Epilepsy and COVID-19

Is epilepsy a risk factor for COVID-19?

Epilepsy is a disease characterized by the spontaneous recurrence of unprovoked seizures and is one of the most common chronic neurological conditions.¹

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a virus that enters the cells through a receptor found in many organs, including the brain.² The virus can bring about a wide range of symptoms, spanning from mild (fever, cough, muscle aches) to moderate (pneumonia) to severe and critical forms that can be fatal.³

It is known that certain medical conditions may pose an increased risk of progression to severe COVID-19. These include:⁴

• respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD)
• cerebrovascular disease
• chronic kidney disease
• diabetes (type 1 and type 2)
• mental–health-related conditions such as mood disturbances, including depression
• neurological conditions such as dementia

Where does epilepsy fit into this picture?

If you fear that having epilepsy puts you at greater risk of COVID-19 infection, you should know that in persons with epilepsy COVID-19 tends to be less severe than in those with other neurological diseases such as dementia, cerebrovascular disease or multiple sclerosis.²

However, about 50% of adults with active epilepsy have at least one comorbidity, that is, an additional condition occurring during the course of their epilepsy.⁵

The comorbidities of epilepsy have a substantial impact on the life of a person with epilepsy.⁵ In fact, some conditions are up to eight times more common in people with epilepsy than in the general population. These include:⁵

• depression
• anxiety
• dementia
• migraine headaches
• heart disease
• peptic ulcer

So, while it is true that epilepsy alone may not be a risk factor for susceptibility to COVID-19 infection, there is evidence that persons with epilepsy more often have serious complications of COVID-19 than those without epilepsy.⁶ Although the causes of this higher frequency have yet to be fully elucidated, a possible explanation may be found in the association between epilepsy and its comorbidities.⁶ Therefore, persons with epilepsy are considered vulnerable and have been listed as a priority group in the COVID-19 vaccination campaign.⁷

The impact of the COVID-19 pandemic on people with epilepsy

The COVID-19 pandemic affected the management of numerous chronic diseases such as cancer, diabetes and cardiovascular disease.⁸ In Italy, the health emergency placed an unprecedented burden on the health care system: rapid reorganization coupled with lockdown measures resulted in limited care services for all non-emergency conditions, including chronic neurological diseases.⁹

In addition, it is important to remember that people with epilepsy are vulnerable to disorders pertaining to the mental health sphere, and that the vast amount of information circulating during the pandemic, often reporting fatal events, fostered increased anxiety, depression and stress as well as feelings of fear.⁸

The pandemic may also have affected the frequency of seizures, with determining factors being⁹

• the severity of epilepsy
• concomitant disability
• depression and anxiety
• new-onset sleep alterations
• limited access to health care facilities

Therefore, the pandemic had an impact on people with epilepsy in terms of

• access to health care services
• mental health
• frequency of seizures

If you have epilepsy or are a family member or caregiver of a person with epilepsy, it is important that you receive adequate information both on how to prevent COVID-19 infection and on the relationship between epilepsy and COVID-19, in order to limit the buildup of unnecessary anxiety and stress.¹ While the internet and social media are easily accessible sources of information, especially during isolation, these mediums can nevertheless be vehicles for false or misleading news. It is important to refer to authoritative sources for correct information to avoid reactions that are potentially harmful to your health. Consult with your doctor if you have any doubts or need further advice.¹