THE COVID-19 CORONAVIRUS: WHAT DOES IT MEAN FOR PEOPLE WITH EPILEPSY

In light of the global outbreak of the Corona virus and in accordance with Ministry of Health instructions aimed at containing this outbreak, it is only natural that specific questions arise about how it affects people with epilepsy.

ARE PEOPLE WITH EPILEPSY AT A HIGHER RISK OF CONTRACTING THE CORONA VIRUS OR A MORE SEVERE ILLNESS

• Children and adults with epilepsy but without any other background disease are not considered to be at higher risk of contracting the COVID-19 Corona virus of developing a more serious illness. Nevertheless, because it is a chronic disease, special attention should be paid to the instructions regarding the prevention of infection and to acting according to the recommendations issued to those in high-risk groups.
• People with epilepsy may be at increased risk for contracting the Corona virus or developing a more serious illness if they are in a group considered to be at higher risk among the general population: over 60 and/or if they have other illnesses such as diabetes, heart disease chronic kidney disease, chronic lung disease, or an illness that influences the immune system.
• The classic anti-epileptic medications do not increase the risk to contract the virus or other serious illness.

• Patients receiving medication that suppresses the immune system may be at higher risk of contracting the virus and of developing a serious illness. For eplileptics, these are orally administered steroids ACTH and mTOR inhibitors (Prednisone, Betnesol, Solumedrol, Synacthen, Afintor, Everolimus, Sirolimus, Votubia).
• Patients receiving treatment that suppresses the immune system or who are planned to start receiving such treatment should take special care to adhere to the cautionary measures recommended to the general public, to contact their neurologist and discuss continuation or initiation of treatment and receive relevant instructions. Do not stop treatment without consulting your neurologist. If he/she is unavailable, consult your family doctor/pediatrician.

IF I CONTRACT THE CORONA VIRUS, CAN IT CAUSE SEIZURES

• There is no evidence that the Corona virus may cause seizures.
• In general, certain people with epilepsy may experience an increase in the frequency of seizures when developing a fever or when contracting an infectious disease.
• Taking non-prescription medication, especially treatments for colds/ congestion/cough, or natural/herbal treatments may cause seizures or an increase in their frequency. Do not take any new non-prescription treatment, or treatment for alleviating symptoms of cold, congestion, and coughing without consulting your doctor.
• There is no problem in using Paracetamol (Acamol) or Dipyrone (Optalgin), Ibuprofen (Nurofen), Vitamin C.

WHAT SHOULD I DO DURING THE NEXT FEW DAYS AND HOW CAN I PREPARE FOR THE POSSIBILITY OF QUARANTINE

• It is important to continue taking anti-epileptic medication as prescribed by your doctor.
• Make sure you have a sufficient supply of medication in case you need to enter quarantine.
• Make sure you have a sufficient supply of Buccolam or Stesolid if you use them.
• There is currently no shortage of anti-epileptic medications.
• Prepare a weekly medicine divider in case your electronic reminder doesn't work.
• Think of help you will need in case you need to enter quarantine.
• For those living alone, prepare an updated list of medications and maintain contact with relatives/a friend/neighbor or someone else at least once a day.

HOW CAN I REDUCE THE RISK OF CONTRACTING CORONA

The following principles are relevant for the general population. At this stage, we recommend taking the same extra care recommended for the other high-risk populations.

• Avoid going to hospitals and health clinics unless absolutely necessary. If you have a scheduled an upcoming appointment with a neurologist, it is recommended to postpone it unless it is urgent (and there are no seizures) or to contact the clinic and check the possibility of conducting the consultation via the telephone or other media without physically visiting the clinic.
• People aged 60 and over and those defined as belonging to a high-risk group (people with chronic background diseases such as heart disease, diabetes, high blood pressure, respiratory diseases or people taking immunity-inhibiting medication) are recommended to avoid gatherings, contact with people who return from overseas (any country), people who have symptoms of congestion, fever or cough, and people suspected as being sick. Leave the house as much as possible.
• Avoid unnecessary travel, spending time in closed places and large-scale events.
• Limit close contact with other people. Maintain a reasonable distance from others when leaving the house.
• Wash your hands frequently.
• Avoid shaking hands, and hugging and kissing others.
• Avoid touching your eyes, nose and mouth as much as possible
• Clean surfaces you touch frequently with cleaning spray or wipes.

Prepared by Prof. Sara Eyal, Prof. Bruria Ben-Zeev and Dr. Iris Neumann, and The Israeli League Against Epilepsy

Sources:

1. American Epilepsy Society. Information on COVID-19. Last Updated: March 10, 2020. https://www.aesnet.org/about_aes/position_statements/covid-19

2. Epilepsy Foundation: Concern About Coronavirus. Authored by: Patty Obsorne Shafer RN, MN | Judy Gretsch on 3/2020. Reviewed by: Elaine Wirrell MD Jacqueline French MD on 3/2020. Originally published February 28, 2020. Revision 1 on March 4, 2020. https://www.epilepsy.com/article/2020/3/concerns-about-coronavirus

3. Epilepsy Action. Coronavirus: what does it mean for people with epilepsy? Last updated 5 March 2020. No further details available. https://www.epilepsy.org.uk/info/daily-life/safety/coronavirus

4. Tuberous Sclerosis Alliance: Corona Virus Disease 2019 ( FAQs) https://www.tsalliance.org/coronavirus-disease-2019-covid-19-questions-and-answers-faqs/