Abstracts

Rationale: People with epilepsy encounter a higher prevalence of mental health comorbidities and poorer psychosocial outcomes. The COVID-19 pandemic has affected people living with neurological conditions, including those who were not infected. The aim of this study was to examine psychosocial outcomes, mental health, healthcare accessibility, and seizure burden in people with epilepsy during the COVID-19 pandemic.

Methods: We conducted a cross-sectional study of eligible adults with epilepsy treated in an urban multicenter health system in 2021-2022. A standardized questionnaire assessed for comorbidities, COVID-19 history, access to antiseizure medications (ASMs) and neurological care, seizure burden, and psychosocial outcomes (e.g., social support, employment, financial support). The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) survey were administered to evaluate for depression and anxiety, respectively. Minors and patients with severe psychiatric conditions (e.g., severe psychosis) or comorbidities requiring palliative management were excluded. Descriptive statistics were generated: frequency and proportions for categorical variables and median and interquartile ranges for continuous variables.

Results: Fifty-five people with epilepsy participated (95% participation rate), of whom 21.8% had been diagnosed with COVID-19. Median age was 40 years (IQR 31.5-66.5), 61.8% were women, 47.3% had a bachelor's degree or higher and 29.1% each had Medicaid and 29.1% Medicare insurance. Of the 55 participants, race (from highest to lowest %) was: 32.7% White, 20% Black, 20% Latino, 14.5% Asian and 12.7% selected “other” or “prefer not to say.” Symptoms suggestive of moderate/severe depression (PHQ-9 score ≥10) and generalized anxiety disorder (GAD-7 score ≥8) were reported by 30.9% and 29.1% of participants, respectively. Seizure burden increased in 21.8% of participants, while 20% reported fewer seizures. Reported economic impacts of the pandemic included job loss (16.4%), new or worsened financial difficulties (36.4%), and new or worsened issues with social support (29.1%). Of all participants, 18.2% reported difficulties accessing ASMs, with 9.1% noting cancelled tests for their epilepsy. While 25.5% of participants reported cancelled visits to their neurologist/epileptologist, 11 (78.6%) of them had their appointments rescheduled as a phone call or virtual visit.

Conclusions: Our cohort of people with epilepsy experienced many challenges during the COVID-19 pandemic. Notably, challenges with mental health and social determinants of health were common, with many encountering financial and employment-related stressors. Encouragingly, healthcare accessibility for people with epilepsy was relatively spared during the COVID-19 crisis, with some patients even reporting a reduction in seizure burden. People with epilepsy require ongoing psychosocial support with particular attention to decompensation of mental health and social stressors that may be exacerbated by the COVID-19 pandemic.

Funding: None