The effect of epilepsy on coronavirus disease 2019 (COVID-19), and vice versa, have been little explored. In a brief communication published in Epilepsy and Behavior, Naoto Kuroda, MD, from Wayne State University, provided information about the associations between, and the considerations for, COVID-19 and epilepsy.

While associations between COVID-19 and epilepsy have not been reported, the Centers for Disease Control and Prevention indicate that epilepsy, among other neurological comorbidities, may be a risk factor for the disease. This is in direct contrast to current medical knowledge and literature, all of which lack data to support an association between epilepsy and a higher risk of COVID-19. However, patients with epilepsy who smoke or have diabetes, cancer, lung disease, or obesity may be at an increased risk.

In addition, the effects of COVID-19 on epilepsy are unclear. It is likely that COVID-19 may cause fever in patients with epilepsy, and this fever may in turn trigger seizures. Symptoms of COVID-19, which are primarily respiratory and gastrointestinal in nature, have not shown any impact on seizure related symptoms in patients with epilepsy.

Future treatment of COVID-19 may impact epilepsy, particularly in terms of drug-drug interactions. Drugs that are being considered for COVID-19 treatment must be considered in relation to how they may interact with anti-epileptic drugs (AEDs). Currently, levetiracetam is of interest for patients with epilepsy as it does not appear to interact with any potential COVID-19 medication.

While some epilepsy medications may affect the immune system (eg, steroids), Dr Kuroda suggests that there is evidence that treatments like everolimus have the potential to prevent viral infections. As such, he emphasizes the need to choose epilepsy medications on an individual basis. In patients with well-controlled seizures, discontinuing or changing AEDs for the purpose of preventing infection is not recommended.

Dr Kuroda also noted that elective surgeries for patients with epilepsy should be postponed to prevent the spread of COVID-19. Urgent interventions should be performed under strict prevention and protection protocols. Healthcare providers and other medical professionals are encouraged to provide this information to patients with epilepsy to help curb anxiety and potentially reduce seizure frequency.

Reference

Kuroda N. Epilepsy and COVID-19: Associations and important considerations. Epilepsy Behav. 2020;108:107122. doi: 10.1016/j.yebeh.2020.107122.

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Epilepsy and COVID-19: Connection and Considerations - Neurology Advisor