Tim J von Oertzen, Ronan McGinty, Martin Holtkamp, Reetta Kalviainen, Stephan Ruegg, Eugen Trinka, Guido Rubboli
3rd April 2020
Physicians of all specialties worldwide are challenged by the new SARS-CoV-2 virus causing corona virus disease 2019 (COVID-19). The virus is causing mainly viral pneumonia and respiratory tract infection. In this statement, we will focus on the impact of COVID-19 on epilepsy.
To our knowledge, no publication covering epilepsy, seizures or paroxysmal events has so far been published in relation to COVID-19. However, there are several general aspects to address:
- During the previous SARS epidemic, some people with epilepsy (PwE) stopped taking their medicine due to isolation, or fear of contracting infection from hospitals, doctors’ offices, pharmacies or surgical procedures. This obviously leads to an increased risk for seizures and status epilepticus with all related complications including injuries, hospital admissions, and potentially sudden unexpected death in people with epilepsy (SUDEP). Hence, patient information is very important and should stress the importance of maintaining concordance with and supply of prescribed medication.
- COVID-19 often presents with high fever over several days. High body temperature can trigger seizures in some PwE. Therefore, antipyretic treatment with e.g. paracetamol should be advised. There has been a debate on ibuprofen causing a negative effect in COVID-19 but there is no evidence available so far. Therefore, ibuprofen use might be considered if deemed necessary and in the absence of alternatives. Metamizol may cause leukopenia, so caution should be advised as well, given that COVID-19 itself often presents with leukopenia.
- Restrictions to health care provision in hospitals may lead to cancellations of non-urgent out-patient appointments. However, continuous care for PwE and other chronic diseases is essential. Therefore, consultations over the phone or where available teleconsultations may help identifying those patients who need a face to face appointment. Particularly in epilepsy, the main information in follow up appointments derives from history taking. Hence, phone consultations might be for many patients an alternative which seems to be appropriate during this challenging time.
- In rare cases, epilepsy is treated with immunomodulatory or –suppressive therapy. This applies to epilepsy syndromes in infancy and childhood (e.g. ACTH) or autoimmune encephalitis in any age group. Treatment might include steroids, IVIg, or even rituximab and/or cyclophosphamide. Hence, the application of risk stratifications is outlined in the recommendations of the neuroimmunology and MS scientific panels.
- New treatment options for COVID-19 include antiviral, immunomodulatory and immunosuppressive drugs, as well as supportive medication. Some of the potential treatments may have drug-drug interactions with AEDs. Hence, dose adjustments of AEDs or COVID treatment might be necessary. A drug-drug interaction table was compiled for COVID-19 in a joint approach of the Liverpool Drug Interaction Group, University Hospital of Basel (Switzerland) and Radboud (Netherlands). This is regularly updated.
Please check www.covid19-druginteractions.org for updates.
- We encourage neurologists and physicians of other specialties to report any occurrence of neurological symptoms including seizures or drug interactions to report or publish this. We need to be cautious to learn about this new disease and its neurological implications.
- We support the initiative of the International League against Epilepsy (ILAE) and the letter of its president Sam Wiebe, as well as the advice for patients with epilepsy from the EpiCare network (European Reference Network for rare and complex epilepsies).