COVID-19, Seizures and Epilepsy
For people with epilepsy, the neurological complications of COVID-19 are of special importance. Although our understanding of the virus continues to evolve and change, some insights have emerged.
The novel coronavirus affects multiple systems in the body, in addition to the lungs. It can travel through damaged nasal membranes into the olfactory bulbs just above the nasal passages inside the skull, resulting in loss of the ability to smell and allowing spread to the rest of the brain. The virus can also travel to the brain through the bloodstream. Whichever way the virus enters the brain, it can cause a variety of neurological symptoms such as headache, fainting, stroke, confusion, inflammation of the linings of the brain (meningitis), muscle weakness and seizures.
[See: Was That a Seizure?]
Early reports highlighted seizures in patients with COVID-19, but now it seems that the incidence of seizures is about what we would expect for any group of critically ill patients. Seizures may occur in anyone with COVID-19, but the rate is increased in people with a pre-existing brain injury, such as a stroke. The good news is that the actual number of people with COVID-19 who develop seizures is low. Whether or not some of these people will continue to experience seizures after recovery is not yet known.
[See: Relieving the Stigma of Epilepsy.]
For people who already have epilepsy before experiencing COVID-19, the risk for increased seizures during illness also appears to be low. In a survey of epilepsy specialists, a third of the responding doctors had patients with epilepsy who experienced COVID-19, and most noted no change in their patients' seizure frequency during the illness. The doctors did, however, voice concern for their patients regarding increased stress, lack of access to specialty care, increase in sleep disturbances and medication shortages, since all these factors can provoke seizures in people with epilepsy.
For anyone who experiences seizures while ill with COVID-19, treatment with antiseizure medication is required. Patients with serious illness may also require drugs to treat the virus and resultant inflammation, and doctors must carefully manage all the medications to prevent side effects and minimize drug interactions. Communication with medical experts is important throughout recovery. Fortunately, access to the medical community has improved since the onset of the pandemic with the rise in virtual visits.
[Read: A Beginner's Guide to a Virtual Doctor's Visit.]
All of us must do what we can to help ourselves and others get through the remaining months of the pandemic until a vaccine becomes available and widespread immunity is established. For people with epilepsy, the following action steps are especially important.
-- Take all doses of your antiseizure medication(s) regularly as prescribed.
-- Communicate closely with your doctor to maintain the best possible seizure control.
-- Maintain a good sleep and exercise schedule for overall well-being.
-- Be proactive and receive the flu vaccine.
-- Protect yourself from getting sick by practicing social distancing, facial masking and proper hand hygiene.
Dr. Elaine Wyllie is a professor in the Cleveland Clinic Lerner College of Medicine and a world-renowned epilepsy specialist who provides cutting-edge treatment for children from around the world. She is editor of Wyllie's Treatment of Epilepsy, the standard in the field now in its 6th edition, and author of "The Cleveland Clinic Guide to Epilepsy," an authoritative book for the lay public.
Her extensive research and scientific reports have greatly expanded the opportunities for children to benefit from epilepsy surgery, and her many honors include the prestigious American Epilepsy Society Research Award and the Maria and Sam Miller Award for Excellence as Master Clinician. Aside from being proud of her two accomplished sons, Dr. Wyllie's hobby outside of work is ballroom dancing with her husband, Dr. Robert Wyllie, Cleveland Clinic's Chief of Medical Operations.
For more information about Dr. Wyllie, please visit https://my.clevelandclinic.org/staff/885-elaine-wyllie.
