key: cord-0818627-qoxxga6u authors: Kuroda, Naoto title: Mental health considerations for patients with epilepsy during COVID-19 crisis date: 2020-05-30 journal: Epilepsy Behav DOI: 10.1016/j.yebeh.2020.107198 sha: 1adc6d7f8d07b0ced0a62c8c3d3ad6c55d0595b8 doc_id: 818627 cord_uid: qoxxga6u nan J o u r n a l P r e -p r o o f Epilepsy is a chronic neurological disorder that causes recurrent, unprovoked seizures. It is known that 20-30% of patients with epilepsy experience symptoms of depression [1] . Compared to healthy people, patients with epilepsy have a 40-50% higher suicide rate [2] . Coronavirus disease 2019 (COVID-19) initially occurred in Wuhan, China in late 2019 before its global outbreak [3] . It is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 crisis has been stressful for people across the world, with everyone having to adapt to the changes involved. It is important for clinicians to consider the psychological impact of this crisis while treating patients with epilepsy. Firstly, we have discussed how epilepsy causes mental stress in patients. (Fig.1 ) We have also considered how the COVID-19 crisis affects the mental health of patients with epilepsy. (Fig.2) J o u r n a l P r e -p r o o f 4 Kuroda on seizures, physicians treating epilepsy need to be aware of the patient's original mental state and premorbid personality. The patient also needs to be evaluated for any changes. Psychiatric symptoms may occur as a symptom of the seizure itself and are known to be more common in temporal lobe epilepsy [4] . As these are seizure symptoms that occur during the duration of the seizure, the quality of life of the patient may be affected because of the fear of the onset of the mood symptoms. The psychiatric symptoms that accompany the end of a seizure are known as postictal psychiatric disturbances or postictal mood disorders and commonly occur after frequent seizures and generalized seizures. There is typically an asymptomatic period spanning hours or days after the seizure, followed by a rapid hallucinatory delirium along with aggression and exaggeration [4] . Basically, it improves within a week with selfremitting. In contrast, postictal depression is less recognized in psychiatric practice as compared to postictal psychoses. However, these are frequently reported by patients and relatives [4] . Its symptoms, including dysphoria and crying bout, are characteristics of J o u r n a l P r e -p r o o f Kuroda Depression in epilepsy: a systematic review and meta-analysis Suicide and epilepsy Coronavirus Disease 2019 in China Ictal and peri-ictal psychopathology The psychiatric comorbidity of epilepsy Relationships between knowledge, attitudes, stigma, anxiety and depression, and quality of life in epilepsy: A structural equation modeling Epilepsy, stigma, and family Antiepileptic drug effects on mood and behavior: molecular targets Antiepileptic drugs and suicidality: an expert consensus statement from the Task Force on Therapeutic Strategies of the ILAE Commission on Neuropsychobiology Predicting and preventing psychopathology following temporal lobe epilepsy surgery Severe psychological distress among epilepsy patients during the COVID-19 outbreak in southwest China The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study COVID-19 and depression Are people with epilepsy using eHealth-tools? Telemedicine and the challenge of epilepsy management at the time of COVID-19 pandemic 10 Tips to help you stay low-carb during COVID-19 isolation Health-related behaviours and mental health in Hong Kong employees High risk of anxiety and depression in caregivers of adult patients with epilepsy and its negative impact on patients' quality of life