1
|
Freund BE, Feyissa AM. EEG as an indispensable tool during and after the COVID-19 pandemic: A review of tribulations and successes. Front Neurol 2022; 13:1087969. [PMID: 36530612 PMCID: PMC9755176 DOI: 10.3389/fneur.2022.1087969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 10/03/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, elective and non-emergent tests and procedures were delayed or suspended in lieu of diverting resources to more emergent treatment of critically ill patients and to avoid the spread and contraction of COVID-19. Further, the workforce was stretched thin, and healthcare facilities saw high turnover rates for full-time and contract employees, which strained the system and reduced the ability to provide clinical services. One of the casualties of these changes was electroencephalography (EEG) procedures, which have been performed less frequently throughout the world since the pandemic. Whether considered routine or emergent, the deferral of EEG studies can cause downstream effects, including a delay in diagnosis and initiation of treatment for epilepsy and non-epileptic seizures resulting in a higher risk of morbidity and mortality. Despite these limitations, the importance and utility of EEG and EEG technologists have been reinforced with the development of COVID-related neurological complications, including encephalopathy and seizures, which require EEG for diagnosis and treatment. Since the pandemic, reliance on remote telemonitoring has further highlighted the value and ease of using EEG. There has also been a heightened interest in rapid EEG devices that non-technologist professionals can attach quickly, allowing minimum patient contact to avoid exposure to COVID-19 and taking advantage of remote EEG monitoring. This review discusses the acute and potential long-term effects of the COVID-19 pandemic on the use and performance of EEG.
Collapse
Affiliation(s)
| | - Anteneh M. Feyissa
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, United States
| |
Collapse
|
2
|
Kuroda N, Kubota T, Horinouchi T, Ikegaya N, Kitazawa Y, Kodama S, Kuramochi I, Matsubara T, Nagino N, Neshige S, Soga T, Takayama Y, Sone D. Impact of COVID-19 pandemic on epilepsy care in Japan: A national-level multicenter retrospective cohort study. Epilepsia Open 2022; 7:431-441. [PMID: 35633311 PMCID: PMC9348370 DOI: 10.1002/epi4.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/25/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The impact of the coronavirus disease 2019 (COVID-19) pandemic on epilepsy care across Japan was investigated by conducting a multicenter retrospective cohort study. METHODS This study included monthly data on the frequency of (1) visits by outpatients with epilepsy, (2) outpatient electroencephalography (EEG) studies, (3) telemedicine for epilepsy, (4) admissions for epilepsy, (5) EEG monitoring, and (6) epilepsy surgery in epilepsy centers and clinics across Japan between January 2019 and December 2020. We defined the primary outcome as epilepsy-center-specific monthly data divided by the 12-month average in 2019 for each facility. We determined whether the COVID-19 pandemic-related factors (such as year [2019 or 2020], COVID-19 cases in each prefecture in the previous month, and the state of emergency) were independently associated with these outcomes. RESULTS In 2020, the frequency of outpatient EEG studies (-10.7%, p<0.001) and cases with telemedicine (+2,608%, p=0.031) were affected. The number of COVID-19 cases was an independent associated factor for epilepsy admission (-3.75*10-3 % per case, p<0.001) and EEG monitoring (-3.81*10-3 % per case, p = 0.004). Further, the state of emergency was an independent factor associated with outpatient with epilepsy (-11.9%, p<0.001), outpatient EEG (-32.3%, p<0.001), telemedicine for epilepsy (+12,915%, p<0.001), epilepsy admissions (-35.3%; p<0.001), EEG monitoring (-24.7%: p<0.001), and epilepsy surgery (-50.3%, p<0.001). SIGNIFICANCE We demonstrated the significant impact that the COVID-19 pandemic had on epilepsy care. These results support those of previous studies and clarify the effect size of each pandemic-related factor on epilepsy care.
