Poor Sleep Quality, Care Management Linked With Worsening of Seizure in Patients With Epilepsy

Amid the coronavirus disease 2019 (COVID-19) pandemic in Italy, a significant number of patients with epilepsy reported difficulties managing their condition, especially those who reported greater use of antiseizure medications (ASMs) forchronic therapy and poor sleep quality, according to study findings published in Frontiers in Neurology.

The COVID-19 pandemic has led to unprecedented health emergencies worldwide, causing governments to dedicate most, if not all, health care—related resources to manage those infected and combat the spread of the virus. Consequently, the deferral of nonessential procedures and checkups has been associated with the potential of undiagnosed conditions and impaired management of disorders that require routine care, such as epilepsy.

“The social and behavioral consequences of COVID-19 lockdown might increase seizure frequency in people with epilepsy (PwE). Furthermore, the COVID-19 viral infection itself can induce a febrile status, which in turn can reduce seizure threshold,” explained the study authors.

Moreover, the researchers note the notable impact of the health industry lockdown on ASM supplies, in which, “the reduced care services limited to emergencies make it difficult for PwE to receive regular follow-up and to keep in touch with their treating physicians.”

The researchers sought to better understand the impact of the pandemic on PwE in Italy by conducting a national survey that evaluated the seizure frequency, needs, and behaviors of patients. The 48-item online survey polled both PwE (n = 456) and people without epilepsy (n = 472) on socio-demographic, epilepsy-related, and psychometric (depression, anxiety, and sleep) variables. Regression analysis was utilized to identify predictors of seizure worsening.

Of the 172 PwE who had a scheduled outpatient visit during the pandemic, 166 (96%) did not keep it. Moreover, 37% (n = 169) of the PwE group reported negative issues with their epilepsy management, of which 61% had their planned examination deferred. The researchers point out that only 71% of these 169 patients reached out to their treating physicians and solved their problems, signifying a gap in care.

Among the study cohort, PwE showed worse depression and anxiety symptoms, as measured by the Beck Depression Inventory-II and the General Anxiety Disorder-7 scale, respectively, than those without epilepsy (P < .001). Seizure worsening was additionally found to occur in 67 PwE (18%), with the number and frequency of seizures indicated as higher during the COVID-19 period compared with before the pandemic.

The researchers highlight that worsening of seizures was best explained by the number of ASM used for chronic therapy and the severity of sleep disorder. Compared with those who did not report worsening of seizures, those who did had a more frequent positive history of depression (P = .01), antidepressant use (P < .0001), tonic-clonic seizures during COVID-19 (P < .0001), and epilepsy-related issues during COVID-19 (P < .0001). This select group also had more severe depression and anxiety symptoms, as well as more disturbed sleep than the rest of the PwE group (P < .001).

“The number of chronically taken ASMs and sleep deterioration were the major factors influencing the risk of seizure worsening experienced by some patients,” said the study authors. “Special attention should be paid to these factors to prevent seizure worsening in PwE and to help set up an efficient telemedicine program devoted to epilepsy care.”

Reference

Assenza G, Lanzone J, Brigo F, et al. Epilepsy care in the time of COVID-19 pandemic in Italy: risk factors for seizure worsening. Front Neurol. Published online July 3, 2020. doi:10.3389/fneur.2020.00737