Impact of COVID-19 vaccine on epilepsy in adult subjects: an Italian multicentric experience

• Published in: Neurological sciences Vol. 43; no. 8; pp. 4627 - 4634
• Main Authors: Romozzi, Marina, Rollo, Eleonora, Quintieri, Paolo, Dono, Fedele, Evangelista, Giacomo, Consoli, Stefano, Veleno, Luigi, Anzellotti, Francesca, Calvello, Carmen, Costa, Cinzia, Servidei, Serenella, Calabresi, Paolo, Vollono, Catello
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2022; Springer Nature B.V
• Subjects: Adult; Aged; Anticonvulsants - therapeutic use; Caffeine; Convulsions & seizures; Coronaviruses; Covid-19; COVID-19 - complications; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - adverse effects; Drug resistance; Epilepsy; Epilepsy - drug therapy; Humans; Immunization; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Patients; Psychiatry; SARS-CoV-2; Seizures; Severe acute respiratory syndrome coronavirus 2; Vaccines; Vaccines - therapeutic use; COVID-19; Vaccine; Coronavirus; Epilepsy; Seizures
• ISSN: 1590-1874; 1590-3478; 1590-3478
• DOI: 10.1007/s10072-022-06100-0

Objectives To investigate the safety and tolerability of COVID-19 vaccines in people with epilepsy (PwE). Methods In this multicentric observational cohort study, we recruited adult patients (age > 18 years old) with epilepsy who attended the Outpatient Epilepsy Clinic from 1st July to 30th October 2021. We administered to the patients a structured questionnaire and interview on demographic and epilepsy characteristics, current treatment, previous SARS-CoV-2 infection, vaccine characteristics, post-vaccine seizure relapse, other side effect, variation of sleep habits, caffeine, or alcohol intake. Seizure frequency worsening was defined as a ratio between mean monthly frequency post-vaccination and mean monthly frequency pre-vaccination superior to 1. Patients were categorized in two groups: patients with seizure frequency worsening (WORSE) and patients with seizure stability (STABLE). Results A total of 358 people participated with a mean age of 47.46 ± 19.04. Focal seizure (79.1%), generalized epilepsy (20.4%), and unknown types of epilepsy (0.5%) were detected among participants. In total, 31 (8.7%) people expressed that they were not willing to receive a COVID-19 vaccine; 302 patients (92.35%) did not experience an increase in the seizure frequency (STABLE-group) whereas 25 patients (7.65%) had a seizure worsening (WORSE-group). Post-vaccine seizures occurred mainly in the 7 days following the administration of the vaccine. Patients in the WORSE-group were treated with a mean higher number of anti-seizure medication (ASMs) ( p  = 0.003) and had a higher pre-vaccine seizure frequency ( p  = 0.009) compared with patients in the STABLE-group. Drug-resistant epilepsy was also associated with seizure worsening ( p  = 0.01). One-year pre-vaccination seizure frequency pattern demonstrated that patients in the WORSE-group had a higher frequency pattern ( p  < 0.001). Multivariate analysis of the vaccinated group showed that only the seizure frequency pattern (confidence interval [CI] = 1.257–2.028; p  < 0.001) was significantly associated with seizure worsening. Conclusion In our cohort of vaccinated PwE, only a little percentage had a transient short-term increase of seizure frequency. The present study demonstrates that COVID-19 vaccines have a good safety and tolerability profile in the short term in PwE.