Epilepsy during COVID-19

Coronavirus or COVID-19 has affected many people around the world and is now a major global health threat. The impact of the new coronavirus on various organs is not fully understood. Until a definitive and approved cure or vaccine is found, a better understanding of the Covid-19 mechanism leading to organs failure would help to identify strategies and/or therapeutically treatment options for the infection. The virus can cause complicated disorders in the nervous system, such as seizures and epilepsy. The destructive effects of Covid-19 in the central nervous system are mainly caused by a cytokine storm produced by either the entry of pro-inflammatory cytokines from the periphery into the CNS or the production of these cytokines by activated microglia. Secondary seizures may be initiated after strokes, electrolyte imbalance, increased oxidative stress, and mitochondrial dysfunction in Covid-19 patients.

Factors May Increase Risk from COVID-19 for Person with Epilepsy
Regardless of seizure control, some people may have other health conditions that put them at higher risk from COVID-19. They may be taking medicines to control seizures that also affect their immune system. It is important to note that most seizure medicines do not affect the immune system. Other neurological or developmental issues can affect immunity. People in these situations are at greater risk of developing more severe symptoms with viral illnesses. Other medical problems could place someone at higher risk of developing more severe symptoms with COVID-19, such as those with:

• Problems swallowing or frequently inhaling food or liquids into their lungs (higher risk for pneumonia).
• Diabetes or underlying heart or lung problems.
• Intellectual and developmental disabilities.

What to Do When Seizure Occur in COVID-19 Time?
If one has never had a seizure before in their lives, it is obviously imperative that they consult a neurologist, urgently and undergo relevant investigations as advised. As most routine clinics are cancelled, the emergency room of a hospital may be a better point of access at this time. However, for people with pre-existent epilepsy, a single seizure is no reason for panic. Call your usual doctor and discuss what you can do to manage your epilepsy better and follow your doctor’s advice.

Avoid visiting clinics and hospitals for single breakthrough seizures unless you feel it is absolutely necessary. However, if seizures cluster together, or indeed a person suffers continuous seizures with no recovery of consciousness in-between, what is called “status epilepticus”, it must be treated as an emergency.

Management of Seizure in Emergency Department
Emergency departments may be busy due to COVID-19, and may have people waiting who have symptoms of COVID-19. However, the advice is to try and avoid the emergency department if you can. It is worth making sure you are clear about when and where you should visit an emergency room with your medical team. Some patients have emergency rescue medication at home and should be clear about when it should be used, and when to go to the emergency room should it fail. Most tonic-clonic seizures (seizures with convulsive activity) last under 2-3 minutes, and do not require any type of emergency medical services or special hospital care.

However, medical/hospital care may be required in case:

• If tonic-clonic seizures last more than 5 minutes or occur in clusters with no rescue medication available,
• If seizures occur in water (baths, swimming),
• If seizures are followed by unusually prolonged postictal symptoms (e.g. confusion after a seizure) or abnormal recovery
• If seizures cause potentially dangerous injury

Approach to Prevent Epilepsy during COVID-19 Time

• People with epilepsy are advised to stock up adequately on their anti-epileptic drugs, as even missing a single dose can cause a breakthrough seizure for some.
• Sleep deprivation is another risk factor for people with epilepsy; adequate rest and sleep are therefore very important.
• Good sleep hygiene: making oneself clean and comfortable before going to bed, making the temperature and lighting in the room ambient and suitable to the extent possible.
• The best way to prevent the small risk of breakthrough or new seizures related to the coronavirus is to avoid exposure to COVID-19 by washing your hands frequently, wearing a mask, and practicing social distancing.

Summary
Seizures may be a rare neurological symptom that can occur during SARS-CoV-2 infection or after COVID-19 recovery. People living with epilepsy do not have an increased risk of SARS-CoV-2 infection or complications of COVID-19. Health experts advise that individuals receive the vaccine and continue taking their anti-seizure medication. For all other people with epilepsy, the principles of social distancing, avoiding unnecessary contact with people outside one’s immediate family, or indeed taking due care around anyone who is symptomatic of COVID, is adequate.

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