Yoo Joonsang, Kim Jee Hyun, Jeon Jimin, Kim Jinkwon, Song Tae-Jin
From the Department of Neurology (J.Y., J.J., J.K.), Yongin Severance Hospital, Yonsei University College of Medicine; and Department of Neurology (J.H.K., T.-J.S.), Seoul Hospital, Ewha Womans University College of Medicine, Republic of Korea.
Neurology. 2022 May 10;98(19):e1886-e1892. doi: 10.1212/WNL.0000000000200195. Epub 2022 Mar 25.
The goal of this work was to evaluate whether patients with epilepsy were more susceptible to coronavirus disease 2019 (COVID-19) infection and at greater risk of severe complications when infected with COVID-19 compared with patients without epilepsy.
We included participants who underwent at least 1 severe acute respiratory syndrome coronavirus 2 real-time reverse-transcription PCR test between January 1 and June 4, 2020, from the Korean nationwide COVID-19 dataset. Epilepsy was defined according to the presence of diagnostic code in health claims data before the COVID-19 diagnosis. To investigate the association between epilepsy and the susceptibility for or severe complications of COVID-19, a 1:6 ratio propensity score matching (PSM) and logistic regression analysis were performed. Severe complications with COVID-19 infection were defined as a composite of the incidence of mechanical ventilation, intensive care unit admission, and death within 2 months after COVID-19 diagnosis.
Among 212,678 study participants who underwent a COVID-19 test, 3,919 (1.8%) had a history of epilepsy. After PSM, there was no significant difference in COVID-19 PCR positivity according to epilepsy history (odds ratio [OR] 0.86, 95% CI 0.67-1.11). Of the 7,713 individuals with confirmed COVID-19 infection, 72 (0.9%) had a history of epilepsy. Among the patients with COVID-19, severe complications occurred in 444 (5.8%) individuals. After PSM, the presence of epilepsy was associated with the occurrence of severe complications after COVID-19 infection (OR 2.05, 95% CI 1.04-4.04). Mortality after COVID-19 infection did not differ according to the presence of epilepsy history (OR 1.55, 95% CI 0.65-3.70).
The presence of epilepsy was not associated with increased susceptibility to COVID-19 infection or mortality related to the infection. However, there was an increased risk of severe complications with COVID-19 in patients with epilepsy; therefore, careful management and monitoring may be necessary.
本研究旨在评估癫痫患者是否比非癫痫患者更易感染2019冠状病毒病（COVID-19），以及感染COVID-19后出现严重并发症的风险是否更高。
我们纳入了2020年1月1日至6月4日期间韩国全国COVID-19数据集中至少接受过1次严重急性呼吸综合征冠状病毒2实时逆转录聚合酶链反应检测的参与者。根据COVID-19诊断前健康声明数据中的诊断代码定义癫痫。为了研究癫痫与COVID-19易感性或严重并发症之间的关联，进行了1:6比例的倾向评分匹配（PSM）和逻辑回归分析。COVID-19感染的严重并发症定义为COVID-19诊断后2个月内机械通气、入住重症监护病房和死亡的发生率的综合指标。
在接受COVID-19检测的212,678名研究参与者中，3,919名（1.8%）有癫痫病史。PSM后，根据癫痫病史，COVID-19 PCR阳性率无显著差异（优势比[OR] 0.86，95%置信区间0.67-1.11）。在7,713名确诊COVID-19感染的个体中，72名（0.9%）有癫痫病史。在COVID-19患者中，444名（5.8%）个体出现了严重并发症。PSM后，癫痫的存在与COVID-19感染后严重并发症的发生相关（OR 2.05，95%置信区间1.04-4.04）。COVID-19感染后的死亡率根据癫痫病史无差异（OR 1.55，95%置信区间0.65-3.70）。
癫痫的存在与COVID-19感染易感性增加或感染相关死亡率无关。然而，癫痫患者发生COVID-19严重并发症的风险增加；因此，可能需要仔细管理和监测。
