Impact of COVID-19 in Patients With Epilepsy: Higher Hospitalization, Death Rates

Among patients with epilepsy, the risk for mortality and hospitalization from COVID-19 infection is higher, according to study results published in Epilepsia.

Researchers conducted a retrospective cohort study to determine whether patients with epilepsy are at a greater risk for being hospitalized with and dying from COVID-19.

The primary outcomes of interest included COVID-19 hospitalization and death, both of which were analyzed using Cox proportional hazard models.

The researchers used the Secure Anonymised Information Linkage (SAIL) database to source hospital admission and demographic data for the entire population of Wales. Patients with epilepsy, defined as a primary care diagnosis and prescription of at least 2 antiseizure medications, living in Wales before or during the study period of March 2020 to June 2021 were identified and matched 1:5 to a control cohort.

A second control cohort was created using 5:1 exact matching for age, sex, and deprivation, as well as propensity-matching for comorbidities increasing risk for COVID-19 hospitalization and death. COVID-19 deaths were defined as having an International Statistical Classification of Diseases, Tenth Revision (ICD-10) code for COVID-19 on death certificates or occurring within 28 days of a positive SARS-CoV-2 polymerase chain reaction (PCR) test. COVID-19 hospitalizations were defined as having a COVID-19 ICD-10 code for the reason for admission or occurring within 28 days of a positive SARS-CoV-2 PCR test.

Overall, 27,279 patients with epilepsy (men, 51.1%; aged 16-65, 68.8%; intellectual disability, 15.8%) were matched to 136,395 patients (men, 51.1%; aged 16-65, 68.8%; diabetes, 6.7%) in the control cohort. Among patients with epilepsy, there were 158 (0.58%) COVID-19-related deaths and 933 (3.4%) COVID-19-related hospitalizations vs 370 (0.27%) deaths and 1871 (1.4%) hospitalizations attributable to COVID-19 among patients in the control cohort.

The hazard ratios (HRs) for COVID-19 death and COVID-19 hospitalization in patients with epilepsy and patients without epilepsy were 2.15 (95% CI, 1.78-2.59; P <.00001) and 2.15 (95% CI, 1.94-2.37; P <.00001), respectively. After adjusting for comorbidities, the HRs for COVID-19 death and COVID-19 hospitalization were 1.32 (95% CI, 1.08-1.62; P =.00680) and 1.60 (95% CI, 1.44-1.78; P <.00001), respectively.

When comparing patients with epilepsy to the control cohort 2, results were similar. The HRs for COVID-19 death and hospitalization were 1.45 (95% CI, 1.22-1.74) and 1.66 (95% CI, 1.51-1.83), respectively.

Study limitations included not accounting for geographical and temporal variation in COVID-19 prevalence and COVID-19 variants, the effect of COVID-19 vaccinations, prior infection with COVID-19, and changes in mental status associated with COVID-19.

“This may have implications for prioritizing future COVID-19 treatments and vaccinations for people with epilepsy,” the researchers concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Neurology Advisor