Jacqueline French, MD, discusses important considerations during the COVID-19 pandemic for those with epilepsy
Professor of Neurology at NYU Langone Hospital and Chief Medical and Innovation Officer of the Epilepsy Foundation Dr. Jacqueline French hosted a Facebook Live for the American Brain Foundation where she discussed epilepsy and COVID-19. She was the first author of a paper, “Keeping people with epilepsy safe during the COVID-19 pandemic,” and in her video she shares some takeaways from the paper along with her experience—answering common questions and providing physician guidelines for keeping epilepsy patients safe during the pandemic. For more information on how to keep epilepsy patients out of hospitals and safe at home, watch her video below.
Considerations for Epilepsy Patients
Dr. French acknowledges that at this time it does not seem like patients with epilepsy have required hospital visits for COVID-19 at a higher rate than the rest of the population. Furthermore, it appears that COVID-19 does not substantially increase the risk of an early seizure or of people presenting with newly diagnosed seizures (although this may happen rarely). However, she explains that a few factors may increase epilepsy patients’ risk for contracting the virus.
Those with focal impaired seizures might experience an altered state of awareness and be unable to maintain proper social distancing protocols—and as a result, put themselves at risk. Others with automatisms may also come in contact with contaminated surfaces unintentionally. She recommends physicians discuss these seizure characteristics and the possible risks with their patients in order to decide whether it is safe for them to go outside alone, if they need a companion to accompany them or if they should stay indoors.
Additionally, Dr. French explains that there is currently no evidence that wearing a mask would block the airway of someone with epilepsy; however, the type of mask—for instance, masks with ties—may pose a hazard for some patients.
Guidelines for Physicians to Keep Epilepsy Patients Safe During the COVID-19 Pandemic
Dr. French explains that keeping epilepsy patients safe during the pandemic involves preventing breakout seizures and, if a seizure happens, lessening the chance that the patient ends up in the emergency department. “We want to, as far as we possibly can, keep people at home taking care of their seizures,” she says. Epilepsy patients in the ED may contribute to the high demand already placed on hospitals, risk COVID-19 infection and face long wait times and single-patient policies that might involve separating caregivers from patients in the examining room.
She offers the following three tips for physicians when it comes to keeping patients with epilepsy safe:
- Recognize that people with epilepsy who are sheltered in place have experienced a disruption in their routines. During telehealth appointments, physicians should talk to their patients about their medical adherence, if they are remembering to take their medication, and, if not, offer suggestions such as using a pill box.
- Help patients obtain their medication. Dr. French recommends healthcare providers prescribe a one- to three-month supply of medications to help keep patients with epilepsy out of hospitals.
- Give patients an action to take if they have a breakthrough seizure at home. Physicians can prescribe a rescue medication to be taken orally, such as lorazepam or diazepam, to buy time for the patient’s family to call their doctor. For those with cluster seizures, a diazepam or midazolam nasal spray would hit the bloodstream faster. Giving a prescription for one to two weeks ensures they have something in case of an attack.
Resources for Physicians and Patients
Dr. French also provides additional resources for physicians looking for information on COVID-19 and seizures. You can find these resources listed below.
- American Epilepsy Society’s COVID-19 page
- National Association of Epilepsy’s list of COVID-19 resources for members
- International League Against Epilepsy’s resources for patients, providers and researchers
- International Bureau for Epilepsy’s resource page for healthcare providers
- Brain & Life’s COVID-19 and Epilepsy page
“When you do a telehealth visit, the first thing the patient is going to ask is about the risk of COVID, the risk to them of COVID and what they should do to protect themselves. It’s important to be able to give the person with epilepsy reading material that’s frequently updated,” Dr. French says. She recommends the American Epilepsy Society’s COVID-19 resource page for patients and families for further reading.
By keeping patients out of the emergency room and providing them with the resources to manage their epilepsy symptoms at home, physicians can arrange for care while lowering patients’ risk for COVID-19 infection.
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