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

Giovanni Assenza

Jacopo Lanzone

Francesco Brigo

Antonietta Coppola

^{Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy}

^{Division of Neurology, “Franz Tappeiner” Hospital, Merano, Italy}

^{Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy}

^{Epilepsy Surgery Center, IRCCS NEUROMED, Pozzilli, Italy}

^{Sleep Medicine Center, IRCCS NEUROMED, Pozzilli, Italy}

^{Department of Human Neurosciences, “Sapienza” University of Rome, Rome, Italy}

Edited by: Rodrigo Rocamora, Pompeu Fabra University, Spain

Reviewed by: Estevo Santamarina, Vall D'Hebron University Hospital, Spain; Mariusz Stanisław Wiglusz, Medical University of Gdansk, Poland

*Correspondence: Giovanni Assenza ti.supmacinu@aznessa.g

This article was submitted to Epilepsy, a section of the journal Frontiers in Neurology

†ORCID: Giovanni Assenza orcid.org/0000-0002-6160-4348

Edited by: Rodrigo Rocamora, Pompeu Fabra University, Spain

Reviewed by: Estevo Santamarina, Vall D'Hebron University Hospital, Spain; Mariusz Stanisław Wiglusz, Medical University of Gdansk, Poland

Received 2020 Apr 28; Accepted 2020 Jun 16.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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: epilepsy, COVID-19, sleep, depression, anxiety

Abstract

Acknowledgments

The authors would give their great thanks to Prof. Amedeo Bianchi, President of the LICE Foundation, for authorizing the publication of the survey contained in this manuscript on the Facebook web page of the LICE Foundation.

Acknowledgments

Click here for additional data file.^{(14K, docx)}

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