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Immediate and 6-month seizure outcomes following first and second SARS-CoV2 mRNA vaccinations: A multicenter study
Megumi Nonaka1, Shuichiro Neshige2, Hidetada Yamada1
1Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan.
Insights
Vaccination against SARS-CoV-2 (COVID-19) rarely causes sustained seizure worsening in people with epilepsy (PWE). Worsening events were infrequent and associated with specific epilepsy types, suggesting vaccinations are safe for most PWE.
Area of Science:
- Neurology
- Immunology
- Public Health
Background:
- Epilepsy management requires understanding potential impacts of public health interventions.
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines are crucial for pandemic control.
- The effect of SARS-CoV-2 vaccination on seizure activity in people with epilepsy (PWE) requires thorough investigation.
Purpose of the Study:
- To determine seizure outcomes in PWE after SARS-CoV-2 mRNA vaccination.
- To identify clinical factors associated with seizure worsening post-vaccination.
- To assess the safety and tolerability of SARS-CoV-2 vaccination in PWE.
Main Methods:
- Retrospective analysis of 332 PWE (≥14 years) vaccinated between 2021-2022 in four tertiary hospitals.
- Assessment of seizure worsening incidence and clinical factors using closed-ended questions.
- Nationwide survey of 261 general practitioners on self-reported seizure worsening in 5156 PWE.
Main Results:
- Seizure worsening occurred in 5.7% of hospital-vaccinated PWE, primarily within 48 hours and non-sustained.
- Focal impaired awareness seizures, high seizure frequency, and drug-resistant epilepsy were associated with worsening.
- Multivariate analysis identified focal impaired awareness seizures as independently associated with worsening (OR, 7.0).
- Nationwide survey revealed a low self-reported seizure worsening rate of 0.43%.
Conclusions:
- SARS-CoV-2 mRNA vaccination is associated with infrequent and non-sustainable seizure worsening in PWE.
- Refractory focal epilepsy is a risk factor for transient seizure worsening.
- The low incidence suggests vaccination is generally safe and should not deter PWE from vaccination.
Objective:
This study aimed to identify seizure outcomes in people with epilepsy (PWE) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) messenger RNA vaccination.
Methods:
We examined PWE (n = 332, age ≥ 14 years) treated in four tertiary hospitals between 2021 and 2022 to assess the incidence of seizure worsening following vaccination using closed questions. We identified the clinical factors associated with worsening and 6-month vaccination outcomes. We also conducted a nationwide survey on self-reported seizure worsening using open questions, to which 261 general practitioners from 99 institutes contributed.
Results:
Of the 282 PWE vaccinated in the four hospitals, 16 (5.7%) exhibited seizure worsening; most of them emerged within 48 h of vaccination and were not sustained. Thus, all PWE were at baseline condition 6 months after their vaccination. PWE with seizure worsening were more significantly associated with focal impaired awareness seizures (p < 0.001), high seizure frequency (p = 0.025), and drug-resistant epilepsy (p = 0.007) at baseline compared to PWE without worsening. Multivariate logistic regression analysis revealed that focal impaired awareness seizures were independently associated with worsening (odds ratio, 7.0; 95% confidence interval, 1.50-32.77). A nationwide survey of 5156 PWE data (real-world data) confirmed an extremely low incidence rate of self-reported seizure worsening (0.43%).
Significance:
Some PWE, particularly refractory focal epilepsy, exhibit seizure worsening. However, the worsening events were infrequent, non-sustainable, and probably under-reported by PWE, suggesting that there is little evidence that worsening seizures discourage current and future vaccinations.
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