Collapse
Affiliation(s)
- Naoto Kuroda
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Pediatrics, Wayne State UniversityDetroitMichiganUSA
| | - Takafumi Kubota
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurology, University Hospitals of Cleveland Medical CenterCase Western Reserve UniversityClevelandOhioUSA
| | - Toru Horinouchi
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Psychiatry and NeurologyHokkaido University Graduate School of MedicineSapporoJapan
| | - Naoki Ikegaya
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurosurgery, Graduate School of MedicineYokohama City UniversityYokohamaJapan
| | - Yu Kitazawa
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurology and Stroke MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Satoshi Kodama
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Izumi Kuramochi
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Psychiatry, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Teppei Matsubara
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Naoto Nagino
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Epilepsy Center, TMG Asaka Medical CenterSaitamaJapan
| | - Shuichiro Neshige
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima UniversityGraduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Temma Soga
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of EpileptologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Yutaro Takayama
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurosurgery, National Center HospitalNational Center of Neurology and PsychiatryTokyoJapan
| | - Daichi Sone
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyLondonUK
| | | |
Collapse
|
3
|
A Comprehensive Review of Neuromuscular Manifestations of COVID-19 and Management of Pre-Existing Neuromuscular Disorders in Children. J Clin Med 2022; 11:jcm11040934. [PMID: 35207206 PMCID: PMC8876161 DOI: 10.3390/jcm11040934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
Since the emergence of SARS-CoV-2, several studies have been published describing neuromuscular manifestations of the disease, as well as management of pre-existing pediatric neuromuscular disorders during the COVID-19 pandemic. These disorders include muscular dystrophies, myasthenic syndromes, peripheral nerve disorders, and spinal muscular atrophy. Such patients are a vulnerable population due to frequent complications such as scoliosis, cardiomyopathy, and restrictive lung disease that put them at risk of severe complications of COVID-19. In this review, neuromuscular manifestations of COVID-19 in children and the management of pre-existing pediatric neuromuscular disorders during the COVID-19 pandemic are discussed. We also review strategies to alleviate pandemic-associated disruptions in clinical care and research, including the emerging role of telemedicine and telerehabilitation to address the continued special needs of these patients.
Collapse
|
4
|
Kuroda N, Kubota T, Horinouchi T, Ikegaya N, Kitazawa Y, Kodama S, Matsubara T, Nagino N, Neshige S, Soga T, Sone D, Takayama Y, Kuramochi I. Risk factors for psychological distress in electroencephalography technicians during the COVID-19 pandemic: A national-level cross-sectional survey in Japan. Epilepsy Behav 2021; 125:108361. [PMID: 34768059 PMCID: PMC8491964 DOI: 10.1016/j.yebeh.2021.108361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify the risk factors for psychological distress in electroencephalography (EEG) technicians during the coronavirus disease 2019 (COVID-19) pandemic. METHOD In this national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan), which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES), a questionnaire was administered to 173 technicians engaged in EEG at four clinics specializing in epilepsy care and 20 hospitals accredited as (quasi-) epilepsy centers or epilepsy training facilities in Japan from March 1 to April 30, 2021. We collected data on participants' profiles, information about work, and psychological distress outcome measurements, such as the K-6 and Tokyo Metropolitan Distress Scale for Pandemic (TMDP). Linear regression analysis was used to identify the risk factors for psychological distress. Factors that were significantly associated with psychological distress in the univariate analysis were subjected to multivariate analysis. RESULTS Among the 142 respondents (response rate: 82%), 128 were included in the final analysis. As many as 35.2% of EEG technicians have been under psychological distress. In multivariate linear regression analysis for K-6, female sex, examination for patients (suspected) with COVID-19, and change in salary or bonus were independent associated factors for psychological distress. Contrastingly, in multivariate linear regression analysis for TMDP, female sex, presence of cohabitants who had to be separated from the respondent due to this pandemic, and change in salary or bonus were independent associated factors for psychological distress. CONCLUSION We successfully identified the risk factors associated with psychological distress in EEG technicians during the COVID-19 pandemic. Our results may help in understanding the psychological stress in EEG technicians during the COVID-19 pandemic and improving the work environment, which is necessary to maintain the mental health of EEG technicians.
