Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA.
Acta Neurol Scand. 2021 Jun;143(6):624-628. doi: 10.1111/ane.13404. Epub 2021 Feb 16.
To determine whether patients with epilepsy (PWE) are particularly over-represented in a very large cohort of patients with COVID-19. We also investigated whether COVID-19 is associated with a different clinical picture or a more severe course of illness in PWE (compared with others).
All consecutive patients who referred to and admitted at healthcare facilities anywhere in Fars province (located in the south of Iran with a population of 4,851,000 people) from February 19, 2020 until November 20, 2020 were included.
A total of 37,968 patients were studied. Eighty-two patients (0.2%) had pre-existing epilepsy. Seizures were significantly more frequent among PWE as a presenting manifestation of COVID-19 compared with that in people without epilepsy (Odds Ratio = 27; p = 0.0001). Furthermore, PWE less often reported cough (significantly) and more often had gastrointestinal symptoms (vomiting and anorexia; as trends) compared with those in people without epilepsy. Patients with epilepsy were not differently likely to be intubated or admitted at ICUs. Case fatality rates were not different between the two groups [9.8% in PWE and 8.5% in people without epilepsy; p = 0.690].
Patients with epilepsy are not susceptible to contracting COVID-19 more than other individuals. Furthermore, COVID-19 in PWE is not associated with a more severe illness or a poorer prognosis. However, PWE and COVID-19 may present somewhat differently than others with such an illness. Why PWE less often present with cough and more often present with gastrointestinal symptoms is not clear yet and should be investigated and clarified in the future studies.
确定癫痫患者（PWE）在 COVID-19 的大量患者中是否特别高发。我们还调查了 COVID-19 是否与 PWE（与其他人相比）的不同临床表现或更严重的疾病过程有关。
从 2020 年 2 月 19 日至 2020 年 11 月 20 日，纳入在伊朗南部的法尔斯省（人口 485.1 万）各地医疗机构就诊和入院的所有连续患者。
共研究了 37968 名患者。82 名患者（0.2%）患有既往癫痫。与无癫痫的患者相比，PWE 作为 COVID-19 的首发表现，癫痫发作的发生率明显更高（优势比=27；p=0.0001）。此外，与无癫痫的患者相比，PWE 较少报告咳嗽（显著），更多报告胃肠道症状（呕吐和食欲不振；呈趋势）。癫痫患者插管或入住 ICU 的可能性没有差异。两组之间的病死率无差异[9.8%在 PWE 中，8.5%在无癫痫的人中；p=0.690]。
癫痫患者与其他人相比不易感染 COVID-19。此外，COVID-19 在 PWE 中与更严重的疾病或更差的预后无关。然而，PWE 和 COVID-19 的表现可能与其他患有这种疾病的人略有不同。为什么 PWE 较少出现咳嗽而更多出现胃肠道症状尚不清楚，应在未来的研究中进行调查和澄清。
