COVID-19 and Epilepsy
Based on an article originally published February 28, 2020, and updated several times.
Available data suggests that people with epilepsy alone or with seizures as their main symptoms do not have a higher risk of getting COVID-19. We encourage you to learn more about COVID-19 symptoms, safety, treatment, and risk factors that may affect your immune system when living with epilepsy.
Are People with Epilepsy at Higher Risk of Developing COVID-19 (coronavirus)?
Epilepsy is a “family” of many different disorders that lead to seizures. Some people will have easily controlled seizures, have no other health problems, and become seizure-free on medications. Or, they may have epilepsy with occasional seizures but no other health problems. For these people, the available data suggests that just having epilepsy alone:
- Does not increase the risk of getting COVID-19
- Does not increase the severity of COVID-19
There is no evidence that people with epilepsy alone have a weakened immune system. They should not be considered “immunocompromised” and would not have an “immune deficiency” from having seizures. People with certain types of epilepsy, or specific causes of epilepsy or other health conditions may have factors affecting their immune system.
What Factors May Increase the Risk from COVID-19 for a Person with Epilepsy?
Regardless of seizure control, some people may have other health conditions that put them at higher risk from COVID-19. They may be taking medicines to control seizures that also affect their immune system (for example, ACTH, steroids, everolimus, immunotherapies). It is important to note that most seizure medicines do not affect the immune system.
Other neurological or developmental issues can affect immunity. People in these situations are at greater risk of developing more severe symptoms with viral illnesses.
Other medical problems could place someone at higher risk of developing more severe symptoms with COVID-19, such as those with:
- Problems swallowing or frequently inhaling food or liquids into their lungs (higher risk for pneumonia)
- Diabetes or underlying heart or lung problems
- Intellectual and developmental disabilities
No matter your situation, it is important for anyone with epilepsy to talk to their treating health care provider about their individual risks and if any specific medical precautions are needed.
Video - COVID-19 And Epilepsy: What is the relationship between health ailments and COVID-19?
Does Autoimmune Epilepsy Increase My Risk for Severe COVID-19?
Some types of epilepsy may be caused by a change in the body's immune function. These are called autoimmune epilepsies. The immune system is a critical part of the body that helps us fight infections and inflammation in the body and brain.
Autoimmune epilepsy may be treated with immunotherapy. Examples of these include steroids or immunoglobulin. A person taking any of these medicines may be at higher risk of developing a serious form of COVID-19.
Video - COVID-19 And Epilepsy: Does having autoimmune epilepsy put someone at greater risk of developing COVID-19?
What Can We Do to Limit Exposure to the Coronavirus?
Follow the advice of the CDC (Centers for Disease Control) and your health care providers to help slow down the spread of COVID-19. Here are extra precautions people at higher risk of severe COVID-19 can take to protect themselves. (Note: These precautions are not necessary for people with epilepsy who are not at higher risk).
- Talk to your health care team for specific recommendations.
- Stay home if feasible.
- If another member of your direct family who lives with you becomes ill:
- Can they stay with someone else? If not possible, each person should have their own room, use separate bathrooms, and wash their hands frequently.
- Visit the CDC recommendations on what to do if you are sick or caring for someone.
- If you or a loved one with epilepsy attends a work or day program in your community, talk to the agency about alternatives. Do they offer small group activities that meet local public health and government guidelines? Do they offer some form of home activity?
- If you or your loved one live in a group setting (group home, assisted living, or other long-term care facility), talk to the administrator and medical staff of the facility. Find out what precautions are being taken. If you have concerns about these, talk to your own healthcare team to see if any adjustments are needed.
- If you have help come into your home, follow common sense and make sure everyone is following good health practices. Talk to the agency responsible for the people coming into your home so you know what to expect and can share your concerns.
- Create a back-up plan for help in the home.
Here are important tips for everyone to protect themselves when the risk for COVID-19 is higher in your community.
- Wash your hands regularly with soap and water for 20 seconds.
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
- Try to keep at least 6 feet of distance between you and others who are not masked and not part of your household.
- Avoid close contact with people who are sick.
- Follow guidelines from your community on when to self-quarantine and when to mask. Masks are generally not required if you are outdoors. Masks are encouraged in indoor public settings if the COVID-19 community level is high.
- Stay home if you are sick and call your health care provider first if you need an appointment.
Video - COVID-19 And Epilepsy: Is it safe to let people into my house?
What Should I Do If I Think I Have COVID-19?
The symptoms of COVID-19 may be similar to the flu or common cold. Symptoms can include fever, cough, or difficulty breathing, loss of smell, sore throat, and cold-like symptoms. Follow CDC guidance for what to do if you think you may have COVID. If your seizures increase, call your epilepsy team or neurologist.
Video - COVID-19 And Epilepsy: What are the signs and symptoms of COVID-19?
Video - COVID-19 And Epilepsy: What are the best ways to manage illness at home?
Treatments for People Who Are Ill with COVID-19
The U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) in December 2021 for nirmatrelvir with ritonavir (PaxlovidTM) for the treatment of mild to moderate COVID-19 infection in adults and children 12 years of age and older. Your healthcare provider will decide whether this treatment is right for you based on your medical history and the severity of your infection. Important considerations for people with epilepsy regarding the use of Paxlovid include:
- The effectiveness of Paxlovid decreases for those taking the following anti-seizure medications: carbamazepine, phenobarbital, phenytoin or primidone. In these cases, your healthcare provider may recommend using another medication to treat COVID-19.
- Paxlovid may increase the blood concentration of many anti-seizure medications, including: carbamazepine, clobazam, clonazepam, diazepam, ethosuximide, everolimus, felbamate, lacosamide, lamotrigine, oxcarbazepine, perampanel, stiripentol, tiagabine and zonisamide. Talk to your doctor or pharmacist for any other possible medication interactions. People with epilepsy should contact their healthcare provider to monitor for any symptoms that could indicate higher blood levels of anti-seizure medications while being treated with Paxlovid.
The FDA also issued an EUA for molnupiravir (LagevrioTM) for the treatment of mild to moderate COVID-19. This drug does not have any interactions with anti-seizure medications and could be an alternative to Paxlovid. However, Lagevrio appears to be less effective in treating COVID-19 and cannot be used in pregnancy.
Intravenous (IV) Medications
The FDA has approved remdesivir (VekluryTM) an intravenous (IV) antiviral drug for treatment of COVID-19 in adults and children 12 years of age and older who are in the hospital or not yet hospitalized. There is no data on anti-seizure medication interactions with Veklury at this time.
Bebtelovimab was issued an EUA by the FDA in February 2022 for the treatment of mild to moderate COVID-19 in adults and in children 12 years of age and older. This treatment is considered when other treatment options are not accessible or clinically appropriate. In some medical centers, this is being reserved for patients who are immunosuppressed. Bebtelovimab is not authorized for administration to hospitalized patients. Currently, there is no data on anti-seizure medication interactions with Bebtelovimab.
Preventative Medication for Use Prior to Exposure of COVID-19
Tixagevimab with cilgavimab (EvusheldTM) received an EUA from the FDA for COVID-19 pre-exposure prevention. Evusheld is given by intramuscular shot.
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