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 Bisulli, MD, PhD IRCCS-ISNB, Bellaria Hospital University of Bologna, Bologna, Italy Co-founded by the EU Your ERN 1 logo here
ITALY COVID-19 EMILIA ROMAGNA (2.108 deaths) Updated 6.4.2020 5pm Your ERN 2 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
2.207 SARS-CoV-2 POSITIVE COVID-19 D ATA OF TESTING: Age Distribution B OLOGNA U PDATED 5° A PRIL Bologna, Emilia-Romagna, Noth-East, Italy Incidence x 10.000 35 850.000 inhabitants 30 25 20 15 10 5 0 0-14 15-24 25-44 45-64 65-74 75+ AGE AGE 192 DEATHS: Sex Distribution 891 49 53 39 MALE 84 61 FEMALE Co-founded by the EU Your ERN logo here
R EORGANIZATION OF EPILEPSY CARE Main changes • Neurological Institute COVID Hospital Your ERN 4 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
I NPATIENT CLINIC PreCovid vid Covid d outbreak ak (beds) ) Neurology (adults ults) 26 26 COVID 5 moved to another ward Neurology (chil ildre dren) ) 12 moved to another Hospital 4 4 COVID EMU Neurosur urgery 44 moved to another Hospital Operating ting rooms 8 10 COVID ICU ICU 16 16 COVID Co-founded by the EU Your ERN 5 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
OUTPATIENT CLINIC INPATIENT CLINIC 2017-2018 2019 N° total pts attending: 2,102 N° total epilepsy pts admited: 100 pre-surgical work-up: 48 20% drug resistant cases epilepsy surgery: 19 1.9% pts/year ER consultations 67% ER admitted (164) VNS implants/battery replacement: 19 30% Hospitalized SE: 14 17.5% targeted epilepsy services Clinical neurophysiology N° of VEM (video-EEG Monitoring): 28 N° of EEG/polygraphic recordings: 2880/year Your ERN 6 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
COVID UNIT 0 185 COVID beds 145 standard care unit 14 subintensive care unit 26 ICU Maxillofacial ward & other elective activities Cardiology Your ERN logo here
R EORGANIZATION OF EPILEPSY CARE AT OUR HOSPITAL Main changes Neurological Institute COVID Hospital • Inpatient Clinic: minimised (only urgencies, SE*) • Limited healthcare resources (Epilepsy staff) • Epileptologists, Residents COVID Staff • Redeployment of Technicians and Nurses • Personnel in quarantine (ill or positive testing) • Personnel in smartworking • Outpatient clinic: reorganized • * not requiring ICU Your ERN 8 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
R EORGANIZATION OF OUTPATIENT CLINIC Top priorities 1. Keeping patients safe 2. Minimising risk for health workers 3. Guarantee assistance for all pts Your ERN 9 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
Outpatient Clinic 13 mar 24 Feb 10 Mar 23 Mar Nurses make all pts sanitize First & control visits Plexiglass Telephone their hands. suspended/postponed screen visits, installed Pt provided with surgical masks, unless essential (triage) even in contacts minimised, signal to Nurse at the entrance of at nurse smartworking reception public health dept ONLY if travel the clinic. Partners not from China/contact with allowed, unless not COVIDpt autonomous pt. If coming Physicians with flu-like from risk zone or flu-like symptoms invited to stay symptoms: physician home/to wear a surgical mask notified, surgical mask and gloves. provided Shortage of surgical masks 21 Mar 1-11 Mar 21-22 Feb 25 Feb 31 Jan 20 Feb 8 Jan Movement ban Lockdown First isolated Quarantine for Extension of Screening First except for Measures gradually contacts, active several cases in measures for outbreak in documented extended to all the surveillance and measures to travelers from flights from China Codogno , essential nation China. Flights 14-days home all Northern at Milan and Lombardy. reasons. Movements stay for travelers Italy. from China Following Rome airports Closing of all restricted. Massive suspended. from risk areas. Smartworking Temperature days: cases in the awareness raising Risk areas: entry promoted. State of measurements, other «nonessential» campaign emergency and exit ban; physicians in Northern Italy industries and #iorestoacasa declared closing of schools, place regions activities public transports, manifestations, Government actions non-essential shops Your ERN 10 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
R EORGANIZATION OF OUTPATIENT CLINIC 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) Your ERN 11 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
EEG N ° of EEG/polygraphic recordings: 2880/year and VEM: 28/year • Outpatients : suspended • Prolonged VEEG monitoring : suspended • Urgencies : outpatients and inpatients (both COVID+ or not) • No HP for all COVID unit • Bedside, 2 technicians for 1 pt • Corporate dressing protocol (differences for ventilated or not pts) • Ad hoc registration protocol for material and methods (disposable caps) https://www.acns.org/practice/covid-19-resources Your ERN 12 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
C OVID -19 AND EPILEPSY : L OCAL ( HELPFUL ) POLICIES • ePrescription • Driving license validity prolonged until 31 Aug 2020 • Drugs requiring a special prescription regime: validity of «therapeutic plans» prolonged for two further months • Subjects with psychic disability partial dispensation from movement restrictions Your ERN 13 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
C OVID -19 AND EPILEPSY . LICE WWW . LICE . IT / PDF / VADEMECUM _ CORONAVIRUS . PDF Your ERN 14 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
C OVID -19 AND EPILEPSY . E PI CARE https://epi-care.eu/wp-content/uploads/2020/04/COVID-19-and- Epilepsy_ERN-EpiCARE_Recommendations_ENGLISH.pdf Your ERN 15 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
C OVID -19 AND EPILEPSY : 6 WEEKS EXPERIENCE • COVID-19+: 3 out of 2,102 pts • Patients “silence” ↓ tendency toward calling the physicians for seizures or adverse effects of medications • Drugs shortage (not in our Region yet) • TDM patchy suspended: pregnant women? seizure worsening? • 1 case of probable SUDEP • 1 case of possible newly onset seizures in COVID-19+ pt Your ERN 16 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
C ASE R EPORT 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 Newly onset epilepsy/seizures? EON: suspected focal seizures with impairment of awareness Viral Encephalities? Started on LEV resolution Interictal EEG : bilateral frontal Autoimmune Encephalities? sharp abnormalities MRI : unremarkable CSF : 7 WBC, normal protein and glucose levels, Oligoclonal bands . Ongoing test for SARS- CoV-2 Your ERN 17 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
C OVID -19 AND EPILEPSY . C RITICAL ISSUES • Inadequate support risk for fragile pts • Seizure action plan • FAST track • Alternative sites to provide ICU-like care for SE • Telemedicine long period? • Management of behavior disorders psichological assistance • Newly onset seizures/epilepsy • Alternative plan for deferred pts (surgery, VNS battery replacement) • Rational allocation of limited healthcare resources the greatest good for the greatest number Your ERN 18 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. logo here
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