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. 2022 May 10;98(19):e1893-e1901.
doi: 10.1212/WNL.0000000000200285. Epub 2022 Mar 15.

Impact of the COVID-19 Pandemic on Epilepsy Center Practice in the United States

Stephanie M Ahrens  1 , Adam P Ostendorf  1 , Fred Alexander Lado  1 , Susan T Arnold  1 , Shasha Bai  1 , Meriem K Bensalem-Owen  1 , Kevin E Chapman  1 , Dave F Clarke  1 , Mariah Eisner  1 , Nathan B Fountain  1 , Johanna M Gray  1 , Muhammed Talha Gunduz  1 , Jennifer L Hopp  1 , Ellen Riker  1 , Stephan U Schuele  1 , Barbara Small  1 , Susan T Herman  1
Affiliations

Impact of the COVID-19 Pandemic on Epilepsy Center Practice in the United States

Stephanie M Ahrens et al. Neurology. .

Abstract

Background and objectives: Persons with epilepsy, especially those with drug resistant epilepsy (DRE), may benefit from inpatient services such as admission to the epilepsy monitoring unit (EMU) and epilepsy surgery. The COVID-19 pandemic caused reductions in these services within the US during 2020. This article highlights changes in resources, admissions, and procedures among epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC).

Methods: We compared data reported in 2019, prior to the COVID-19 pandemic, and 2020 from all 260 level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level, center population category, and geographical location. Qualitative responses from center directors to questions regarding the impact from COVID-19 were summarized utilizing thematic analysis. Responses from the NAEC center annual reports as well as a supplemental COVID-19 survey were included.

Results: EMU admissions declined 23% (-21,515) in 2020, with largest median reductions in level 3 centers [-55 admissions (-44%)] and adult centers [-57 admissions (-39%)]. The drop in admissions was more substantial in the East North Central, East South Central, Mid Atlantic, and New England US Census divisions. Survey respondents attributed reduced admissions to re-assigning EMU beds, restrictions on elective admissions, reduced staffing, and patient reluctance for elective admission. Treatment surgeries declined by 371 cases (5.7%), with the largest reduction occurring in VNS implantations [-486 cases (-19%)] and temporal lobectomies [-227 cases (-16%)]. All other procedure volumes increased, including a 35% (54 cases) increase in corpus callosotomies.

Discussion: In the US, access to care for persons with epilepsy declined during the COVID-19 pandemic in 2020. Adult patients, those relying on level 3 centers for care, and many persons in the eastern half of the US were most affected.

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Figures

Figure 1
Figure 1. Changes in Aggregate Admissions by US Census Division From 2019 to 2020
NE = Northeast.
Figure 2
Figure 2. Changes in Epilepsy Monitoring Unit Admissions and Total Procedures by NAEC Level or Patient Population
Changes in epilepsy monitoring unit (EMU) admissions (A) and total procedures (B) displayed by National Association of Epilepsy Center (NAEC) level or patient population. Violin plots by center level and overlaid box plots with median and interquartile range also show the smoothed density at different values. These plots include values of zero, as reported by the respondents.
See this image and copyright information in PMC

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