tetano
Editor, Senior Moderator
Epilepsia
. 2020 Aug 6.
doi: 10.1111/epi.16635. Online ahead of print.
COVID-19 outbreak: The impact of stress on seizures in patients with epilepsy
Shanshan Huang[SUP] 1 [/SUP], Chunmei Wu[SUP] 1 [/SUP], Yuchao Jia[SUP] 1 [/SUP], Guo Li[SUP] 1 [/SUP], Zhou Zhu[SUP] 1 [/SUP], Kai Lu[SUP] 1 [/SUP], Yuyan Yang[SUP] 1 [/SUP], Furong Wang[SUP] 1 [/SUP], Suiqiang Zhu[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: Stress is a known trigger for seizures in patients with epilepsy (PWE). However, the association between stress and seizures has not been thoroughly investigated. In December 2019, an outbreak of coronavirus disease (COVID-19) occurred in Wuhan, Hubei province, China, causing tremendous collateral stress. This study was designed to evaluate the influence of the COVID-19 outbreak on seizures in PWE in the most severely affected area, Wuhan, and its surrounding cities.
Methods: In this single-center, cross-sectional study, PWE were surveyed via online questionnaires between February 23 and March 5, 2020. Collected data included demographic information, epilepsy-related characteristics (seizure type, frequency, antiepileptic drugs [AEDs], and medication management), direct and perceived threat of COVID-19, and changes in seizures during the outbreak. Psychological comorbidities were evaluated by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 items, and Insomnia Severity Index (ISI). Multivariate logistic regression was used to identify precipitants for seizure exacerbation.
Results: We received 362 completed questionnaires after excluding 12 duplicates (response rate = 63.51%). A total of 31 (8.56%) patients had increased seizures during the outbreak. Exposure history to COVID-19 (P = .001), uncontrolled seizure after AED therapy (P = .020), seizure frequency of two or more times per month before the outbreak (P = .005), change of AED regimen during the outbreak (AED reduction, withdrawal, replacement, skipping altogether; P = .002), and worry about the adverse effect of the outbreak on overall seizure-related issues (severity = moderate to critical; P = .038) were risk factors for increased seizures.
Significance: A minority of PWE experienced seizure exacerbation during the outbreak of COVID-19. Stress, uncontrolled seizures, and inappropriate change in AED regimen were associated with increased seizures. Based on these findings, stress might be an independent precipitant for triggering seizures in some PWE.
Keywords: COVID-19; epilepsy; precipitant; seizure exacerbation; stress.
. 2020 Aug 6.
doi: 10.1111/epi.16635. Online ahead of print.
COVID-19 outbreak: The impact of stress on seizures in patients with epilepsy
Shanshan Huang[SUP] 1 [/SUP], Chunmei Wu[SUP] 1 [/SUP], Yuchao Jia[SUP] 1 [/SUP], Guo Li[SUP] 1 [/SUP], Zhou Zhu[SUP] 1 [/SUP], Kai Lu[SUP] 1 [/SUP], Yuyan Yang[SUP] 1 [/SUP], Furong Wang[SUP] 1 [/SUP], Suiqiang Zhu[SUP] 1 [/SUP]
Affiliations
- PMID: 32761900
- DOI: 10.1111/epi.16635
Abstract
Objective: Stress is a known trigger for seizures in patients with epilepsy (PWE). However, the association between stress and seizures has not been thoroughly investigated. In December 2019, an outbreak of coronavirus disease (COVID-19) occurred in Wuhan, Hubei province, China, causing tremendous collateral stress. This study was designed to evaluate the influence of the COVID-19 outbreak on seizures in PWE in the most severely affected area, Wuhan, and its surrounding cities.
Methods: In this single-center, cross-sectional study, PWE were surveyed via online questionnaires between February 23 and March 5, 2020. Collected data included demographic information, epilepsy-related characteristics (seizure type, frequency, antiepileptic drugs [AEDs], and medication management), direct and perceived threat of COVID-19, and changes in seizures during the outbreak. Psychological comorbidities were evaluated by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 items, and Insomnia Severity Index (ISI). Multivariate logistic regression was used to identify precipitants for seizure exacerbation.
Results: We received 362 completed questionnaires after excluding 12 duplicates (response rate = 63.51%). A total of 31 (8.56%) patients had increased seizures during the outbreak. Exposure history to COVID-19 (P = .001), uncontrolled seizure after AED therapy (P = .020), seizure frequency of two or more times per month before the outbreak (P = .005), change of AED regimen during the outbreak (AED reduction, withdrawal, replacement, skipping altogether; P = .002), and worry about the adverse effect of the outbreak on overall seizure-related issues (severity = moderate to critical; P = .038) were risk factors for increased seizures.
Significance: A minority of PWE experienced seizure exacerbation during the outbreak of COVID-19. Stress, uncontrolled seizures, and inappropriate change in AED regimen were associated with increased seizures. Based on these findings, stress might be an independent precipitant for triggering seizures in some PWE.
Keywords: COVID-19; epilepsy; precipitant; seizure exacerbation; stress.