COVID-19 among patients with epilepsy: Clinical characteristics and outcomes in a large single-center cohort

To assess the prevalence and clinical course of COVID-19 in adults with epilepsy, CLINICAL RATIONALE FOR THE STUDY: People with epilepsy (PWE) have been considered a potentially vulnerable population during the COVID-19 pandemic, yet data on infection risk, disease severity, and seizure exacerbation remain inconsistent. Clarifying these relationships is essential for patient counseling and risk stratification in clinical practice.

We conducted a retrospective observational study of 407 adult patients treated at a tertiary epilepsy center. Demographic and epilepsy characteristics, comorbidities, COVID-19 infection history, vaccination status, symptom profile, and seizure occurrence during infection, were analyzed. Comparisons were performed between patients with and without prior COVID-19.

A history of COVID-19 was reported by 138 patients (33.9%). Nearly one third of infections were asymptomatic, and only 7.4% required hospitalization. Fever, fatigue, and cough were the most common symptoms. Seizures during infection occurred in 15.7% of patients, but only 4.1% experienced a clinically meaningful increase in seizure frequency. COVID-19 was more frequent in women and in patients in remission.

COVID-19 in PWE is usually mild and rarely associated with seizure worsening. These findings support reassuring patients that SARS-CoV-2 infection is unlikely to destabilize seizure control, while emphasizing focused vigilance in clinically complex individuals.