灭活 COVID-19 疫苗对癫痫患者癫痫发作频率的影响：一项多中心前瞻性研究。
Effect of inactivated COVID-19 vaccines on seizure frequency in patients with epilepsy: A multicenter, prospective study.
机构信息
Department of Neurology, Qilu Hospital, Shandong University, Jinan, China.
Institute of Epilepsy, Shandong University, Jinan, China.
出版信息
Front Immunol. 2022 Dec 7;13:984789. doi: 10.3389/fimmu.2022.984789. eCollection 2022.
OBJECTIVES
Several COVID-19 vaccines list "uncontrolled epilepsy" as a contraindication for vaccination. This consequently restricts vaccination against COVID-19 in patients with epilepsy (PWE). However, there is no strong evidence that COVID-19 vaccination can exacerbate conditions in PWE. This study aims to determine the impact of COVID-19 vaccination on PWE.
METHODS
PWE were prospectively recruited from 25 epilepsy centers. We recorded the seizure frequency at three time periods (one month before the first vaccination and one month after the first and second vaccinations). A generalized linear mixed-effects model (GLMM) was used for analysis, and the adjusted incidence rate ratio (AIRR) with 95% CI was presented and interpreted accordingly.
RESULTS
Overall, 859 PWE were included in the analysis. Thirty-one (3.6%) and 35 (4.1%) patients were found to have increased seizure frequency after the two doses, respectively. Age had an interaction with time. The seizure frequency in adults decreased by 81% after the first dose (AIRR=0.19, 95% CI:0.11-0.34) and 85% after the second dose (AIRR=0.16, 95% CI:0.08-0.30). In juveniles (<18), it was 25% (AIRR=0.75, 95% CI:0.42-1.34) and 51% (AIRR=0.49, 95% CI:0.25-0.95), respectively. Interval between the last seizure before vaccination and the first dose of vaccination (ILSFV) had a significant effect on seizure frequency after vaccination. Seizure frequency in PWE with hereditary epilepsy after vaccination was significantly higher than that in PWE with unknown etiology (AIRR=1.95, 95% CI: 1.17-3.24). Two hundred and seventeen (25.3%) patients experienced non-epileptic but not serious adverse reactions.
DISCUSSION
The inactivated COVID-19 vaccine does not significantly increase seizure frequency in PWE. The limitations of vaccination in PWE should focus on aspects other than control status. Juvenile PWE should be of greater concern after vaccination because they have lower safety. Finally, PWE should not reduce the dosage of anti-seizure medication during the peri-vaccination period.
目的
几种 COVID-19 疫苗将“未得到控制的癫痫”列为接种禁忌。这导致癫痫患者（PWE）不能接种 COVID-19 疫苗。然而，没有强有力的证据表明 COVID-19 疫苗接种会使 PWE 的病情恶化。本研究旨在确定 COVID-19 疫苗接种对 PWE 的影响。
方法
前瞻性地从 25 个癫痫中心招募 PWE。我们记录了三个时间段的癫痫发作频率（第一次接种前一个月、第一次接种后一个月和第二次接种后一个月）。采用广义线性混合效应模型（GLMM）进行分析，并用 95%CI 表示调整后的发病率比（AIRR）并进行相应解释。
结果
共有 859 名 PWE 纳入分析。分别有 31 名（3.6%）和 35 名（4.1%）患者在接种两剂后发现癫痫发作频率增加。年龄与时间存在交互作用。首次接种后，成人癫痫发作频率降低 81%（AIRR=0.19，95%CI：0.11-0.34），第二次接种后降低 85%（AIRR=0.16，95%CI：0.08-0.30）。青少年（<18 岁）患者分别为 25%（AIRR=0.75，95%CI：0.42-1.34）和 51%（AIRR=0.49，95%CI：0.25-0.95）。疫苗接种前最后一次癫痫发作与第一次疫苗接种之间的间隔时间（ILSFV）对疫苗接种后癫痫发作频率有显著影响。接种后遗传性癫痫患者的癫痫发作频率明显高于病因不明的癫痫患者（AIRR=1.95，95%CI：1.17-3.24）。217 名（25.3%）患者出现非癫痫但非严重不良反应。
讨论
灭活 COVID-19 疫苗不会显著增加 PWE 的癫痫发作频率。在 PWE 中，疫苗接种的限制不应仅限于控制状态。接种后青少年 PWE 应引起更大关注，因为他们的安全性较低。最后，PWE 不应在接种期间减少抗癫痫药物的剂量。
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