PDF(Pubmed)
Abstract：
Although Coronavirus disease 2019 (COVID-19) vaccinations are generally recommended for persons with epilepsy (PwE), a significant vaccination gap remains due to patient concerns over the risk of post-vaccination seizure aggravation (PVSA). In this single-centre, retrospective cohort study, we aimed to determine the early (7-day) and delayed (30-day) risk of PVSA, and to identify clinical predictors of PVSA among PwE. Adult epilepsy patients aged ≥18 years without a history of COVID-19 infection were recruited from a specialty epilepsy clinic in early 2022. Demographic, epilepsy characteristics, and vaccination data were extracted from a centralized electronic patient record. Seizure frequency before and after vaccination, vaccination-related adverse effects, and reasons for or against vaccination were obtained by a structured questionnaire. A total of 786 PwEs were included, of which 27.0% were drug-resistant. At the time of recruitment, 74.6% had at least 1 dose of the COVID-19 vaccine. Subjects with higher seizure frequency (p < 0.0005), on more anti-seizure medications (p = 0.004), or had drug-resistant epilepsy (p = 0.001) were less likely to be vaccinated. No significant increase in seizure frequency was observed in the early (7 days) and delayed phases (30 days) after vaccination in our cohort. On the contrary, there was an overall significant reduction in seizure frequency 30 days after vaccination (1.31 vs. 1.89, t = 3.436; p = 0.001). This difference was seen in both types of vaccine (BNT162b2 and CoronaVac) and drug-resistant epilepsy, but just missed significance for the second dose (1.13 vs. 1.87, t = 1.921; p = 0.055). Only 5.3% had PVSA after either dose of vaccine. Higher pre-vaccination seizure frequency of ≥1 per week (OR 3.01, 95% CI 1.05-8.62; p = 0.04) and drug-resistant status (OR 3.32, 95% CI 1.45-249 7.61; p = 0.005) were predictive of PVSA. Meanwhile, seizure freedom for 3 months before vaccination was independently associated with a lower risk of PVSA (OR 0.11, 95% CI 0.04-0.28; p < 0.0005). This may guide epilepsy treatment strategies to achieve better seizure control for at least 3 months prior to vaccination. As COVID-19 shifts to an endemic phase, this study provides important data demonstrating the overall safety of COVID-19 vaccinations among PwE. Identification of high-risk patients with subsequent individualized approaches in treatment and monitoring strategies may alleviate vaccination hesitancy among PwE.
摘要：
虽然2019年冠状病毒病（COVID-19）通常建议癫痫患者接种疫苗（PwE），由于患者担心疫苗接种后癫痫发作加重(PVSA)的风险,疫苗接种仍存在显著差距.在这个单一中心，回顾性队列研究，我们旨在确定PVSA的早期（7天）和延迟（30天）风险，并确定PwE中PVSA的临床预测因子。2022年初从一家专业癫痫诊所招募年龄≥18岁无COVID-19感染史的成人癫痫患者。人口统计,癫痫的特点，和疫苗接种数据从集中的电子病历中提取.疫苗接种前后的癫痫发作频率，疫苗接种相关的不良反应，通过结构化问卷获得支持或反对疫苗接种的原因。总共包括786个PwE，其中27.0%耐药。在招聘的时候,74.6%的人接种了至少1剂COVID-19疫苗。癫痫发作频率较高的受试者（p<0.0005），更多的抗癫痫药物（p=0.004），或有耐药性癫痫(p=0.001)接种疫苗的可能性较小。在我们的队列中，在疫苗接种后的早期（7天）和延迟期（30天）没有观察到癫痫发作频率的显着增加。相反,疫苗接种后30天，癫痫发作频率总体显着降低(1.31vs.1.89，t=3.436；p=0.001）。这种差异在两种类型的疫苗（BNT162b2和CoronaVac）和耐药性癫痫中都可以看到，但只是错过了第二剂的意义（1.13vs.1.87，t=1.921；p=0.055）。只有5.3%的人在任一剂量的疫苗后患有PVSA。疫苗接种前发作频率较高，每周≥1次（OR3.01，95％CI1.05-8.62；p=0.04）和耐药状态（OR3.32，95％CI1.45-2497.61；p=0.005）是PVSA的预测因素。同时,疫苗接种前3个月无癫痫发作与较低的PVSA风险独立相关(OR0.11,95%CI0.04-0.28;p<0.0005).这可以指导癫痫治疗策略在疫苗接种前至少3个月实现更好的癫痫发作控制。随着COVID-19进入流行阶段，本研究提供了重要数据,证明了PwE中COVID-19疫苗接种的总体安全性.通过随后的个性化治疗方法和监测策略识别高危患者可能会减轻PwE疫苗接种的犹豫。
