Association between telemedicine and incidence of status epilepticus during the COVID-19 pandemic

Takafumi Kubota; Naoto Kuroda

doi:10.1016/j.yebeh.2021.108303

Association between telemedicine and incidence of status epilepticus during the COVID-19 pandemic

Epilepsy Behav. 2021 Sep 20:124:108303. doi: 10.1016/j.yebeh.2021.108303. Online ahead of print.

Authors

Takafumi Kubota¹, Naoto Kuroda²

Affiliations

¹ Department of Neurology, University Hospitals of Cleveland Medical Center, Case Western Reserve University, Cleveland, USA; Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: takafumi.kubota.c7@tohoku.ac.jp.
² Department of Pediatrics, Wayne State University, Detroit, USA; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan.

Abstract

Objective: We aimed to investigate the association between telemedicine and the incidence of status epilepticus (SE) in patients with epilepsy (PWE) during the coronavirus disease 2019 (COVID-19) pandemic using a large population database in the United States.

Methods: We performed a retrospective analysis of a private, cloud-based healthcare platform (Explorys Inc., Cleveland, Ohio, USA). We compared each of the previously reported risk factors for SE, such as child, male, and refractory epilepsy, using the chi-square test or Fisher's exact test in two groups: PWE with SE or without SE. We determined whether telemedicine could be a risk factor for the incidence of SE using multivariate binary logistic regression analysis incorporating statistically significant variables in the chi-square test or Fisher's exact test (p < 0.05). Statistical significance was set at p < 0.05.

Results: We identified 1600 PWE with SE and 61,700 PWE without SE from May 2020 to May 2021. The proportion of children, males, refractory epilepsy, and telemedicine was higher in PWE with SE than in PWE without SE (children: 21.9% vs. 17.7%, p < 0.001; male: 52.5% vs. 48.2%, p = 0.001; refractory epilepsy: 20.6% vs. 8.2%, p < 0.001; telemedicine: 42.5% vs. 23.6%, p < 0.001). The multivariate binary logistic regression model identified four significant variables as follows: child (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.17-1.50), male (OR, 1.19; 95% CI, 1.07-1.31), refractory epilepsy (OR, 2.44; 95% CI, 2.15-2.77), and telemedicine (OR, 2.29; 95% CI, 2.07-2.54).

Conclusion: Telemedicine might be associated with an increased risk of SE in PWE during the COVID-19 pandemic.

Keywords: COVID-19; Epilepsy; Seizure; Status epilepticus; Telemedicine.