COVID-19 prevalence and mortality in people with epilepsy: a nation-wide multicenter study

Sanchez-Larsen, Alvaro Conde-Blanco Estefanía Viloria-Alebesque Alejandro Sánchez-Vizcaíno Buendía Cristina Espinosa Oltra Tatiana Alvarez-Noval Amanda Aledo-Serrano Angel Martin-Garcia Raquel Ramos-Araque María E.; Campos, Dulce Valle-Peñacoba Gonzalo Sierra-Gómez Alicia De Ceballos-Cerrajería Pablo Agundez-Sarasola Marta Khawaja Mariam Hampel Kevin G.; Serra-Martínez, Maria Arbós-Barber Clara Gómez-Ibáñez Asier Villino-Boquete Rafael Cabezudo-García Pablo Rodríguez-Lavado Ignacio Principe Alessandro Sopelana-Garay David

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, 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.