Seizure- or Epilepsy-Related Emergency Department Visits Before and During the COVID-19 Pandemic

United States, 2019-2021

Sanjeeb Sapkota, MBBS; Elise Caruso, MPH; Rosemarie Kobau, MPH; Lakshmi Radhakrishnan, MPH; Barbara Jobst, MD; Jourdan DeVies, MS; Niu Tian, MD, PhD; R. Edward Hogan, MD; Matthew M. Zack, MD; Daniel M. Pastula, MD


Morbidity and Mortality Weekly Report. 2022;71(21):703-708. 

In This Article


In this study of trends in seizure-related ED visits during the COVID-19 pandemic, seizure-related ED visits during the initial COVID-19 waves declined among all age groups, especially among children aged 0–9 years. These findings are consistent with several other studies.[6–8] In one analysis of U.S. ED visits during January 2019–May 2020, the number of weekly all-cause ED visits declined abruptly during March 29–April 25, 2020, along with a decline in ED visits among children aged 0–9 years attributable to common conditions, including influenza, otitis media, upper respiratory conditions, asthma, viral infection, respiratory symptoms, and fever.[6] International studies have described a reduction in seizure-related ED visits among children during the COVID-19 pandemic, with one study reporting a notable decline in febrile seizure–related ED visits among children aged 0–6 years.[7,8]

The percentages of ED visits attributable to febrile seizures among children aged 0–9 years in this study were relatively stable, therefore any changes in ED visits for febrile seizures during the study period were unlikely to explain the overall change of trend in seizure-related ED visits in this age group. Researchers in Italy examined selected causes for seizure-related ED visits during February 23–April 21, 2020 (e.g., first episode or breakthrough seizure), but could not attribute the observed decrease in seizure-related ED visits to seizure type (e.g., febrile versus first episode seizures).[7] However, a limitation of the Italian study was small sample size; thus, the findings warrant additional study. The findings related to febrile seizure–attributable ED use in the current report differ from, but supplement growing research in this area.[8]

In the present study, school closures and the need to shelter at home could have facilitated heightened supervision of children while at home, including increased monitoring and promotion of healthful behaviors reducing seizure risk (e.g., medication adherence and regular sleep) or seizure sequelae (e.g., injury), thereby reducing the need for ED care.[7,9] The decrease in weekly seizure-related ED visits among children aged 0–9 years might also have been associated with concern about risk for COVID-19 in EDs, deterring parents or guardians from seeking care for their children. It is also possible that expanded access and increased use of telehealth facilitated triaged telephone support or virtual health care encounters, especially for children with epilepsy and high-risk comorbidities, otherwise obtained in EDs.[5,10] Additional studies are warranted to determine whether decreased in-person ED care for children with seizures or epilepsy during the initial COVID-19 pandemic was associated with any differences in risk for infection, injury, or delayed care, seizure type, or other factors and any associations between these factors and adverse outcomes.

The findings in this report are subject to at least four limitations. First, because NSSP coverage varies both within and across states, NSSP data are not nationally representative. In some states nearly all hospitals report, while in others only those in certain counties or health care systems report. Thus, these findings might not be generalizable. Second, differences in availability, coding practices, and reporting of chief complaints and discharge diagnoses from facilities might influence trends. To limit the impact of changing data volume and underlying data quality on results, only data from hospitals with consistent reporting and more complete data were included in this analysis. Third, trends displayed are restricted to ED visits only, and do not capture treatment sought for seizures in other settings. Finally, distinguishing initial seizure-related visits from subsequent visits was not possible, therefore the numbers of ED visits reported might represent multiple visits by one person.

These findings reinforce the importance of understanding factors associated with ED avoidance among persons with epilepsy or seizures, and any alternative care approaches among persons with epilepsy or seizures and the need to encourage persons to seek appropriate care for seizure-related emergencies. Vaccination against SARS-CoV-2, the virus that causes COVID-19, of all age-eligible persons, including those with epilepsy, is recommended to protect against the adverse effects of COVID-19.[9]