P ARC DE S ALUT M AR , 2 H OSPITALS , +1000 B EDS (400 ACUTE ) Your - - PowerPoint PPT Presentation

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PRACTICE

24 April, 2020

Co-founded by the EU

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REORGANISATION OF EPILEPSY UNITS DURING

THE COVID-19 PANDEMIA:

PERSPECTIVES FROM BARCELONA

Rodrigo Rocamora MD, PhD

European Reference Epilepsy Centre Neurology Department Hospital del Mar. Barcelona, Spain

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COVID, SPAIN: CASES, MORTALITY

24 April, 2020

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COVID, SPAIN: MORTALITY RATE BY AGE GROUP

24 April, 2020

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COVID, SPAIN: DISTRIBUTION OF PEOPLE AFFECTED

24 April, 2020

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PARC DE SALUT MAR, 2 HOSPITALS, +1000 BEDS (400 ACUTE)

24 April, 2020

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1287 cases 89 deaths

PARC DE SALUT MAR, 2 HOSPITALS, +1000 BEDS (400 ACUTE)

24 April, 2020

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PSMAR, BARCELONA

24 April, 2020

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FACTS

• Complete reorganization of clinical and surgical

departments

• Training of personal for COVID-19 diagnosis and

treatment

• Closure of non-acute pathology units (included

Epilepsy Units)

• ICUS starts to screen admissions for life expectancy
• Risk of exceeding ICU beds and respiratory support

capabilities

RISKS FOR EPILEPSY PATIENTS

• Lack of therapeutic recommendations for epilepsy

in different contexts (first seizures, series, status, reduced consciousness)

• Lack of specific guidelines for COVID treatment in

rare diseases

• Restriction of ICU beds due to occupation with

COVID-19 patients in cases of status

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OUTPATIENTS

First visits

• Scheduled visits cancelled
• Rescheduled for 2-3 months

24 April, 2020

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Controls

• In-person visits cancelled
• Use of video conferencing systems vs

phone calls

• Depending on informatic skills of

patients

• Reprograming of visits
• Organization of telemedicine
• Protocol for telephone calls

Organizational measures

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Organizational measures

• Recommendations for first seizures
• Recommendations for status epilepticus
• AEDs changes in patients with reduced consciousness
• Chart of AEDs-COVID therapeutic interactions

INPATIENTS

24 April, 2020

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Wards

• Avoid ER if not strictly necessary
• First seizures in COVID-19 patients:
• Choose AEDs according to interactions with COVID-19 treatment
• Less cardiac interactions and avoid enzymatic inductors
• Status epilepticus:
• Careful use of BDZs due to respiratory depression
• Sedation with the lowest doses and shortest half-life

ICUs

• Refractory status epilepticus:
• Treatment as usual but:
• Review the order of AEDs treatment according to potential interactions
• Use close ECG and EEG monitoring
• Monitoring of AEDs plasmatic levels

INPATIENTS

24 April, 2020

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NEUROPHYSIOLOGY/ NEUROSURGERY

EEG routine

• Urgencies:
• + Protection of personal (gloves, FF3

masks)

• + hat disinfection and cleaning of the EEG

device

• ICU:
• Same as before
• Just use EEG box into the room

24 April, 2020

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VEEG Monitoring /Neurosurgery

• VEEGs for presurgical diagnosis delayed
• Neurosurgery only in urgent cases

(tumours, bleeding, decompression, etc)

• Protocol for performing EEG
• Antisepsis measures for personal

and devices

• Reprograming of EEG controls

Organizational measures

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RARE DISEASES

Challenges

• Hospitals screen ICUs

admissions for life expectancy

• Rare diseases need specific

triage guidelines

24 April, 2020

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Recommendations

• 1. Appoint a person responsible for COVID-19

in patients with rare diseases

• 2. Contact patient’s permanent specialist

and/or expert centre

• 3. CPMS to expedite exchange of information
• 4. Experts on the disease should be

permitted to attend the ER

• 5. Caregivers should be a priority population

in preventative measures/ equipment

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CLINICAL STUDIES

Recruitments

• Cancelled
• Until the end of quarantine

24 April, 2020

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Controls

• If possible, make a phone call
• In-person visit only if procedures are

required

• Distribution of drugs by courier

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GENERAL RECOMMENDATIONS

• Constant review of recommended COVID treatment guidelines
• Hydroxychloroquine:
• May rarely cause seizures in susceptible individuals
• Known interactions of COVID-19 medication with hepatic metabolism:
• Lopinavir: cytochrome p450 3a4, 2c19, 2b6, 3a, 1a2 inhibitor; 2c9 inducer
• Tocilizumab (TCZ): cytochrome p450 3a4 inducer
• Sarilumab: cytochrome p450 3a4 inhibitor
• Remdesivir (RDV): unknown interaction
• Cave on AEDs:
• With potential effect on cardiac conduction (QTt)
• That can induce hepatic metabolism
• Determine plasmatic levels of AEDs after COVID-19 treatment begin
• Implement of telemedicine during the pandemia

24 April, 2020

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CURRENT EVIDENCE IN EPILEPSY

• People with epilepsy (PWE) are not at increased risk for COVID-19 infection
• No evidence of increased severity of COVID-19 infection in PWE
• There is no evidence of an increased risk of COVID-19 infection in people taking

(classic) AEDs

• Seizures are not a primary symptom of COVID-19 infection
• There is no evidence to suggest that coronavirus itself can trigger seizures in PWE
• There is no reported increase of the incidence of status epileptic in PWE
• But, there is evidence of potential interaction between COVID-19 treatment and

AEDs

24 April, 2020

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Co-funded by the EU

THANK YOU

CONTACT NAME: RODRIGO ROCAMORA EMAIL: RROCAMORA@PARCDESALUTMAR.CAT