Health care access, psychosocial outcomes and mental health in adults living with epilepsy during the COVID-19 pandemic.

PURPOSE: People living with epilepsy (PLWE) have a higher prevalence of mental health comorbidities and poorer psychosocial outcomes compared to the general population. The aim of this study was to examine psychosocial outcomes, mental health, healthcare accessibility, and seizure burden in PLWE during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study of adults with epilepsy treated in an urban multicenter health system from 2021 to 2022. A standardized questionnaire assessed for COVID-19 history, comorbidities, access to antiseizure medications (ASMs) and neurological care, seizure burden, and psychosocial outcomes (e.g., employment, social and financial support). The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were administered to evaluate for depression and anxiety. Frequency and proportions for categorical variables and median and interquartile ranges for continuous variables were calculated. RESULTS: Fifty-five PLWE participated (95 % response rate). 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 Medicare insurance. Race (from highest to lowest %) was: 32.7 % White, 20 % Black, 20 % Latinx, 14.5 % Asian, and 12.7 % selected "other" or "prefer not to say." COVID-19 had been diagnosed in 21.8 % of participants. Symptoms of anxiety and depression were self-reported by 43.6 % and 34.5 % of patients, respectively, with many describing this symptom as new post-pandemic (37.5 % and 31.6 %, respectively). Using validated scales, 52.7 % had depression (PHQ-9 score ≥ 5) with 30.9 % having moderate/severe depression (PHQ-9 score ≥ 10), while 29.1 % had probable generalized anxiety disorder (GAD-7 score ≥ 8). Seizure burden increased in 21.8 % of participants, while 20 % reported fewer seizures and 29.1 % were seizure free since the COVID-19 pandemic. Economic impacts of the pandemic included job loss (25 % amongst those employed at onset of pandemic), new or worsened financial difficulties (40 %), and new or worsened social support issues (30.9 %). Of all participants, 18.2 % reported difficulties accessing ASMs and 25.5 % cancelled visits, but of those with cancelled visits, 78.6 % had their appointments rescheduled as a telehealth visit. CONCLUSION: Our cohort of PLWE experienced some challenges during the COVID-19 pandemic including poorer mental health and financial and employment-related stressors. Encouragingly, healthcare access was relatively spared during the COVID-19 crisis, with some patients even reporting a reduction in seizure burden. However, PLWE require ongoing psychosocial support with particular attention to decompensation of mental health and social stressors that may be exacerbated by the COVID-19 pandemic.

Quantitative analysis of the EEG posterior-dominant rhythm in healthy adolescents.

OBJECTIVE: Pivotal studies of the normal EEG posterior-dominant rhythm (PDR) typically relied on visual inspection of a few seconds of EEG data from a relatively small number of subjects in each age category. We sought to analyze and characterize the PDR in a large cohort of healthy 15-year-olds, and to determine if PDR characteristics mature over the following year. METHODS: Seventy-nine healthy 15-year-olds free of neurologic and psychiatric disease underwent a resting-awake EEG, which was repeated 1 year later. In each study, PDR frequency was determined with fast Fourier transform analysis of a continuous 2-min EEG segment. t-Tests were used to compare relevant variables. RESULTS: From age 15 to 16 the mean PDR frequency increased from 9.9 to 10.0Hz, a small but statistically significant difference. The PDR frequency range at both ages was 8.9-11.0Hz, similar to values reported in prior studies on healthy young adults. There was no significant difference in PDR frequency between genders or hemispheres. CONCLUSIONS: Maturation of the PDR is nearly complete at age 16. The frequency range of the PDR in healthy adolescents and adults is substantially narrower than the alpha band. SIGNIFICANCE: Based on this and prior studies, a PDR frequency of less than 8.5 or greater than 11.5Hz should be considered abnormal in adolescents and adults.