Collapse
Affiliation(s)
- Naoto Kuroda
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Pediatrics, Wayne State University, Detroit, MI, USA,Corresponding authors at: Department of Pediatrics, Wayne State University, 3901 Beaubien St, Detroit, MI 48201, USA (N. Kuroda). Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan (N. Ikegaya)
| | - Takafumi Kubota
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Neurology, University Hospitals of Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Toru Horinouchi
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Psychiatry and Neurology, Hokkaido University Graduate School of Medicine, Japan
| | - Naoki Ikegaya
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Japan,Corresponding authors at: Department of Pediatrics, Wayne State University, 3901 Beaubien St, Detroit, MI 48201, USA (N. Kuroda). Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan (N. Ikegaya)
| | - Yu Kitazawa
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Japan
| | - Satoshi Kodama
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Teppei Matsubara
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Naoto Nagino
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Epilepsy Center, TMG Asaka Medical Center, Japan
| | - Shuichiro Neshige
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan
| | - Temma Soga
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Daichi Sone
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, United Kingdom
| | - Yutaro Takayama
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Japan
| | - Izumi Kuramochi
- Japan Young Epilepsy Section (YES-Japan), Kodaira, Tokyo, Japan,Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - IMPACT-J EPILEPSY (In-depth Multicenter analysis during Pandemic of Covid19 Throughout Japan for Epilepsy practice) study groupKanemotoKousukeoIkedaAkiopTeradaKiyohitoqGojiHirokooOharaShinjirHagiwaraKoichisKamadaTakashisIidaKojitIshikawaNobutsuneuShiraishiHideakivIwataOsatowSuganoHidenorixIimuraYasushixHigashiTakuichiroyHosoyamaHiroshiyHanayaRyosukeyShimotakeAkihirozKikuchiTakayukiaaYoshidaTakeshiabShigetoHiroshiacYokoyamaJunadMukainoTakahikoadKatoMasaakiaeSekimotoMasanoriaeMizobuchiMasahiroafAburakawaYokoafIwasakiMasakimNakagawaEijiagIwataTomohiroahTokumotoKentaroaiNishidaTakujiaiTakahashiYukitoshiaiKikuchiKenjiroajMatsuuraRyukiajHamanoShin-ichiroajYamanouchiHideoakWatanabeSatsukialFujimotoAyatakaamEnokiHideoamTomotoKyoichianWatanabeMasakoaoTakuboYoujiaoFukuchiToshihikoapNakamotoHidetoshiiKubotaYuichiiKuniiNaotoaqShirotaYuichiroarIshikawaEiichiasNakasatoNobukazukMaeharaTaketoshiatInajiMotokiatTakagiShunsukeauEnokizonoTakashiavMasudaYosukeawHayashiTakahiroeDepartment of Neurosurgery, Graduate School of Medicine, Yokohama City University, JapanEpilepsy Center, TMG Asaka Medical Center, JapanDepartment of Epileptology, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, JapanNeuropsychiatric Department, Aichi Medical University, JapanDepartment of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, JapanYokohama Minoru Epilepsy & Developmental Clinic, JapanDepartment of Neurosurgery, Fukuoka Sanno Hospital, JapanEpilepsy and Sleep Center, Fukuoka Sanno Hospital, JapanDepartment of Neurosurgery, Epilepsy Center, Hiroshima University, Graduate School of Biomedical and Health Sciences, JapanDepartment of Pediatrics, Epilepsy Center, Hiroshima University, Graduate School of Biomedical and Health Sciences, JapanDepartment of Pediatrics, Hokkaido University Hospital, Epilepsy Center, JapanIwata Clinic, JapanDepartment of Neurosurgery, Juntendo University, Epilepsy Center, JapanDepartment of Neurosurgery, Kagoshima University, Graduate School of Medical and Dental Sciences, JapanDepartment of Neurology, Kyoto University, Graduate School of Medicine, JapanDepartment of Neurosurgery, Kyoto University, Graduate School of Medicine, JapanDepartment of Pediatrics, Kyoto University, Graduate School of Medicine, JapanDivision of Medical Technology, Department of Health Sciences, Kyushu University, Graduate School of Medical Sciences, JapanNeurological Institute, Department of Neurology, Kyushu University, Graduate School of Medical Sciences, JapanMusashino Kokubunji Clinic, JapanDepartment of Neurology, Nakamura Memorial Hospital, JapanDepartment of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, JapanDepartment of Psychiatry, National Defense Medical College, JapanEpilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, JapanDivision of Neurology, Saitama Children’s Medical Center, JapanDepartment of Pediatrics, Saitama Medical