Impact of the coronavirus disease (COVID-19) crisis on older patients with epilepsy

全文

(1)Epilepsy & Seizure. Journal of Japan Epilepsy Society Vol. 13 No. 1 (2021) pp. 17–21. Mini-Review. Impact of the coronavirus disease (COVID-19) crisis on older patients with epilepsy Takafumi Kubota1, Naoto Kuroda2,3 1. Department of Neurology, University Hospitals of Cleveland Medical Center, Case Western Reserve University, OH, USA 2 Department of Pediatrics, Wayne State University, Detroit, MI, USA 3 Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan Key words: Epilepsy; COVID-19; Older patients; Novel coronavirus disease; Neurology. Received: October 6, 2020; Accepted: January 25, 2021. Abstract Epilepsy is a chronic neurological disorder that causes spontaneous recurrence of unprovoked seizures. The incidence rate is known to be bimodal with peaks in children and older people. Older people have been found to be particularly susceptible to threats posed by the coronavirus disease 2019 (COVID-19). In this article, we discuss the vulnerability of older patients with epilepsy and the importance of comprehensive support for this population during the COVID-19 crisis. Epilepsy clinicians need to understand their situations in order to provide proper care for older patients with epilepsy.. Corresponding author: Naoto Kuroda, MD Department of Pediatrics, Wayne State University, Detroit Medical Center, 3901 Beaubien St, Detroit, MI 48201, USA Tel: 313-212-6759; E-mail: naoto.kuroda@wayne.edu. 17.

(2) Takafumi Kubota & Naoto Kuroda. Impact of COVID-19 crisis on older epilepsy patients. Introduction. high risk of developing severe COVID-19 and face a high mortality rate [5]. In general, the mortality rate among elderly patients with epilepsy is high, particularly those presenting with status epilepticus [6]. In a single-center study of 21 patients with epilepsy and COVID-19, epilepsy was associated with increased risk of fatality [7]. A survey study reported exacerbation of seizure and anxiety among patients with epilepsy during the COVID-19 pandemic [8]. Furthermore, seizures and post-ictal disorientation in older patients can easily lead to falls, trauma, and delirium, resulting in a decline in activities of daily living (ADLs) [6]. Therefore, epileptologists should instruct older patients with epilepsy to take thorough steps to prevent infection, particularly, in older patients with epilepsy who have other medical comorbidities.. Epilepsy is a chronic neurological disorder that causes spontaneously recurring unprovoked seizures. The incidence rate of epilepsy is bimodal with peaks in children and older people [1]. On the other hand, coronavirus disease 2019 (COVID-19) was first detected in Wuhan, China in late 2019 and subsequently spread across the globe. It is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV -2). The whole world has to adapt to changes brought on by the COVID-19 crisis. COVID19 also has a serious impact on patients with neurological disorders including epilepsy [2, 3]. Older people (aged 60 years and older) have been found to be particularly susceptible to the threats posed by the COVID-19 crisis. Thus, it is important to consider the impact of this crisis on older patients with epilepsy. In this article, we briefly review relevant articles searched from PubMed and Google Scholar, and discuss unique challenges faced by older patients with epilepsy, which clinicians must be aware of in order to provide proper care.. Difficulties faced by older patients in accessing telemedicine In various clinical areas, outpatient management via telemedicine has been recommended in order to minimize exposure to SARS-CoV-2 [9]. Telemedicine is also useful in the treatment of epilepsy [10]. Telemedicine not only distances patients from the virus but also has the advantage of saving time and travel costs for people living in medically deprived areas [11]. However, a weakness associated with telemedicine is that some patients have difficulties in accessing or continuing to use such services [10]. Older people are less likely to benefit from patient education using the internet than younger people. Telemedicine can be associated with increased communication problems for patients who are blind or have impaired hearing, compared to. Consideration for older patients with epilepsy during COVID-19 crisis Older people with epilepsy are vulnerable to COVID-19 It has been reported that approximately 15% of the people infected with COVID-19 become severely ill, approximately 5% have respiratory distress to the extent that they require a ventilator, and the mortality rate is approximately 1-2% [4]. Older people are at. 18.

