PRACTICE R EORGANISATION OF EPILEPSY UNITS DURING THE COVID-19 PANDEMIA : P ERSPECTIVES FROM B ARCELONA Rodrigo Rocamora MD, PhD European Reference Epilepsy Centre Neurology Department Hospital del Mar. Barcelona, Spain Co-founded by the EU Your ERN 2 24 April, 2020 logo here
COVID, SPAIN: C ASES , M ORTALITY Your ERN 3 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
COVID, SPAIN: M ORTALITY R ATE BY A GE G ROUP Your ERN 4 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
COVID, SPAIN: D ISTRIBUTION OF P EOPLE A FFECTED Your ERN 5 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
P ARC DE S ALUT M AR , 2 H OSPITALS , +1000 B EDS (400 ACUTE ) Your ERN 6 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
P ARC DE S ALUT M AR , 2 H OSPITALS , +1000 B EDS (400 ACUTE ) 1287 cases 89 deaths Your ERN 7 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
PSMAR, BARCELONA 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 Your ERN 8 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
O UTPATIENTS Organizational measures First visits • Reprograming of visits • Scheduled visits cancelled • Organization of telemedicine • Rescheduled for 2-3 months • Protocol for telephone calls Controls • In-person visits cancelled • Use of video conferencing systems vs phone calls • Depending on informatic skills of patients Your ERN 9 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
I NPATIENTS Organizational measures • Recommendations for first seizures • Recommendations for status epilepticus • AEDs changes in patients with reduced consciousness • Chart of AEDs-COVID therapeutic interactions Your ERN 10 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
I NPATIENTS 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 Your ERN 11 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
N EUROPHYSIOLOGY / N EUROSURGERY EEG routine Organizational measures • Urgencies: • Protocol for performing EEG • + Protection of personal (gloves, FF3 • Antisepsis measures for personal masks) and devices • + hat disinfection and cleaning of the EEG • Reprograming of EEG controls device • ICU: • Same as before • Just use EEG box into the room VEEG Monitoring /Neurosurgery • VEEGs for presurgical diagnosis delayed • Neurosurgery only in urgent cases (tumours, bleeding, decompression, etc) 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
R ARE DISEASES Challenges Recommendations • Hospitals screen ICUs 1. Appoint a person responsible for COVID-19 admissions for life in patients with rare diseases expectancy 2. Contact patient’s permanent specialist • Rare diseases need specific and/or expert centre triage guidelines 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 Your ERN 13 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 LINICAL STUDIES Recruitments Controls • Cancelled • If possible, make a phone call • Until the end of quarantine • In-person visit only if procedures are required • Distribution of drugs by courier Your ERN 14 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
G ENERAL 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 Your ERN 15 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 URRENT 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 Your ERN 16 This presentation is owned by the ERN and may contain information that is confidential, proprietary or otherwise legally protected. 24 April, 2020 logo here
T HANK YOU C ONTACT N AME : RODRIGO ROCAMORA E MAIL : RROCAMORA @ PARCDESALUTMAR . CAT Your ERN Co-funded by the EU logo here
Recommend
More recommend
