Epilepsy care during COVID-19

Are people with epilepsy more predisposed (vice versa) to COVID-19?

Epilepsy is a “family” of many different disorders that lead to seizures. 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. In addition, the effects of COVID-19 on epilepsy are unclear. It is likely that COVID-19 may cause fever in patients with epilepsy, and this fever may in turn trigger seizures.

For people with epilepsy, what factors may increase the risk of serious problems from COVID-19?
People with epilepsy may also have other health conditions and treatments may put them at higher risk from COVID-19.
•   Medications: Taking medicines to control seizures also affect immune system. Neurological issues sometimes affect immunity. People in these situations are at greater risk of developing more severe symptoms with viral illnesses.
•   Other neurological conditions: People with epilepsy may have other medical problems that could place them at higher risk of developing more severe symptoms with COVID-19.
•   Other health conditions:

• People who have problems swallowing or frequently inhale food or liquids into their lungs (aspiration) are at higher risk for pneumonia.
• Diabetes, heart or lung problems may increase your risk for severe COVID-19

Recommendations by Physicians to People with Epilepsy during Covid-19
•   The importance of adherence and maintaining routines should be emphasized. Use of pillboxes, cell phone alarms may be helpful, especially if the individual with epilepsy is separated from their caregivers/family member, who may be ill and were helping to administer medication.
•   Instructions should be given to maintain a regular medication supply. People with epilepsy and their families/caregivers should work to prevent medication shortages and ensure that repeat prescriptions are available.
•   General advice should be given to ensure adequate sleep where possible and engage in routine exercise, healthy eating, and avoidance of alcohol where appropriate. For those with stimulus-induced reflex epilepsies (photosensitive epilepsy), discussion of reducing or eliminating provocative stimuli may be warranted.
•   Mental health issues, already common among individuals with epilepsy, and families in general, may be exacerbated; reassurance that this is to be expected, with access to telephone advice, may alleviate anxiety.
•   For newly diagnosed patients, evaluation is based on careful history and home video, while medical examination, laboratory tests and diagnostic EEG should be postponed in most cases.

Physicians should be reassured that in the absence of risk factors, including older age, immobility, coexistent respiratory disease, diabetes mellitus, hypertension, severe heart disease, or immunosuppression, people with epilepsy are not at a higher risk. It is prudent, however, for them to remain isolated from contacts and symptomatic individuals where possible.

Disclaimer: The views, suggestions and opinions expressed here are the sole responsibility of the experts. No Forbes India journalist was involved in the writing and production of this article.