Epilepsy Care in the Time of COVID-19 Pandemic in Italy: Risk Factors for Seizure Worsening

Abstract

Objective: In early 2020, Italy struggled with an unprecedented health emergency related to the COVID-19 pandemic. Medical care of chronic neurological diseases, such as epilepsy, is being sorely neglected. In this national survey, we aimed at understanding the impact of COVID-19 lockdown on the care of people with epilepsy (PwE) and identifying PwE risk factors for seizure worsening to direct telemedicine efforts. Methods: We administered a 48-items online survey (published on April 11, 2020) including socio-demographic, epilepsy-related, and psychometric variables (BDI-II for depression, GAD-7 for anxiety, and PSQI for sleep) to PwE and people without epilepsy (PwoE). Regression analysis identified predictors of seizure worsening. Results: We collected responses from 456 PwE (344 females) and 472 PwoE (347 females). Outpatient examinations of PwE were postponed in 95% of cases. One-third of PwE complained of issues with epilepsy management, but only 71% of them reached the treating physician and solved their problems. PwE had worse depressive and anxiety symptoms (higher BDI-II and GAD-7 scores; p < 0.001) than PwoE. Sleep quality was equally compromised in both groups (47 and 42%). Sixty-seven PwE (18%) reported seizure worsening, which was best explained by the number of anti-seizure medications (ASM) of chronic therapy and the severity of sleep disorder. Conclusions: During the current COVID-19 pandemic, a significant percentage of PwE experienced difficulties in follow-up and a seizure number increase, in particular those chronically taking more ASMs and with poor sleep quality. This dramatic experience outlines the urgent need for validation and implementation of telemedicine services for epileptic patients in order to provide regular follow-up.

Keywords: COVID-19; anxiety; depression; epilepsy; sleep.

Figure 1

Clinical variables in people with epilepsy according to seizure worsening during the COVID-19 pandemic. The figure displays a paired plot that highlights differences between PwE who experienced worsening (Orange) and those who did not (Blue). WPwE, Worsened People with Epilepsy; nWPwE, non-Worsened People with Epilepsy; ASM, Anti-Seizure Medications; GAD, Generalized Anxiety Disorder 7; PSQI, Pittsburgh Sleep Quality Index; BDI, Beck Depression Inventory; Sex (0 = Female,1 = Male); Seizures (Percentage increase/decrease in seizure frequency compared to previous months).

Figure 2

Epilepsy-related issues during the COVID-19 pandemic. Among the whole PwE sample, 169 (37%, in this figure) persons reported negative issues related to the management of epilepsy (left). Attempt to contact treating neurologist (right up): 120 (71%) out of 169 PwE managed to reach their neurologist, and all of them solved their problem thanks to the advice given by the treating physician. Types of issues they were concerned about (right down): 68 PwE (40%) had problems with ASM availability, 20 PwE (12%) had to increase their therapy, 6 (3%) experienced ASM-related adverse effects, and 75 (44%) had anxiety/mood problems.

Figure 3

(A) Correlations among psychiatric scales for depression (BDI), anxiety (GAD7), and sleep (PSQI), and logistic regression for seizure worsening in PwE. Illustrates the relationship among psychometric (PSQI, GAD, BDI) tests in people with epilepsy; subjects that underwent worsening (WPwE) are color-coded (red). In the 3D plot, it can be noted that WPwE tend to fall within a widespread cluster of subjects with more impairment, while there is a dense cluster of subjects with normal tests that do not report worsening. (B) In order to evaluate which psychometric test and variable did independently influence the likelihood of worsening, we designed a logistic regression model that identified the number of ASMs and the PSQI score as significant predictors. We show the increase in the likelihood of worsening for each score of PSQI and for each number of ASMs. WPwE, Worsened People with Epilepsy; nWPwE, non-Worsened People with Epilepsy; ASM, Anti-Seizure Medications; GAD, Generalized Anxiety Disorder 7; PSQI, Pittsburgh Sleep Quality Index; BDI, Beck Depression Inventory.