Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Chongqing, China.
Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
Epilepsia Open. 2023 Sep;8(3):1133-1141. doi: 10.1002/epi4.12794. Epub 2023 Jul 28.
Despite strong evidence on the safety and tolerability of the COVID-19 vaccine, data on vaccination in children with epilepsy, particular younger children with specific epilepsy syndromes, are limited. The protective effects of vaccination against seizure increase upon COVID-19 infection also remain to be elucidated.
Questionnaire surveys were distributed online via an established WeChat group for patient management as well as in our outpatient clinic. The data collected included demographics and clinical information related to COVID-19 vaccination and infection. Detailed information related to epilepsy diagnosis and treatment was also collected from our patient database. Logistic regression analysis was performed to determine the factors associated with non-vaccination. The characteristics of seizures following COVID-19 infection were described.
In total, 354 suitable questionnaires were included in the study. The median age at survey was 6 years (interquartile range 4, 9). The most common epilepsy syndrome was self-limited epilepsy (n = 153, 43.2%), followed by developmental and/or epileptic encephalopathy (D/EE, n = 81, 22.9%) and genetic generalized epilepsy (n = 59, 16.7%). The vaccine uptake rate was 43.8% (n = 155), and all related side-effects (n = 11, 7.1%) remitted spontaneously. Younger age (odds ratio [OR] = 0.877, P = 0.001), D/EE (OR = 5.096, P = 0.008), and less than six months seizure-freedom before vaccination (OR = 3.026, P = 0.005) were associated with unwillingness to be vaccinated. There were no significant differences in the rate of COVID-19 infection (33.7% vs 32.7%, P = 0.879) and resultant increased seizure activity following infection between the vaccinated and unvaccinated groups after propensity score matching (9.1% vs 15.6%, P = 0.428).Three unvaccinated cases of Dravet syndrome developed status epilepticus following COVID-19 infection.
Vaccination against COVID-19 is safe and well tolerated in children, even in younger patients with D/EE. Although the risk of worsening seizures following COVID-19 infection may not be reduced by immunization, education focused on increased vaccination in pediatric epilepsy is still warranted.
尽管有大量证据表明 COVID-19 疫苗的安全性和耐受性良好，但关于儿童接种疫苗的数据，尤其是特定癫痫综合征的年幼儿童的数据有限。疫苗接种对 COVID-19 感染后癫痫发作的保护作用仍有待阐明。
通过已建立的微信群组对患者管理以及我们的门诊进行在线问卷调查。收集的数据包括与 COVID-19 疫苗接种和感染相关的人口统计学和临床信息。还从我们的患者数据库中收集了有关癫痫诊断和治疗的详细信息。采用 logistic 回归分析确定与未接种相关的因素。描述了 COVID-19 感染后癫痫发作的特征。
共有 354 份合适的问卷纳入研究。调查时的中位年龄为 6 岁（四分位距 4，9）。最常见的癫痫综合征是自限性癫痫（n=153，43.2%），其次是发育性和/或癫痫性脑病（D/EE，n=81，22.9%）和遗传性全面性癫痫（n=59，16.7%）。疫苗接种率为 43.8%（n=155），所有相关副作用（n=11，7.1%）均自行消退。年龄较小（比值比[OR] = 0.877，P=0.001）、D/EE（OR = 5.096，P=0.008）和接种前不到 6 个月无癫痫发作（OR = 3.026，P=0.005）与不愿接种有关。在倾向性评分匹配后，疫苗接种组和未接种组 COVID-19 感染率（33.7%比 32.7%，P=0.879）和感染后癫痫发作增加率无显著差异（9.1%比 15.6%，P=0.428）。3 例未接种的德雷夫特综合征患儿在 COVID-19 感染后出现癫痫持续状态。
COVID-19 疫苗在儿童中安全且耐受性良好，即使是患有 D/EE 的年幼患者也是如此。尽管免疫接种可能无法降低 COVID-19 感染后癫痫发作恶化的风险，但仍需关注儿科癫痫患者增加疫苗接种的教育。
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