Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
Epilepsia. 2021 Jan;62(1):41-50. doi: 10.1111/epi.16779. Epub 2020 Nov 30.
Our epilepsy population recently experienced the acute effects of the COVID-19 pandemic in New York City. Herein, we aimed to determine patient-perceived seizure control during the surge, specific variables associated with worsened seizures, the prevalence of specific barriers to care, and patient-perceived efficacy of epilepsy care delivered via telephone and live video visits during the pandemic.
We performed a cross-sectional questionnaire study of adult epilepsy patients who had a scheduled appointment at a single urban Comprehensive Epilepsy Center (Montefiore Medical Center) between March 1, 2020 and May 31, 2020 during the peak of the COVID-19 pandemic in the Bronx. Subjects able to answer the questionnaire themselves in English or Spanish were eligible to complete a one-time survey via telephone or secure online platform (REDCap).
Of 1212 subjects screened, 675 were eligible, and 177 adequately completed the questionnaire. During the COVID-19 pandemic, 75.1% of patients reported no change in seizure control, whereas 17.5% reported that their seizure control had worsened, and 7.3% reported improvement. Subjects who reported worsened seizure control had more frequent seizures at baseline, were more likely to identify stress and headaches/migraines as their typical seizure precipitants, and were significantly more likely to report increased stress related to the pandemic. Subjects with confirmed or suspected COVID-19 did not report worsened seizure control. Nearly 17% of subjects reported poorer epilepsy care, and 9.6% had difficulty obtaining their antiseizure medications; these subjects were significantly more likely to report worse seizure control.
Of the nearly 20% of subjects who reported worsened seizure control during the COVID-19 pandemic, stress and barriers to care appear to have posed the greatest challenge. This unprecedented pandemic exacerbated existing and created new barriers to epilepsy care, which must be addressed.
我们的癫痫患者群体最近在纽约市经历了 COVID-19 大流行的急性影响。在此，我们旨在确定疫情高峰期患者感知的癫痫发作控制情况、与癫痫发作恶化相关的具体变量、具体护理障碍的发生率以及患者对大流行期间通过电话和实时视频就诊提供的癫痫护理的感知效果。
我们对 2020 年 3 月 1 日至 5 月 31 日期间在 Bronx COVID-19 大流行高峰期在单一城市综合癫痫中心（Montefiore 医疗中心）预约的成年癫痫患者进行了横断面问卷调查研究。能够用英语或西班牙语回答问卷的患者有资格通过电话或安全在线平台（REDCap）完成一次性调查。
在筛选的 1212 名患者中，有 675 名符合条件，有 177 名患者充分完成了问卷。在 COVID-19 大流行期间，75.1%的患者报告癫痫发作控制无变化，17.5%报告癫痫发作控制恶化，7.3%报告癫痫发作控制改善。报告癫痫发作控制恶化的患者基线时癫痫发作更频繁，更可能将压力和头痛/偏头痛识别为其典型的癫痫发作诱因，并且显著更可能报告与大流行相关的压力增加。确诊或疑似 COVID-19 的患者未报告癫痫发作控制恶化。近 17%的患者报告癫痫护理较差，9.6%的患者难以获得抗癫痫药物；这些患者更有可能报告癫痫发作控制更差。
在报告 COVID-19 大流行期间癫痫发作控制恶化的近 20%的患者中，压力和护理障碍似乎构成了最大的挑战。这场前所未有的大流行加剧了现有的和新的癫痫护理障碍，必须加以解决。
