Abstracts

Rationale: Novel coronavirus-19 (COVID) emerged in 12/2019, resulting in a pandemic. COVID-19 infection has been reported to increase seizures in up to 17.5% of adult epilepsy patients.[1] As availability of doses increased, vaccine eligibility in the US expanded to all adults without medical exclusions in mid-April 2021. COVID vaccination may be especially important in epilepsy patients as COVID infection is associated with higher-than-expected case-fatality ratio compared to patients without comorbid medical conditions.[2]

Vaccine hesitancy refers to delay in acceptance or refusal of vaccine despite availability to that person. Causes for hesitancy are complex and context specific, including lack of confidence, complacency, and inconvenience.[3] In addition to social, political and personal reasons shared with the general population, epilepsy patients may have hesitancy by the perception that the vaccine itself risks seizures. For seizure-free patients, any seizure recurrence can risk loss of driving and employment.

We studied a population of COVID vaccine eligible adult epilepsy patients and review vaccine compliance and hesitancy, to compare seizure exacerbations following vaccine or COVID infection.

Methods: We conducted a retrospective review of new and established adult epilepsy clinic patients between 4/2021 and 11/2021 at Atrium Health Wake Forest Baptist.  All patients had a confirmed clinical diagnosis of epilepsy, and those ineligible for COVID vaccine were excluded.  We reviewed age, race, sex, seizure classification, treatments and frequency, as well as COVID infection and vaccine history.

Results: We reviewed 126 clinic visits in 100 patients during the study period. Patient ages ranged from 18-86, and race distribution was 75% White, 18% Black, 3% Hispanic or Latino, 1% Asian, and 3% unspecified.

A total of 55 patients received at least one COVID vaccine: 5 Janssen, 13 Moderna, 19 Pfizer, and 18 were unspecified. 45 patients received no vaccines. Reasons for vaccine hesitancy were recorded, when reported.

Eight patients had prior COVID history or had COVID during the study period. Of these, 4 received vaccines. One patient had seizures related to COVID infection and 2 patients were hospitalized.

Nine patients had a self-reported or documented seizure within 14 days after a vaccine. Only one of these patients was seizure free (for more than 6 months) prior to vaccine. No patients were hospitalized following a vaccine.

Conclusions: Our study documents COVID vaccine characteristics of an epilepsy population. While a small number of patients experienced seizures soon after vaccination, most patients receiving vaccines did not have seizure exacerbations. In well controlled epilepsy patients, seizures following vaccine were rare.

References:
1. Vossler, DG. COVID-19 Incidence and Death Rate in Epilepsy: Too Early to Tell? Epilepsy Currents 2021 Apr 30;21(4):261-263.

2. Cabezudo-Garcia P, et al Incidence and case fatality rate of COVID-19 in patients with active epilepsy. Neurology 2020 Sep 8; 95 (10) e1417-e1425.

3. MacDonald NE, et al. Vaccine hesitancy: Definition, scope and determinants. Vaccine 33 (2015) 4161-4164.

Funding: None