University, Comprehensive Epilepsy Center, JapanDepartment of Psychiatry, Saitama Medical University, Comprehensive Epilepsy Center, JapanComprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, JapanDepartment of Neurosurgery, Seirei Hamamatsu General Hospital, JapanShinjuku Neuro Clinic, JapanSuzukake Clinic, JapanDepartment of Neurosurgery, The University of Tokyo, Graduate School of Medicine, JapanDepartment of Clinical Laboratory Medicine, The University of Tokyo, Graduate School of Medicine, JapanDepartment of Neurosurgery, The University of Tsukuba, Faculty of Medicine, JapanDepartment of Neurosurgery, Tokyo Medical and Dental University, JapanDepartment of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University, JapanDepartment of Pediatrics, University of Tsukuba Hospital, JapanDepartment of Neurosurgery, University of Tsukuba Hospital, Japan
| |
Collapse
|
5
|
Tatum WO, Desai N, Feyissa A. Ambulatory EEG: Crossing the divide during a pandemic. Epilepsy Behav Rep 2021; 16:100500. [PMID: 34778740 PMCID: PMC8578031 DOI: 10.1016/j.ebr.2021.100500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
The COVID-19 pandemic forced temporary closure of epilepsy monitoring units across the globe due to potential hospital-based contagion. As COVID-19 exposures and deaths continues to surge in the United States and around the world, other types of long-term EEG monitoring have risen to fill the gap and minimize hospital exposure. AEEG has high yield compared to standard EEG. Prolonged audio-visual video-EEG capability can record events and epileptiform activity with quality like inpatient video-EEG monitoring. Technological advances in AEEG using miniaturized hardware and wireless secure transmission have evolved to small portable devices that are perfect for people forced to stay at home during the pandemic. Application of seizure detection algorithms and Cloud-based storage with real-time access provides connectivity to AEEG interpreters during prolonged "shut-down". In this article we highlight the benefits of AEEG as an alternative to diagnostic inpatient VEM during the paradigm shift to mobile heath forced by the Coronavirus.
Collapse
Affiliation(s)
| | - Nimit Desai
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
6
|
The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic. Epilepsy Behav 2021; 122:108229. [PMID: 34364025 PMCID: PMC8302842 DOI: 10.1016/j.yebeh.2021.108229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has impacted admission to epilepsy monitoring units (EMUs) for classification and presurgical evaluation of patients with refractory epilepsy. We modified the EMU admission protocol via anti-seizure medications (ASM) withdrawal implemented one day before admission; thus, we aimed to evaluate the efficacy and safety of this modified protocol. METHODS In January 2021, we initiated ASM tapering 24 h before-rather than on the first day after-EMU admission, contrasting with the previous protocol. We retrospectively reviewed EMU admissions between January and April of 2018, 2019, and 2021, and identified the time required to record the first seizure, and EMU yield to confirm or change the epilepsy classification. We also evaluated the safety of the modified protocol, by monitoring the seizure frequency for up to 5 months after the discharge from the hospital. RESULTS One hundred four patients were included (mean age: 30 years, men: 43%); excluding a longer disease duration and abundance of normal routine electro-encephalogram (EEG) in patients admitted before the pandemic, no differences were observed in patients' characteristics. On average, it took 41 h and 21 h to record the first seizure using the standard and modified protocols, respectively (p < 0.001, 95% CI: 10-30). Other characteristics were investigated both before and after the COVID-19 pandemic, and epilepsy classifications were confirmed twice using the modified protocol (OR = 2.4, p = 0.04, 95% CI: 1.1-5.5). Multivariate regression analysis confirmed the shorter time to record the first seizure using the modified admission protocol (23 h less, p < 0.001; 95% CI: 12-34). Finally, 36 (86%) patients admitted during the pandemic exhibited no increase in seizure frequency after the discharge from the hospital. CONCLUSIONS Initiating ASM withdrawal one day before EMU admission was deemed to be an efficient and safe way to confirm epilepsy classification and significantly decrease the length of hospital stay. Ultimately, this will shorten the long waiting list for EMU admission created by the COVID-19 pandemic.
Collapse
|