To better understand the impact of the COVID-19 pandemic on seizure frequency in patients with epilepsy (PWE) with an RNS implanted.

The COVID-19 pandemic represents a challenge to care of PWE. Some reports suggest COVID-19 can cause increased seizures in PWE, which may be related to psychosocial distress during the pandemic. Conversely, the pandemic may have brought about a decrease in daily demands and stressors, which could cause decreased seizure frequency in PWE. While surveys and record reviews provide some indication of the effect of the pandemic on seizures, RNS can potentially provide more accurate counts.

Patients with an RNS system implanted before September 2019 were included. We analyzed the weekly number of long episodes counts (LEC) as a proxy for seizures for 6 months (26 weeks) prior to the COVID-19 pandemic declaration (Sep 2019-Mar 2020) and after the declaration (Mar 2020-Sep 2020). Additionally, telephone surveys and chart review were conducted to assess patient mental health during the pandemic. The correlation between change in LEC and reported stressors was assessed.

Twenty patients were included. The average age was 41.2 years (SD=11.9). Thirteen (65%) patients were male. Comparing the pre-COVID-19 period to COVID-19 period, we found 5 (25%) patients had increased LEC compared to 15 (75%) patients who did not have significant increase in LEC. Change in anti-seizure medications (p = 0.031) and bilateral seizure types (p=0.031) were associated with an increase in LEC. Anxiety(p=1.00), depression(p=0.58), and sleep disturbances(p=1.00) were not significantly correlated with increases in LEC.

Contrary to some published literature, we did not find a significant increase in seizures following the pandemic when assessed using the objective measure of RNS LEC and subjective self-reports on a telephone survey. Additionally, we did not find a correlation between pandemic-related stress and seizures in those who were found to have increased seizures.