Cross-sectional case-control studies (Blue)
The objective of this study was to determine whether patients with epilepsy (PWE) were particularly over-represented in a very large cohort of patients with COVID-19. The authors also investigated whether COVID-19 is associated with a different clinical picture or a more severe course of illness in PWE (compared with others). All consecutive patients referred to and admitted at healthcare facilities anywhere in Fars province (located in the south of Iran with a population of 4,851,000 people) from February 19, 2020 until November 20, 2020 were included. A total of 37,968 patients were studied. Eighty-two patients (0.2%) had pre-existing epilepsy. Seizures were significantly more frequent among PWE as a presenting manifestation of COVID-19 compared to people without epilepsy (Odds Ratio = 27; p = 0.0001). Furthermore, PWE less often reported cough (significantly) and more often had gastrointestinal symptoms (vomiting and anorexia; as trends) compared to people without epilepsy. Patients with epilepsy were no more likely to be intubated or admitted at ICUs. Case fatality rates were not different between the two groups [9.8% in PWE and 8.5% in people without epilepsy; p = 0.690]. The authors concluded that patients with epilepsy were not more susceptible to contracting COVID-19, and COVID-19 in PWE was not associated with more severe illness or a worse prognosis. However, PWE and COVID-19 may present somewhat differently to people without epilepsy. Why PWE less often present with cough and more often present with gastrointestinal symptoms is not yet clear and could be investigated and clarified in future studies.