FDA) and Guidance for AES Members. Epilepsy Currents. April 2022. doi:10.1177/15357597221088415
How can we best protect our patients from COVID-19 infection?
We should try to keep our patients out of hospital and medical offices where possible, administering as much care as possible at home. Ensure that your patients have an emergency care plan, with a clear outline of when and how emergency rescue medications should be used, when they can be repeated, and when emergency room visits are necessary. We should ensure a regular supply of anti-seizure medications for each patient. Telehealth should be utilised where possible. See: Telemedicine for Epilepsy Care in the COVID-19 Era
How can we minimise risk of seizure exacerbation in our patients with epilepsy?
Ensure a regular supply of anti-seizure medications.
A lower threshold may be considered to providing emergency rescue medication, with clear instruction on when this should be used, when it should be repeated, and when attendance at an emergency room is advised.
One major symptom is fatigue, and consequent sleep. Poor appetite combined with this may reduce adherence to medication and in theory trigger seizures
How should I manage patients with drug resistant epilepsy who warrant evaluation for other treatments?
To minimise the risk of infection, most epilepsy programs have discontinued elective procedures – including video EEG telemetry, epilepsy surgery, and VNS insertion/adjustment. Provide general support to these patients, with ongoing advice about medical treatment and investigation/surgery arranged post pandemic once services have returned.
When is an EEG warranted in the current pandemic?
To minimise the risk of infection there are only a few instances where an EEG would be considered as required. Examples may include
- Suspicion of non-convulsive status epilepticus
- Electrical status epilepticus of slow sleep
- Diagnosis of infantile spasms (link to CNS advice on IS, AESNT advice)
- Monitoring of status epilepticus on the ICU
EEG can be postponed for new presentations of seizures, with a diagnosis may be made through careful history-taking.
What general advice should we give our patients with epilepsy?
- Reassure patients and provide basic advice about minimising the likelihood of seizure exacerbation.
- Consider a ‘comprehensive care plan,’ with information about what should happen if families/caregivers are ill or not available.
- Emphasise the importance of medication adherence and maintaining routines
- Provide instructions and assistance about maintaining a regular medication supply. People with epilepsy and their families/caregivers should work to prevent medication shortages and ensure that repeat prescriptions are available.
- Emphasise the importance of adequate sleep where possible, routine exercise, healthy eating, and avoidance of alcohol and recreational drugs, where appropriate. For patients with stimulus-induced ‘reflex’ epilepsies (e.g., photosensitive epilepsy), discuss reducing or eliminating provocative stimuli (e.g., computer games).
- Reassure patients that mental health issues – such as anxiety and depression – may worsen during this stressful time, among both patients and their families. Help can be provided through access to telephone advice, or other resources to manage stress.
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