COVID-19 prevalence and mortality in people with epilepsy: A nation-wide multicenter study
Alvaro Sanchez-Larsen 1 , Estefanía Conde-Blanco 2 , Alejandro Viloria-Alebesque 3 , Cristina Sánchez-Vizcaíno Buendía 4 , Tatiana Espinosa Oltra 4 , Amanda Alvarez-Noval 5 , Angel Aledo-Serrano 6 , Raquel Martin-Garcia 7 , María E Ramos-Araque 8 , Dulce Campos 9 , Gonzalo Valle-Peñacoba 9 , Alicia Sierra-Gómez 10 , Pablo De Ceballos-Cerrajería 11 , Marta Agundez-Sarasola 11 , Mariam Khawaja 12 , Kevin G Hampel 13 , Maria Serra-Martínez 14 , Clara Arbós-Barber 14 , Asier Gómez-Ibáñez 15 , Rafael Villino-Boquete 16 , Pablo Cabezudo-García 17 , Ignacio Rodríguez-Lavado 17 , Alessandro Principe 18 , David Sopelana-Garay 19
Background: To assess the prevalence, severity, and mortality of COVID-19 in people with epilepsy (PWE) and evaluate seizure control in PWE during and after COVID-19.
Methods: Retrospective, observational, multicenter study conducted in 14 hospitals. Medical records of randomly selected PWE followed at neurology outpatient clinics were reviewed.
Proportion of PWE with a positive test for SARS-CoV-2 during 2020 was calculated. Risk factors associated with COVID-19 and its morbimortality were evaluated.
Results: 2751 PWE were included, mean age 48.8 years (18-99), 72.4% had focal epilepsy, and 35% were drug-refractory. COVID-19 prevalence in PWE was 5.53%, while in the Spanish population was 4.26%. Proportion of admissions to hospital, ICU, and deaths in PWE were 17.1%, 2%, and 4.61% of COVID-19 cases, while in Spanish population were 10.81%, 0.95%, and 2.57%, respectively.
A severe form of COVID-19 occurred in 11.8%; dyslipidemia, institutionalization at long-term care facilities, intellectual disability, and older age were associated risk factors. Older age, hypertension, dyslipidemia, cardiac disease, and institutionalization were associated with mortality from COVID-19. Seizure control was stable in 90.1% of PWE during acute COVID-19, while 8.6% reported an increase in seizure frequency. During post-COVID-19 follow-up, 4.6% reported seizure control worsening.
Conclusions: COVID-19 was moderately prevalent in PWE. One out of 5 patients required medical attention and 4.6% died due to COVID-19. Older age, dyslipidemia, institutionalization, and intellectual disability were significant risk factors associated with severe COVID-19. Seizure control remained stable during COVID-19 and throughout long-term follow-up in most PWE who contracted the infection.