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The nature of epilepsy clinical care in the time of Covid-19

About 10% of people have epilepsy, making it the most common of neurological illnesses. It affects people of any age, with one in four experiencing their first seizure by the age of 20.

Yet few people understand what it is, and how it is treated.

National Epilepsy Day, commemorated on 21 June, is intended to raise awareness of the common, treatable neurological condition.

The neurology service at Red Cross War Memorial Children’s Hospital in Mowbray, Cape Town is committed to improving the lives of children with epilepsy through dedicated weekly outpatient epilepsy clinics and access to qualified and experienced clinicians on a daily basis. There are around 2 000 clinic visits by about 800 regular and new young patients each year.

According to Professor Jo Wilmshurst, Head of Paediatric Neurology at Red Cross, the service is unique in that it offers care to children from self-limiting forms of epilepsy through to children who are medically resistant and may need alternative interventions and treatments.

“The service is strengthened by the multidisciplinary team coordinating optimal care, which includes neurologists (neurosurgeons), neurophysiological technologists, child development specialists, child psychologists and psychiatrists, nurses and rehabilitation staff.”

The neurophysiology service has two trained paediatric clinical technologists who perform detailed electrophysiology studies that include video EEG telemetry. This is the only centre in the government sphere with access to these tools, which are essential for understanding complex and undefined epilepsies.

Most people with epilepsy have their seizures controlled by anti-epileptic medication. The choice of drug depends not only on the type of seizure, but also on the individual, and it may take some time to achieve the right dose for each person.

The Covid-19 pandemic has meant the service has had to adapt, and many children are managed by telemedicine to limit their exposure to the hospital setting. But urgent cases are still seen and provided with full access to care.

Members of the team have assisted with the development of International League Against Epilepsy guidelines for the safe care of people with epilepsy during the pandemic.

The team is reassured that there is no apparent evidence that Covid-19 exacerbates epilepsy.

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