Since the declaration of the State of Alarm (RD463/2020) as an emergency measure to prevent the spread of SARS-CoV2 infection (COVID-19), the population has become aware of the seriousness of the current pandemic. Although data suggest that children are at less risk of developing a severe respiratory illness than adults, those with chronic pathologies such as those suffering from epilepsy, wonder if they are at greater risk than the healthy population.
What is epilepsy?
Epilepsy is one of the most common neurological disorders. It affects more than 50 million people worldwide, a large proportion of whom are children.
It is a very heterogeneous disorder from a clinical, etiological (causal) and evolutionary point of view, which predisposes the sufferer to repeated seizures.
Epileptic seizures are very common in childhood, however, it is important to emphasize that having an isolated seizure does not imply having epilepsy. At least 2 unprovoked seizure episodes are necessary to be able to say that this person suffers from epilepsy. In other words, a child who only has seizures provoked by fever does not have epilepsy.
The causes in childhood are very varied and although they are often due to brain lesions, there are many types of epilepsy that are benign and often disappear on their own with age.
Despite the great concern that a diagnosis of epilepsy represents for a family, we must emphasize that currently we have multiple effective treatments (drugs, diet, epilepsy surgery … etc) and we manage to control seizures in up to 70% of cases.
Are people with epilepsy considered “at risk”?
At this point we must be categorical, epilepsy by itself does not increase the risk of infection by coronavirus, nor the severity of the process in the case of infection. However, some children suffering from epilepsy, either due to drugs or to various pathologies associated with their disease, may be at risk:
1. 1. Those who take drugs for seizure control or for some added pathology that may weaken their immune system:
- Immunotherapy: corticosteroids, immunogloblins, ACTH.
- Immunosuppressive drugs: azathioprine, mycophenolate, cyclophosphamide, methotrexate, cyclosporine, tacrolimus, sirolimus, rituximab, etanercep…etc.
1. 2. Those with other associated neurological pathologies that affect the muscles and may have a weakened respiratory system:
- Severe cerebral palsy
- Neuromuscular diseases
- Dysphagia with risk of aspiration and therefore pneumonia.
1. 3. Those with associated medical pathology that increases the risk by itself:
- Heart disease
- Pulmonary pathology such as bronchopulmonary dysplasia, which large premature babies may suffer from.
- Diabetes mellitus…etc.
This point is controversial. Although it is true that in the series of patients described in other populations that have been infected before us, a greater susceptibility to suffer seizures associated with the infection has not been described, it is true that the fact of having fever is a risk factor for decompensating patients suffering from epilepsy and provoking in itself febrile seizures in susceptible children (even if they do not suffer from epilepsy).
What should I do if I notice a change or increase in epileptic seizures?
Whether they are in the context of the infectious process or not, a change in the frequency or intensity of the seizures requires consultation with the pediatric neurologist of reference, if possible by telepathic means to avoid the use of hospital emergency services.
- If the seizure is with fever, it is probably only necessary to monitor the frequency and to resort to rescue drugs (rectal diazepam or oral midazolam) if the seizures last a long time.
- If they are not related to fever, we should assess compliance with treatment and the dose of drugs adjusted for weight. If we can, we will adjust the medication.
- If, however, the seizures are of long duration or are not controlled over time, regardless of whether or not they are with fever, the patient should be evaluated urgently.
Another question that arises in times of health emergencies such as the one we are experiencing is whether they will find the medications in the usual pharmacy. To this question we must answer that Spain today is a country that has no supply problems and pharmaceutical products are considered a basic necessity. Therefore, barring any incidents, it is logical that there will be no problem in obtaining the medication.
We can only encounter a supply problem in the event that the electronic medical prescription expires. In this case we will try to contact the neuropediatrician to renew the prescription without having to go to the hospital.
What happens with the tests I have pending?
If the epilepsy is controlled, neither the performance of an Electroencephalogram (EEG) or a brain imaging test (Magnetic Resonance Imaging) will change the therapeutic attitude. Therefore, I can wait for the epidemic to pass.
In summary, it is essential to eliminate false myths about childhood epilepsy and to emphasize that children with epilepsy can have a full life and do the same things as the rest of their peers (sport, study, etc…). In this way, they will also have the same risks against coronavirus infection.