In this survey, most respondents had positive attitudes towards the COVID-19 pandemic. At the same time, the negative impacts of the pandemic on patients with neurological illnesses in Jordan were evident. Understanding the attitudes and beliefs of a population towards the pandemic has significant implications for implementing and planning of mitigation strategies and for vaccination campaigns. We found that most patients (96%) who participated in the survey believed in the seriousness of the pandemic and demonstrated a positive attitude towards it such as adherence to prevention measures and support of national infection control plans. A previous national survey in April of 2020 revealed similar findings [14]. Therefore, despite different methodologies and target populations, the findings of our study reflect that awareness and positive attitude towards the pandemic among Jordanians remain high. We also found that nearly 97% of patients resorted to the internet and media outlets for medical information about the pandemic, a critical finding in an era where public perceptions about the pandemic are increasingly shaped by social media [15].
The findings of this study also reveal some aspects of how COVID-19 pandemic impacted health services in Jordan. Nearly one in five clinic visitors had their appointments delayed due to the interruptions of health services caused by the pandemic. Also, a similar percentage of patients with MS, epilepsy, and migraine or tension headache reported medication interruptions because of the pandemic and quarantine measures. On the other hand, nearly one in three patients with epilepsy or headache reported sleep disturbances, and half of those believed the pandemic was responsible. This is significant since sleep disturbance is a known trigger in both epilepsy and migraine headache [16, 17]. Finally, nearly one in two of surveyed patients reported new events or worsening illnesses since the start of the pandemic. This finding mostly is the outcome of a multitude of factors, such as medication interruptions, sleep disturbances, new social and financial stressors, limitations on accessibility to health services, pandemic-related anxiety, lifestyle changes, and others [18].
Surveys from other countries and regions reported varying but consistent findings underpinning the impacts of the COVID-19 pandemic. For instance, surveys that have been published recently reported that between 4 and 35% of persons with epilepsy had seizure worsening during the pandemic, and the worsening was mainly correlated with epilepsy severity, sleep disturbances, and COVID-19-related factors [16, 18]. Also, in a UK-based study that surveyed persons with epilepsy, a third reported difficulty accessing medical services, with 8% having had an appointment canceled. Meanwhile, medication shortages were noted by approximately 30% of neurologists in a survey of the American Epilepsy Society members [19]. On the other hand, a survey of 176 MS patients from Saudi Arabia found that 15% of the patients had a relapse but did not seek medical help because of the pandemic, while 15.9% stopped their DMTs, and 35.2% reported missing drug infusions or refills [20]. Moreover, in a survey of 1018 persons with migraine headache from Kuwait, 59.6% of sampled patients reported an increase in migraine frequency, and 78.1% reported sleep disturbances [17].
This study is not without limitations. Although recruiting patients from outpatient clinics reduced selection bias as opposed to online surveys, it remains based on a single center and medical diagnoses were ascertained retrospectively from patient files. Additionally, the establishment of a direct causal relationship through observational surveys is difficult. Nonetheless, this study is a steppingstone for future efforts in this regard.
