Epilepsy and COVID-19 vaccination: what you should know

Sally V. Mathias, MD, is a neurologist and epileptologist at the Kentucky Neuroscience Institute as well as Associate Program Director of Adult Neurology Residency at the University of Kentucky College of Medicine. 

Epilepsy, also known as seizure disorder, is a neurologic condition that predisposes a person to have recurrent seizures. About 3.4 million people in the United States have epilepsy. Patients with epilepsy are on anti-seizure medications that have to be taken every day.

Epilepsy and COVID-19

While anyone can develop severe disease with COVID-19, the elderly and people with underlying medical conditions are at the highest risk. There is no strong evidence thus far the people with epilepsy are at high risk for severe disease due to COVID.

On December 11, 2020, the U.S. Food and Drug Administration (FDA) approved the use of vaccines for the prevention of COVID-19 in individuals 16 years of age and older. The current vaccines reduce the risk of getting COVID-19 infection by up to 90 percent, depending on the vaccine.

While there are no national guidelines, neurologists and epilepsy specialists recommend patients with epilepsy to receive the COVID-19 vaccine for several reasons:

1. There is currently no evidence to suggest that having epilepsy is specifically associated with a higher risk of side effects from a COVID-19 vaccine. For patients with epilepsy, the risk of COVID-19 infection and potential complications far outweighs the risk of side effects from a COVID-19 vaccine.
2. The risk of COVID-19 vaccine interacting with anti-seizure medications is very low. This is because vaccines work in a different way when compared to most anti-seizure medications. Anti-seizure medications typically do not suppress the immune system. A very small number of people who have seizures as part of another medical condition may be prescribed medicines that can weaken the immune system, like steroids and everolimus, a medicine taken by some people with tuberous sclerosis complex. If patients are taking these medicines, then these patients must speak to their doctor for advice before COVID-19 vaccination.
3. As with other vaccines, a fever can develop after a COVID-19 vaccination. This could lower the seizure threshold in some people, especially patients who have a breakthrough seizure with a fever. Over the counter medications for fever such as acetaminophen or ibuprofen taken for 48 hours after the vaccination (or for the duration of fever) will minimize this risk.The most common side effects after the vaccinations are muscle aches, chills, fatigue, headache or a mild sore throat; these side effects typically do not cause a breakthrough seizure. 
4. Thus far, COVID-19 vaccination has not been approved in pregnant women or lactating women. Therefore, if a patient with epilepsy is pregnant or breastfeeding, they will have to check with their neurologist and OBGYN, or their child’s pediatrician before receiving the vaccine.
5. If patients with epilepsy have had allergies to prior vaccines (such as flu vaccine), have an ongoing infection during the time of the vaccine, or are taking immunosuppressant medications for another condition, they should discuss with their neurologist/primary care provider before receiving the COVID-19 vaccine. If patients with epilepsy have had an allergic reaction to the first dose of COVID-19 vaccine, or have allergies to any ingredient in the vaccine, then they should not get the COVID-19 vaccine.

COVID-19 vaccines are recommended for majority of patients with epilepsy. If patients have any questions or concerns, they should reach out to their neurologist or epilepsy specialist.