(3) Epilepsy & Seizure Vol. 13 No. 1 (2021). physically meeting with a health care provider. Many older people have functional impairment of the eyes and ears, which can also be a barrier to the continuation of using telemedicine [12].. spreading COVID-19. Reports indicate that while representing less than 0.5% of the total U.S. population (approximately 1.5 million), nursing home residents account for approximately 25% of all COVID-19-related deaths [15]. Thus, nursing homes are one of the communities that are most negatively affected by the COVID-19 crisis. These facilities require immediate support from clinicians, including epileptologists . On the other hand, older people who live alone are also vulnerable to the impact of COVID-19. People with epilepsy who live alone are more likely to be isolated from the society and face difficulties in seeking help when they are in need. There is an urgent need for society as a whole to create a system of relief for the older population.. Effects of staying home and self-isolation on older people Stay-at-home and self-isolation measures are being practiced to prevent the spread of COVID-19, but it can be stressful for people to observe these rules as they require significant lifestyle changes. These measures can be particularly stressful for older people for a variety of reasons. First, older people, especially those who are retired, often stay connected to the society through their hobbies. It is known that older people who continue to engage in social activities and hobbies are less likely to experience depression than those who do not [13]. In addition, physical activity through engaging in hobbies can help prevent physical deterioration in older individuals. A decline in physical function can lead to falls or cognitive decline. In addition, less time spent outside decreases the activation of vitamin D, which can cause osteoporosis [14]. Lifestyle changes can also lead to insomnia and reduced medication adherence. These effects of COVID-19 could result in increased frequencies of seizures in older patients with epilepsy. Therefore, epileptologists should provide comprehensive guidance that includes promoting healthy lifestyle choices.. Management of older patients with epilepsy during the COVID-19 crisis Epileptologists providing care to older patients with epilepsy should have a full understanding of their circumstances, as described above. To prevent COVID-19 infection in older patients with epilepsy, in addition to wearing a mask and avoiding crowds, telemedicine should be used as much as possible when seizure control is stable. In cases where older patients have difficulties using telemedicine, the cause of the difficulties must be determined. If the difficulty is technical, it should be resolved, and if the cause is difficult to resolve, direct clinical care should be considered. When older people physically visit medical institutions, care must be taken to minimize their risk of viral exposure. Regarding medications, treatment plans involving prescription drugs should be as simple as possible. Drug adherence should also be. Consideration for older patients in nursing homes and those living alone Nursing homes where many older people live together are at a heightened risk of. 19.

(4) Impact of COVID-19 crisis on older epilepsy patients. Takafumi Kubota & Naoto Kuroda. monitored, and the cause(s) of poor adherence should be identified if applicable. Older people are more vulnerable to side effects and interactions associated with medications; therefore, it is necessary to verify all medications currently being taken, not just AEDs. Combined with the impact of COVID-19 on mental health, some AEDs can cause symptoms of depression in older patients with epilepsy [16]. Any lifestyle changes or stress caused by COVID-19 may trigger an increase in seizures. Furthermore, since it is difficult for the older patients with epilepsy to prevent COVID-19 infection and continue epilepsy care by themselves, physicians need to pay attention to the support system of family members, nursing homes, and home nursing care services. Therefore, epileptologists should provide comprehensive support to older patients, not only by checking seizure frequency and adherence to medication but by taking a more holistic approach.. Financial disclosures This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.. Conflict of Interest The authors declare that they have no conflicts of interest.. References [1] Werhahn KJ. Epilepsy in the Elderly. Dtsch Arztebl Int 2009; 106: 135–143. [2] Kuroda N. Epilepsy and COVID-19: Associations and important considerations. Epilepsy Behav 2020; 108: 107122. [3] Kubota T, Kuroda N. Exacerbation of neurological symptoms and COVID-19 severity in patients with preexisting neurological disorders and COVID-19: A systematic review. Clin Neurol Neurosurg 2020: 106349. [4] Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239–1242. [5] Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020; 146: 110–118. [6] Brodie MJ, Kwan P. Epilepsy in elderly people. BMJ 2005; 331: 1317–1322. [7] Cabezudo-García P, Ciano-Petersen NL, Mena-Vázquez N, Pons-Pons G,. Conclusion In this article, we have discussed the importance of providing comprehensive support to older people with epilepsy during the COVID-19 crisis. Older patients with epilepsy are physically, mentally, and socially vulnerable. Epileptologists must therefore understand their patients’ situation in order to provide proper care.. Acknowledgement This work was conducted by the Publication Task Force of Japan Young Epilepsy Section.. 20.

(5) Epilepsy & Seizure Vol. 13 No. 1 (2021). [8]. [9]. [10]. [11]. [12]. [13]. [14]. Castro-Sánchez MV, Serrano-Castro PJ. Incidence and case fatality rate of COVID-19 in patients with active epilepsy. Neurology 2020; 95: e1417– e1425. Huang S, Wu C, Jia Y, Li G, Zhu Z, Lu K, et al. COVID-19 outbreak: The impact of stress on seizures in patients with epilepsy. Epilepsia 2020; 61: 1884 –1893. Bloem BR, Dorsey ER, Okun MS. The coronavirus disease 2019 crisis as catalyst for telemedicine for chronic neurological disorders. JAMA Neurol 2020; 77(8): 927–928. Kuroda N. What should we ask patients with epilepsy on telemedicine during the COVID-19 crisis? A checklist for clinicians. Epilepsy Behav 2020; 111: 107184. Patterson V, Patterson V. Managing epilepsy by telemedicine in resource-poor settings. Front Public Health 2019; 7: 321 Leenen LAM, Wijnen BFM, de Kinderen RJA, van Heugten CM, Evers SMAA, Majoie MHJM. Are people with epilepsy using eHealth-tools? Epilepsy Behav 2016; 64: 268–272. Domènech-Abella J, Lara E, RubioValera M, Olaya B, Moneta MV, RicoUribe LA, et al. Loneliness and depression in the elderly: the role of social network. Soc Psychiatry Psychiatr Epidemiol 2017; 52: 381–390. McMillan LB, Zengin A, Ebeling PR, Scott D. Prescribing physical activity for the prevention and treatment of osteoporosis in older adults. Healthcare (Basel) 2017; 5: 85.. [15] Grabowski D, Mor V. Nursing home care in crisis in the wake of COVID-19. JAMA 2020; 324(1): 23-24 [16] Perucca P, Mula M. Antiepileptic drug effects on mood and behavior: Molecular targets. Epilepsy Behav 2013; 26: 440–449.. 21.

(6)