Friday, September 25, 2020

Blog # 122: EPILEPSY IS ASSOCIATED WITH HIGHER DEATH RISK FROM COVID-19

 A recent article summarized a Spanish study1 (published only on line to date) to estimate incidence and case fatality rate of patients with epilepsy and COVID-19.

It is known that patients with epilepsy are at elevated risk of respiratory diseases, especially those due to infections. This referenced investigation supports this. Spanish investigators studied 1,537 patients with COVID-19 admitted over one month in spring, 2020, including 21 with active epilepsy and 1,516 controls without active epilepsy.

 

A cumulative case fatality rate of 1.2 percent was found in the patients with COVID-19. The general population with COVID-19 without active epilepsy had a lower death rate due to COVID-19 of 0.5 percent. Patients with high blood pressure and with epilepsy and COVID-19 predicted even greater mortality.

We all must be attentive to safe distancing and mask-wearing at this time. My blogs #117 on April 25, 2020; #118 on May 25, 2020 and #120 on July 25, 2020 at LanceFogan.com deal with COVID-19. They discuss more helpful information on your epilepsy and staying safe during this covid-19 pandemic. Infections with COVID-19 are associated with worsening seizures in many people with epilepsy. I urge you to practice recommended safety measures to protect yourselves from COVID.

 

1)     P.Cabezudo-Garcia, N. Lundahl Ciano-Petersen, N.Mena-Vazquez, et.al. Incidence and case fatality rate of COVID-19 in patients with active epilepsy. Neurology 2020;95:e1417-1425 2020 Sep 8;95(10):e1417-e1425. doi: 10.1212/WNL.0000000000010033. Epub 2020 Jun 17

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

 

Tuesday, August 25, 2020

Blog #121: IF YOUR SEIZURES AREN’T CONTROLLED EPILEPSY SURGERY IS SAFE AND REALLY CAN HELP

I have addressed epilepsy surgery before in several of my 120 monthly epilepsy blogs published at LanceFogan.com since 2011. Evidence is overwhelming that epilepsy surgery, if you are a candidate, is safe and can be tremendously beneficial in reducing, or even, curing your epilepsy.

 

The chief research officer and epilepsy specialist at Cleveland Clinic, Lara Jehi, MD, detailed the patient-centered pros and cons associated with epilepsy surgery, as well as the stigmas related to it. “Even before you put a patient through the surgical testing, neurologists have to identify if they’re a surgical candidate. The most cost-effective option is to send them to get that evaluation.” Jehi hopes that her study can help demystify some of the preconceived notions that surround epilepsy surgery. NeurologyLive /www.neurologylive.com/videos/lara-jehi-md-pros-and-cons-of-epilepsy-surgery.

 

A recently published study that evaluated costs found epilepsy surgery was cost effective ($328,000) compared to medical management ($423,000) in surgically eligible patients and more effective (measuring Quality Adjusted Life Year of 16.6 vs. 13.6 QALY) than medical management in the long run. The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived.1

 

The data has potential to raise eyebrows within the epilepsy community, and ultimately sway more patients to not only get the surgery, but to at least have their own surgery-eligibility evaluated. Dr. Lara Jehi feels that patients don’t fully understand the benefits that come with epilepsy surgery. She encourages those eligible to at least consider surgery knowing their less-than-effective anti-seizure medication will probably not improve their quality of life.

 

“There are a lot of fears out there. Some justified, but some due to misperception and misinformation that may stop someone from getting to the point of looking at brain surgery.” Jehi provides insight on the truth behind the stigmas related to epilepsy surgery and whether patient fears are legitimate. In the above video Jehi discusses moms worried about weeks long hospitalizations for testing, other family responsibilities during that time; time off work; relatives with past complications due to other types of surgeries.

 

Her study results confirm the positives of surgery. Epilepsy surgery is underutilized and not recommended to a large number of patients by their neurologists despite multiple studies proving its effectiveness and long-term benefit with drug-resistant temporal lobe epilepsy. Jehi hopes that her study can help demystify some of the preconceived notions that surround epilepsy surgery.

