(2.108 deaths) Updated 6.4.2020 5pm Your ERN 2 This presentation - - PowerPoint PPT Presentation
W EBINAR EXTRA - I TALIAN AND S PANISH EXPERIENCE ABOUT THE CHANGE IN EPILEPSY CARE DUE TO CORONAVIRUS COVID-19 OUTBREAK AND EPILEPSY CARE The experience of a Neuroscience Institute that turns into a COVID Hospital 7 th April Francesca
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WEBINAR EXTRA - ITALIAN AND SPANISH EXPERIENCE
ABOUT THE CHANGE IN EPILEPSY CARE DUE TO CORONAVIRUS
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7th April Francesca Bisulli, MD, PhD IRCCS-ISNB, Bellaria Hospital University of Bologna, Bologna, Italy
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COVID-19 EMILIA ROMAGNA
Updated 6.4.2020 5pm
ITALY
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MALE FEMALE
192 DEATHS: Sex Distribution
35 30 25 20 15 10 5
0-14 15-24 25-44 45-64 AGE 65-74 75+
Incidence x 10.000
2.207 SARS-CoV-2 POSITIVE TESTING: Age Distribution
COVID-19 DATA OF BOLOGNA UPDATED 5° APRIL
Bologna, Emilia-Romagna, Noth-East, Italy 850.000 inhabitants
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AGE
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PreCovid vid (beds) ) Covid d outbreak ak Neurology (adults ults) 26 26 COVID 5 moved to another ward Neurology (chil ildre dren) ) 12 moved to another Hospital EMU 4 4 COVID Neurosur urgery 44 moved to another Hospital Operating ting rooms 8 10 COVID ICU ICU 16 16 COVID
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OUTPATIENT CLINIC N° total pts attending: 2,102 20% drug resistant cases 1.9% pts/year ER consultations 67% ER admitted (164) 30% Hospitalized 17.5% targeted epilepsy services
N° of EEG/polygraphic recordings: 2880/year
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2017-2018 INPATIENT CLINIC 2019 N° total epilepsy pts admited: 100 pre-surgical work-up: 48 epilepsy surgery: 19 VNS implants/battery replacement: 19 SE: 14
N° of VEM (video-EEG Monitoring): 28
Clinical neurophysiology
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0 185 COVID beds 145 standard care unit 14 subintensive care unit 26 ICU
Maxillofacial ward & other elective activities Cardiology
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* not requiring ICU
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Outpatient Clinic
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Government actions
8 Jan Screening measures for flights from China at Milan and Rome airports Temperature measurements, physicians in place 31 Jan First isolated cases in travelers from
from China suspended. State of emergency declared 20 Feb First
Codogno, Lombardy. Following days: cases in
Northern Italy regions 21-22 Feb Quarantine for contacts, active surveillance and 14-days home stay for travelers from risk areas. Risk areas: entry and exit ban; closing of schools, public transports, manifestations, non-essential shops 25 Feb Extension of several measures to all Northern Italy. Smartworking promoted. 24 Feb Nurses make all pts sanitize their hands. Pt provided with surgical masks, contacts minimised, signal to public health dept ONLY if travel from China/contact with COVIDpt Physicians with flu-like symptoms invited to stay home/to wear a surgical mask and gloves. Shortage of surgical masks 1-11 Mar Lockdown Measures gradually extended to all the nation Movements
awareness raising campaign #iorestoacasa 21 Mar Movement ban except for documented essential reasons. Closing of all the «nonessential» industries and activities 10 Mar First & control visits suspended/postponed unless essential (triage) Nurse at the entrance of the clinic. Partners not allowed, unless not autonomous pt. If coming from risk zone or flu-like symptoms: physician notified, surgical mask provided 13 mar Plexiglass screen installed at nurse reception 23 Mar Telephone visits, even in smartworking
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First visits postponed indefinitely (few exceptions: transitions) Telehealth Control visits converted in telephone visits (supplied also in smartworking) Telephone line with an expert nurse active 8am-2.30pm All epileptologists available via e-mail Telephone visit with a psychologist available upon request Home-video encouraged Urgent visits/EEGs guaranteed as usual (subject to triage) Investigations minimized (MRI & EEG)
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24 April, 2020
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N° of EEG/polygraphic recordings: 2880/year and VEM: 28/year
COVID unit
caps)
https://www.acns.org/practice/covid-19-resources
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«therapeutic plans» prolonged for two further months
movement restrictions
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WWW.LICE.IT/PDF/VADEMECUM_CORONAVIRUS.PDF
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https://epi-care.eu/wp-content/uploads/2020/04/COVID-19-and- Epilepsy_ERN-EpiCARE_Recommendations_ENGLISH.pdf
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↓ tendency toward calling the physicians for seizures or adverse effects of medications
seizure worsening?
COVID-19+ pt
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CASE REPORT
47-year-old woman admitted for COVID-19, placed on O2 therapy but with fair respiratory status (P/F 300). 7 days after flu symptoms subacute-onset of fluctuating altered mental status without focal neurological deficits EON: suspected focal seizures with impairment of awareness Started on LEVresolution Interictal EEG: bilateral frontal sharp abnormalities MRI: unremarkable CSF: 7 WBC, normal protein and glucose levels, Oligoclonal
CoV-2
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replacement)
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Co-funded by the EU
EPILEPSY TEAM
DR LICCHETTA
DR DI VITO
DR FERRI
ALL THE RESIDENTS COVID STAFF DR GUERRA EPILEPSY NURSE GAMBERINI CONTACT NAME FRANCESCA BISULLI EMAIL: FRANCESCA.BISULLI@UNIBO.IT
BEFORE COVID-19 AFTER COVID-19