الفهرس 
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Abstract
Introduction
In epilepsy patients, the pandemic has led to postponement of outpatient visits, cancellation of epilepsy‐related tests, such as electroencephalograms (EEG) and magnetic resonance imaging (MRI) studies, and even difficulties in attending emergency situations due to saturation of the healthcare services, which can create life threatening situations for patients who present to the emergency rooms with non-COVID related complaints.
The social and behavioral consequences of COVID19 lockdown might increase seizure frequency in people with epilepsy (PWE). Furthermore, the COVID-19 viral infection itself can induce a febrile status, which in turn can reduce seizure threshold.
Aim of the study
To apply a parent based questionnaire in arabic language to explore the impact of Covid-19 on health care services, seizure control, and behavioral and sleep characteristics for children with epilepsy and their caretakers, in the Pediatric Neurology Clinic, Ain Shams University. Also, to assess the ability to receive medical care and to obtain anti-epileptic drugs
Methodology
This observational cross-sectional study was carried out at Pediatric Neurology Clinic, Children’s hospital, Ain Shams University on care givers of children with epilepsy.
A parent based questionnaire was constructed in arabic language by the authors based on their practice and experience with children with epilepsy during the COVID19 pandemic, with the questions cover the following items:
A. Patient characteristics: Epilepsy characteristics (baseline/pre-pandemic), Impact of the COVID19 pandemic on epilepsy/comorbidity characteristics, Covid-19 symptoms and testing, Telemedicine.
B. Caretaker of child with epilepsy: COVID19 symptoms and testing, Impact of COVID19 on daily life and finances.
The questionnaire was administered first to small number of subjects (Pilot study) then it will be validated and then given out to the full number of intended recipients before data will be statistically analyzed.
In this study we applied the questionnaire on 126 caregivers (mothers) of children with epilepsy who were aged 2 to 18 years, had a diagnosis of Epilepsy (including idiopathic and cryptogenic epilepsy) for at least one year before the onset of the COVID19 pandemic. I.e., Epilepsy diagnosed at or before March 2019, were following up at the Pediatric Neurology Clinic, Children’s Hospital, Ain Shams University.
Results
Our study showed that 67% of the studied epileptic children had other comorbidities besides seizures and the most common comorbidity is cognitive disability followed by sleep disturbance.
Also it showed that most of the studied epileptic children reported no change in Seizure frequency during the pandemic compared to pre-pandemic, and about 12% of them reported increasing frequency. The most common problem reported causing increase in the frequency of seizures is decreased compliance to treatment.
About 65% of the epileptic children complained that there is lack in the presence of usual rehabilitation services.
Only 22% of the epileptic children had trouble in obtaining the anti-epileptic drug/drugs; where the most common problem was financial problems followed by drug shortage.
Most of the epileptic children didn’t have a change in the treatment regimen during the last year.
About half of caregivers (mothers) reported that the expenses related to the care of their children with epilepsy have increased during the pandemic; and the most common cause is “Medications out of pocket”.
About 75% of caregivers reported that “Telemedicine could be an adequate substitute to in-clinic visits”. And the most common advantage of telemedicine is “spare journey”.
About 77% of Caregivers experienced financial difficulties since the beginning of the pandemic.
The most common problems were increased life costs followed by salary cuts.
Only 29% of Caregivers reported that financial difficulty has affected their ability to pay for their child’s medication and/or neuro-rehabilitation sessions.
Our study showed statistically significant increased seizure frequency during the pandemic compared to pre-pandemic in children who had flu-like symptoms over the past year (p<0.001).
Also, statistically significant increased seizure frequency during the pandemic compared to pre-pandemic with less rehabilitation services (p<0.05).
Additionally, there is statistically significant increased seizure frequency during the pandemic compared to pre-pandemic with presence of change in the treatment regimen during the last year, same effect is noticed in the children who weren’t eligible for going to school before or during the pandemic (p<0.05).
Shows highly statistically significant increased behavioral disturbance(s) during the pandemic compared to pre-pandemic and the increased seizure frequency during the pandemic compared to pre-pandemic (p<0.001).
Also, statistically significant association between increased behavioral disturbance(s) during the pandemic compared to pre-pandemic and the change in the treatment regimen during the last year (p=0.046).
Also statistically significant increased children sleep disturbance by the pandemic in case of pre-existing sleep disturbance compared to getting tested for COVID19 (p=0.007), as well as the increased of number AED (p=0.035), and presence of change in the treatment regimen during the last year (p=0.010).
While there is no statistically significant effect on increased children sleep disturbance by the pandemic in case of pre-existing sleep disturbance compared to their having had flu-like symptoms over the past year, being diagnosed with COVID19
Also, statistically significant association between level of stress after the pandemic compared to having had flu-like symptoms over the past year, getting tested for COVID19, experiencing financial difficulties since the beginning of the pandemic, your concern about going to the ER during this COVID19 pandemic (p=0.024, <0.001 & 0.024 respectively).
While, there is no statistically significant association between level of stress after the pandemic compared to being diagnosed with COVID19 & your affected ability to pay for your child’s medication and/or neuro-rehabilitation sessions due to financial difficulty (p>0.05).
There is statistically significant relation between caregiver experiencing difficulty in obtaining the anti-epileptic drug/drugs and their residence where rural areas had more difficulties than urban areas; and with educational level where difficulties were observed in those with low education than those with high education level.