Epilepsy and COVID-19: Risks, vaccination, and safety

Anybody can acquire a SARS-CoV-2 infection and develop COVID-19. Some individuals — including those who are older, have a weakened immune system, or have underlying health conditions such as diabetes, chronic respiratory diseases, or cancer — may be at a higher risk of COVID-19 and its potential complications. However, no current evidence indicates that individuals living with epilepsy have an increased risk.

Additionally, the International League Against Epilepsy (ILAE) states that there is currently no evidence of increased risk of SARS-CoV-2 infection in people with epilepsy. The organization adds that unless an individual has a compromised immune system or other ongoing medical challenges, epilepsy is unlikely to increase the risk of complications. It also notes that anti-seizure medications do not increase the risk of infection or complications.

Experts know that coronaviruses, such as SARS-CoV-2, attack the nervous system. A retrospective 2020 case series notes that 36.4% of the participants with COVID-19 had neurological manifestations, including seizures.

Moreover, the ILAE mentions that there is a risk, albeit low, of seizures getting worse for most people with epilepsy if they acquire a SARS-CoV-2 infection. This is possible because illness, particularly with a fever, can stress the body and increase the risk and frequency of seizures.

COVID-19 can also cause symptoms, including fever, lack of sleep, and tiredness, that may trigger seizures and make them longer and more intense. However, a 2020 review suggests that the risk of having COVID-19-related seizures is low unless a person is critically ill or in the terminal stage of illness.

A 2019 study found that 8–34% of critically ill patients have seizures. These individuals can experience severe symptoms such as low oxygen levels in the blood, shock, hypoglycemia, hyperglycemia, metabolic and electrolyte imbalance, and multiorgan damage, which can cause seizures in people with or without epilepsy.

A 2021 study also indicates that inflammation of the brain or the membranes that surround it — known as encephalitis and meningitis, respectively — is the most common neurological complication of COVID-19. The second most common symptom of this complication is seizures.

A joint statement from the ILAE and the International Bureau for Epilepsy affirms that all individuals with epilepsy should receive the vaccine unless they are allergic to the vaccine ingredients.

At present, there is no evidence to indicate that having epilepsy is associated with a higher risk of potential COVID-19 vaccine side effects, including seizures. A 2021 study in Germany found that the vaccine is well-tolerated by people with epilepsy, with only 2 out of 54 patients experiencing epilepsy-related side effects.

However, as with any vaccine, a fever may develop as a side effect, which could lower the seizure threshold in some people. Taking paracetamol or acetaminophen regularly for 48 hours after the vaccine, or for the duration of the fever, should minimize this risk.

Most health experts advise that for people with epilepsy, the risk of COVID-19 and its potential complications far outweighs the possible risk of vaccine side effects.

The ILAE states that there is no evidence to suggest that anti-seizure medications may increase the risk of SARS-CoV-2 infection or possible complications.

Although a 2020 study highlights the importance of considering potential adverse effects and drug interactions in people with epilepsy who acquire a SARS-CoV-2 infection, most guidelines advise that people take a regular supply of medication to minimize the risk of seizure exacerbation.

There have been occasional reports of people having seizures for the first time after recovering from COVID-19. Some evidence suggests that seizures may be a potential manifestation of long COVID.

A 2020 case study reports on a person experiencing refractory status epilepticus due to postinfectious inflammation after their recovery from COVID-19. Another case study from 2021 involves a person experiencing an epileptic seizure after recovering from COVID-19.

The best way to prevent seizures due to SARS-CoV-2 infection is to avoid and limit exposure to the virus as much as possible. The Centers for Disease Control and Prevention (CDC) recommend that people help protect themselves and others by:

• getting a vaccination
• wearing a mask
• observing physical distancing
• limiting their attendance at poorly ventilated areas and crowded places
• washing the hands often
• cleaning and disinfecting surfaces regularly
• observing proper coughing and sneezing etiquette
• accomplishing daily health monitoring

People who find that fever, infection, and stress trigger their seizures may wish to consult a doctor for specific recommendations and an action plan. It is advisable for people with epilepsy to avoid crowded spaces, continue with their medical appointments, take their medications according to the prescription, and ensure that they have an ample supply of medicine.

If a person has a loved one with epilepsy living in a long-term care facility or group setting, they should confirm the safety precautions with the facility and ask the healthcare team whether any adjustments are necessary.

Some evidence suggests that seizures may be a rare neurological symptom that can occur during SARS-CoV-2 infection or after COVID-19 recovery.

People living with epilepsy do not have an increased risk of SARS-CoV-2 infection or complications of COVID-19. Health experts advise that individuals receive the vaccine and continue taking their anti-seizure medication.