Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, 430021, China.
Department of Pharmacy, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, 430021, China.
Int J Infect Dis. 2021 Feb;103:647-653. doi: 10.1016/j.ijid.2020.09.1475. Epub 2020 Oct 2.
This study aims to present the clinical characteristics of 30 hospitalized cases with epileptic seizures and coronavirus disease 2019(COVID-19).
This is a retrospective observational research study. Clinical data were extracted from electronic medical records in 1550 patients with a laboratory-confirmed diagnosis of COVID-19, who were hospitalized in Wuhan Central Hospital, China, from 1 January to 31 April 2020. 30 COVID-19 patients with the diagnosis of epilepsy were enrolled. The clinical characteristics, complications, treatments, and clinical outcomes of 30 cases were collected and analyzed.
Of 30 patients with a diagnosis of epilepsy and COVID-19, 13 patients (43.4%) had new-onset epileptic seizures without an epilepsy history(new-onset seizure group, NS group), ten patients(33.3%) had an epilepsy history with a recurrent epileptic seizure (recurrent seizure group, RS group) and seven patients(23.3%) had an epilepsy history but no seizure during the course of COVID-19 (epilepsy history group, EH group). Patients in the RS group had a larger number of other-neurological-disease histories than those in the NS and EH groups (7/10[70%] VS 1/13 [7.7%] VS 1/7[14.3%]); the difference between the RS group and NS group is significant (P < 0.05). Patients in the NE and RS groups suffered more severe/critical COVID-19 infection than patients in the EH group (10/13[76.9%] VS 6/10[60%] VS 1/7[14.3%]); the difference between the NS group and EH group is significant (P < 0.05). 36.7% of patients had one to five neurological complications, and 46.4% of patients had 6-10 neurological complications. The complications in patients with seizures (in the RS and NS groups) seem to be more than those without seizures (in the EH group), but it did not reach statistical significance. The proportion of antiepileptic drugs (AEDs) treatment before admission was higher in the EH group than in the RE group(7/7 [100%] VS 2/10 [20%], P < 0.05). The mortality of 30 patients with epilepsy and COVID-19 was 36.67%. The mortality of the NS group(38.5%) and the RS group(50%) were a little higher than in the EH group(14.3%). None of the convalescent patients had a recurrent seizure, and there were no more deaths in the 3-month follow-up after discharge.
COVID-19 patients with recurrent epileptic seizures had more underlying neurological diseases than patients who had an epilepsy history but without a seizure. Patients with new-onset and recurrent epileptic seizures suffered more severe/critical COVID-19, which may lead to a worse prognosis. If patients with epilepsy history continue using AEDs during COVID-19 pandemics, the risk of recurrent seizure may be reduced, and a good prognosis for patients with epilepsy history could be expected.
本研究旨在介绍 30 例住院癫痫发作合并 2019 年冠状病毒病（COVID-19）患者的临床特征。
这是一项回顾性观察性研究。从 2020 年 1 月 1 日至 4 月 31 日在中国武汉中心医院住院的 1550 例实验室确诊 COVID-19 患者的电子病历中提取临床数据。纳入 30 例 COVID-19 合并癫痫诊断的患者。收集并分析了 30 例患者的临床特征、并发症、治疗和临床结局。
在诊断为癫痫合并 COVID-19 的 30 例患者中，13 例（43.4%）为无癫痫病史的新发癫痫发作（新发癫痫发作组，NS 组），10 例（33.3%）为有癫痫病史的复发性癫痫发作（复发性癫痫发作组，RS 组），7 例（23.3%）为有癫痫病史但在 COVID-19 期间无癫痫发作（癫痫病史组，EH 组）。RS 组患者的其他神经疾病史数量多于 NS 组和 EH 组（7/10[70%]比 1/13[7.7%]比 1/7[14.3%]），差异具有统计学意义（P<0.05）。NE 和 RS 组患者的 COVID-19 感染更严重/危急，比 EH 组患者严重（10/13[76.9%]比 6/10[60%]比 1/7[14.3%]），差异具有统计学意义（P<0.05）。36.7%的患者有 1 至 5 种神经系统并发症，46.4%的患者有 6-10 种神经系统并发症。有癫痫发作的患者（RS 组和 NS 组）的并发症似乎比无癫痫发作的患者（EH 组）多，但未达到统计学意义。EH 组入院前使用抗癫痫药物（AED）治疗的比例高于 RS 组（7/7[100%]比 2/10[20%]，P<0.05）。30 例癫痫合并 COVID-19 患者的死亡率为 36.67%。NS 组（38.5%）和 RS 组（50%）的死亡率略高于 EH 组（14.3%）。无复发性癫痫发作的恢复期患者，出院后 3 个月随访无死亡。
复发性癫痫发作的 COVID-19 患者比有癫痫病史但无癫痫发作的患者有更多的基础神经疾病。新发和复发性癫痫发作的患者患有更严重/危急的 COVID-19，这可能导致预后较差。如果癫痫病史患者在 COVID-19 大流行期间继续使用 AED，复发癫痫的风险可能降低，并且可以预期有癫痫病史的患者预后良好。
