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Leung WC, Ho RWH, Leung AKL, Chu FHN, Lo CNR, Chan AA, Chan CYC, Chan DYH, Chui JHY, Li WTV, Yeung EHL, Teo KC, Lau GKK, Chang RSK. Risk of Seizure Aggravation after COVID-19 Vaccinations in Patients with Epilepsy. Vaccines (Basel) 2024; 12:593. [PMID: 38932322 PMCID: PMC11209536 DOI: 10.3390/vaccines12060593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Although Coronavirus disease 2019 (COVID-19) vaccinations are generally recommended for persons with epilepsy (PwE), a significant vaccination gap remains due to patient concerns over the risk of post-vaccination seizure aggravation (PVSA). In this single-centre, retrospective cohort study, we aimed to determine the early (7-day) and delayed (30-day) risk of PVSA, and to identify clinical predictors of PVSA among PwE. Adult epilepsy patients aged ≥18 years without a history of COVID-19 infection were recruited from a specialty epilepsy clinic in early 2022. Demographic, epilepsy characteristics, and vaccination data were extracted from a centralized electronic patient record. Seizure frequency before and after vaccination, vaccination-related adverse effects, and reasons for or against vaccination were obtained by a structured questionnaire. A total of 786 PwEs were included, of which 27.0% were drug-resistant. At the time of recruitment, 74.6% had at least 1 dose of the COVID-19 vaccine. Subjects with higher seizure frequency (p < 0.0005), on more anti-seizure medications (p = 0.004), or had drug-resistant epilepsy (p = 0.001) were less likely to be vaccinated. No significant increase in seizure frequency was observed in the early (7 days) and delayed phases (30 days) after vaccination in our cohort. On the contrary, there was an overall significant reduction in seizure frequency 30 days after vaccination (1.31 vs. 1.89, t = 3.436; p = 0.001). This difference was seen in both types of vaccine (BNT162b2 and CoronaVac) and drug-resistant epilepsy, but just missed significance for the second dose (1.13 vs. 1.87, t = 1.921; p = 0.055). Only 5.3% had PVSA after either dose of vaccine. Higher pre-vaccination seizure frequency of ≥1 per week (OR 3.01, 95% CI 1.05-8.62; p = 0.04) and drug-resistant status (OR 3.32, 95% CI 1.45-249 7.61; p = 0.005) were predictive of PVSA. Meanwhile, seizure freedom for 3 months before vaccination was independently associated with a lower risk of PVSA (OR 0.11, 95% CI 0.04-0.28; p < 0.0005). This may guide epilepsy treatment strategies to achieve better seizure control for at least 3 months prior to vaccination. As COVID-19 shifts to an endemic phase, this study provides important data demonstrating the overall safety of COVID-19 vaccinations among PwE. Identification of high-risk patients with subsequent individualized approaches in treatment and monitoring strategies may alleviate vaccination hesitancy among PwE.
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Affiliation(s)
- William C.Y. Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Ryan Wui-Hang Ho
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Anthony Ka-Long Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Florinda Hui-Ning Chu
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Cheuk Nam Rachel Lo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Andrian A. Chan
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Cheuk Yan Claudia Chan
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Desmond Yin Hei Chan
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Jacklyn Hoi Ying Chui
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Wai Tak Victor Li
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Elton Hau Lam Yeung
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Kay Cheong Teo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Gary Kui-Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
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Costa B, Vale N. Virus-Induced Epilepsy vs. Epilepsy Patients Acquiring Viral Infection: Unravelling the Complex Relationship for Precision Treatment. Int J Mol Sci 2024; 25:3730. [PMID: 38612542 PMCID: PMC11011490 DOI: 10.3390/ijms25073730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/04/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The intricate relationship between viruses and epilepsy involves a bidirectional interaction. Certain viruses can induce epilepsy by infecting the brain, leading to inflammation, damage, or abnormal electrical activity. Conversely, epilepsy patients may be more susceptible to viral infections due to factors, such as compromised immune systems, anticonvulsant drugs, or surgical interventions. Neuroinflammation, a common factor in both scenarios, exhibits onset, duration, intensity, and consequence variations. It can modulate epileptogenesis, increase seizure susceptibility, and impact anticonvulsant drug pharmacokinetics, immune system function, and brain physiology. Viral infections significantly impact the clinical management of epilepsy patients, necessitating a multidisciplinary approach encompassing diagnosis, prevention, and treatment of both conditions. We delved into the dual dynamics of viruses inducing epilepsy and epilepsy patients acquiring viruses, examining the unique features of each case. For virus-induced epilepsy, we specify virus types, elucidate mechanisms of epilepsy induction, emphasize neuroinflammation's impact, and analyze its effects on anticonvulsant drug pharmacokinetics. Conversely, in epilepsy patients acquiring viruses, we detail the acquired virus, its interaction with existing epilepsy, neuroinflammation effects, and changes in anticonvulsant drug pharmacokinetics. Understanding this interplay advances precision therapies for epilepsy during viral infections, providing mechanistic insights, identifying biomarkers and therapeutic targets, and supporting optimized dosing regimens. However, further studies are crucial to validate tools, discover new biomarkers and therapeutic targets, and evaluate targeted therapy safety and efficacy in diverse epilepsy and viral infection scenarios.
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Affiliation(s)
- Bárbara Costa
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Nuno Vale
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
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