 

  1. Sheikh SR, Kattan MW, Steinmetz M, Singer ME, Udeh BL, Jehi L. Cost effectiveness of surgery for drug resistant temporal lobe epilepsy in the US. Neurology. Published online July 8, 2020. doi: 10/1212/WNL.0000000000010185

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

 

 

Saturday, July 25, 2020

Blog #120: IS YOUR EPILEPSY CURRENTLY WORSENING? YOU’RE NOT ALONE.

 
The United Kingdom’s (UK) charity for young people with epilepsy, YOUNG EPILEPSY, evaluated the difficulties under lockdown for the 112,000 young people with epilepsy. I would extrapolate these difficulties to the general epilepsy population in the United States. You are not alone.

Key findings from the study of nearly 300 young people with epilepsy and their parents and carers probably parallel your experiences in the U.S. under COVID-19. These are:
  • 30% of respondents reported an increase in seizures during lockdown - this may be related to a change in routine and lack of the usual support mechanisms.
  • The majority of young people with epilepsy report deteriorations in sleep (72%) and mood (63%) in lockdown - young people with epilepsy are four times more likely than their peers to suffer from mental health issues. Their parents and carers themselves also reported increased stress and anxiety.
  • Nearly a quarter (23%) also say that they've had clinical procedures or investigations cancelled during lockdown - in addition, 61% are more reluctant to go to hospital, with both issues likely to increase stress if it means a young person’s epilepsy going unmanaged.
  • Nearly a quarter (23%) say that they have had trouble getting medication during lockdown - respondents mentioned pharmacies not stocking their regular medication, having to drive further to get the medication or switch between brands or types of medication, while others were frustrated that existing difficulties in obtaining medicines had been exacerbated.
  • Most respondents (82%) say they worry that catching coronavirus would impact negatively on the frequency and severity of seizures - fever is a known trigger of seizures in some epilepsies, and one respondent said they had their first seizure in five years while suffering from Covid-19.

People with epilepsy already feel isolated; they face significant challenges even before the Covid-19 pandemic, including a higher likelihood of unemployment and mental health issues compared with the general population.
Comments covered by Medical Sciences News by Mark Devlin, CEO of the UK’s Young Epilepsy organization, report lockdown has exacerbated the many challenges which children and young people with epilepsy already face. Just 34% of working-age people with epilepsy in the UK are employed, and many have co-existing conditions such as autism which create further barriers to work, meaning that the recession offers bleak prospects for young people.
Young Epilepsy hopes that in the lifting of lockdown and recovery from the pandemic, the UK’s National Health Service and wider society will learn lessons in how to provide the support to help people with epilepsy lead the life they want to live. Wider access to remote health appointments is one specific measure, as is the urgent rescheduling of any treatment or appointment postponed due to Covid-19 pressures.”
One of Young Epilepsy’s representatives said: “Throughout this time I've had to postpone several appointments, and missed blood tests that I'm supposed to get every three months to make sure my main antiepileptic drug levels don't get too high and potentially put me in a coma. My meds, which were finally being ordered automatically by my pharmacy at the right time each month after a year of dose changes which confused everyone but me, are now messed up again with them giving me two months of some and not others.
“It's these small uncertainties and frustrations that add up and amount to the kind of stress that can cause a sudden peak in seizures. My seizure control has already dropped in the last month and the fear that it could continue to get worse with this ongoing stress is concerning —nobody wants to end up in emergency departments during a pandemic.”
In the UK in April Young Epilepsy launched its ground-breaking digital platform, The Channel. This platform, co-produced with young people, was launched because the charity recognized that young people with epilepsy have complex and often poorly met needs - even outside of lockdown - and that there was an appetite for reliable, specialist information provided remotely. Content on The Channel, which has already been accessed by thousands of users, includes advice and guidance on a range of topics from health and wellbeing to the personal and social lives of young people with epilepsy - including staying healthy in lockdown, and issues around Covid-19.
The Epilepsy Foundation of America provides similar digital support.



Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.