Effect of COVID-19 Vaccination on Seizures in Patients With Epilepsy: a Multicenter, Retrospective Study

Background: Previous study have shown that seizures may occur as a result of vaccination. This study aimed to evaluate the risk and correlative factors of seizures in patients with epilepsy (PWE) after being vaccinated with COVID-19 and to provide reference opinions for PWE to receive COVID-19 vaccine.Methods: We retrospectively enrolled PWE patients who were vaccinated against COVID-19 in the epilepsy centers of nine hospitals in China. The binary logistic regression analysis included variables with a P-value less than 0.1 in the univariate analysis.Results: The study included 290 patients, of which 40 (13.8%) developed seizures within 14 days after vaccination, whereas 250 (86.2%) remained seizure-free. The binary logistic regression analysis revealed statistical significance in seizures within three months before vaccination (P<0.001, OR=10.121, 95% CI: 4.301-23.816) and withdrawal or reduction of anti-seizures medications (ASM) during the peri-vaccination period (P=0.027, OR=4.452, 95% CI: 1.182-16.768). In addition, 32 of 33 patients (97.0%) who were seizure-free within three months before vaccination and had normal EEG results before vaccination did not have any seizures within 14 days following vaccination.Conclusions: SARS-CoV-2 may induce epilepsy through an inflammatory cascade. It is recommended to provide the COVID-19 vaccine to seizure-free patients for at least three months before vaccination, and the vaccination is safer if EEG result is normal. During peri-vaccination period, all PWE should be prohibited from reducing ASM dosage. PWE with well-controlled seizures who have discontinued ASM might consider resuming ASM during the peri-vaccination period if their EEG results are aberrant.