LAUSR

As health care institutions accommodated the evolving needs of the COVID-19 pandemic, there was a tremendous reallocation of resources, including hospital beds, clinical staff, and treatment space. In their survey of epilepsy centers accredited by the National Association of Epilepsy Centers, Dr. Ahrens et al. reported prominent declines in epilepsy monitoring unit admissions and many surgical treatments for refractory epilepsy. In particular, vagus nerve stimulator implantations (−19%) and temporal lobectomies (−16%) saw sharp declines. Dr. Saluja et al. comment that these data reflect the COVID-19 impact in comprehensive epilepsy centers, which manage a minority of the world's population of patients suffering from epilepsy. Furthermore, these survey data are not generalizable to more resource-limited settings, where the impact of the COVID-19 pandemic was likely more detrimental to care of non–COVID-19 patients. They report a small survey of their patients which showed increased seizure frequency and anxiety highlighting a broader effect of the pandemic on patients with epilepsy. Similarly, some data provided by Ahrens et al summarize regional differences in treatment paradigms, and these suggest the differential impact of COVID-19 in US institutions with more limited resources. This exchange highlights the challenge patients with epilepsy have had during the pandemic in a variety of clinical settings across the world.