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The influence of statins on the risk of post-stroke epilepsy

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Abstract

Background

Currently, statins are widely used for secondary prevention of stroke due to their pleiotropic neuroprotective effects. Epilepsy is a common complication of cerebrovascular diseases. The purpose of this study was to evaluate the effect of statin therapy on the occurrence of post-stroke epilepsy (PSE).

Methods

In this prospective cohort study, patients who suffered an ischemic stroke and without history of epilepsy before stroke were enrolled. At baseline, patients were classified according to the particularities of statin therapy. Statin use onset and adherence to treatment were registered as well. After a follow-up period of 1 year, we assessed the occurrence of seizures and PSE.

Results

Among the 477 patients included in our cohort, there were 91 (19.1%) patients without statins, 160 (33.5%) with simvastatin 20 mg, 180 (37.7%) with simvastatin 40 mg, and 46 (9.6%) with high-potency statins. Overall, PSE emerged in 53 (11.1%) patients. PSE was significantly more prevalent among those who did not receive statins and those with lower doses of simvastatin. Acute onset of statin use was associated with reduced odds of having PSE.

Conclusion

Adequate treatment with statins after stroke may lower the risk of PSE.

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References

  1. Lossius MI, Rønning OM, Slapø GD, Mowinckel P, Gjerstad L (2005) Poststroke epilepsy: occurrence and predictors - a long-term prospective controlled study (Akershus Stroke Study). Epilepsia. 46(8):1246–1251. https://doi.org/10.1111/j.1528-1167.2005.57904.x

    Article  Google Scholar 

  2. Jungehulsing GJ, Heuschmann PU, Holtkamp M, Schwab S, Kolominsky-Rabas PL (2013) Incidence and predictors of post-stroke epilepsy. Acta Neurol Scand 127(6):427–430. https://doi.org/10.1111/ane.12070

    Article  Google Scholar 

  3. Arntz RM, Maaijwee NAM, Rutten-Jacobs LCA et al (2013) Epilepsy after TIA or stroke in young patients impairs long-term functional outcome the future study. Neurology. 81(22):1907–1913. https://doi.org/10.1212/01.wnl.0000436619.25532.f3

    Article  Google Scholar 

  4. Arntz RM, Rutten-Jacobs LCA, Maaijwee NAM et al (2015) Poststroke epilepsy is associated with a high mortality after a stroke at young age: follow-up of transient ischemic attack and stroke patients and unelucidated risk factor evaluation study. Stroke. 46(8):2309–2311. https://doi.org/10.1161/STROKEAHA.115.010115

    Article  CAS  Google Scholar 

  5. Winter Y, Daneshkhah N, Galland N, Kotulla I, Krüger A, Groppa S (2018) Health-related quality of life in patients with poststroke epilepsy. Epilepsy Behav 80:303–306. https://doi.org/10.1016/j.yebeh.2017.12.037

    Article  Google Scholar 

  6. Castilla-Guerra L, MDC F-M, Leon-Jimenez D, Rico-Corral MA (2019) Statins in ischemic stroke prevention: what have we learned in the post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) decade? Curr Treat Options Neurol 21(5):22. https://doi.org/10.1007/s11940-019-0563-4

    Article  Google Scholar 

  7. Squizzato A, Romualdi E, Dentali F, Ageno W (2012) Statins for acute ischemic stroke. Stroke. 43:e18–e19. https://doi.org/10.1161/STROKEAHA.111.638940

    Article  Google Scholar 

  8. Adams HP, Bendixen BH, Kappelle LJ et al (2011) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 24(1):35–41. https://doi.org/10.1161/01.str.24.1.35

    Article  Google Scholar 

  9. Beghi E, D’Alessandro R, Beretta S et al (2011) Incidence and predictors of acute symptomatic seizures after stroke. Neurology. 77:1785–1793

    Article  CAS  Google Scholar 

  10. Kusznir Vitturi B, José GR (2019) Use of CHADS2 and CHA2DS2-VASc scores to predict prognosis after stroke. Rev Neurol (Paris) (19):30469–30462. https://doi.org/10.1016/j.neurol.2019.05.001

  11. Stefanidou M, Das RR, Beiser AS, Sundar B, Kelly-Hayes M, Kase CS, Devinsky O, Seshadri S, Friedman D (2017) Incidence of seizures following initial ischemic stroke in a community-based cohort: the Framingham Heart Study. Seizure. 47:105–110. https://doi.org/10.1016/j.seizure.2017.03.009

    Article  Google Scholar 

  12. Bentes C, Martins H, Peralta AR et al (2017) Post-stroke seizures are clinically underestimated. J Neurol 264(9):1978–1985. https://doi.org/10.1007/s00415-017-8586-9

    Article  Google Scholar 

  13. Holtkamp M, Beghi E, Benninger F, Kälviäinen R, Rocamora R, Christensen H (2017) European Stroke Organisation guidelines for the management of post-stroke seizures and epilepsy. Eur Stroke J 2(2):103–115. https://doi.org/10.1177/2396987317705536

    Article  PubMed Central  Google Scholar 

  14. Ferro JM, Pinto F (2004) Poststroke epilepsy: epidemiology, pathophysiology and management. Drugs Aging 21(10):639–653. https://doi.org/10.2165/00002512-200421100-00003

    Article  CAS  Google Scholar 

  15. Camilo O, Goldstein LB (2004) Seizures and epilepsy after ischemic stroke. Stroke. 35(7):1769–1775. https://doi.org/10.1161/01.STR.0000130989.17100.96

    Article  Google Scholar 

  16. Silverman IE, Restrepo L, Mathews GC (2002) Poststroke seizures. Arch Neurol 59(2):195–201. https://doi.org/10.1001/archneur.59.2.195

    Article  Google Scholar 

  17. Myint PK, Staufenberg EFA, Sabanathan K (2006) Post-stroke seizure and post-stroke epilepsy. Postgrad Med J 82(971):568–572. https://doi.org/10.1136/pgmj.2005.041426

    Article  CAS  PubMed Central  Google Scholar 

  18. Sarecka-Hujar B, Kopyta I (2019) Poststroke epilepsy: current perspectives on diagnosis and treatment. Neuropsychiatr Dis Treat 15:95–103. https://doi.org/10.2147/NDT.S169579

    Article  CAS  Google Scholar 

  19. Pitkänen A, Roivainen R, Lukasiuk K (2016) Development of epilepsy after ischaemic stroke. Lancet Neurol 15(2):185–197. https://doi.org/10.1016/S1474-4422(15)00248-3

    Article  Google Scholar 

  20. Rumbach L, Sablot D, Berger E, Tatu L, Vuillier F, Moulin T (2012) Status epilepticus in stroke: report on a hospital-based stroke cohort. Neurology. 54(2):350–354. https://doi.org/10.1212/wnl.54.2.350

    Article  Google Scholar 

  21. Lin HW, Ho YF, Lin FJ (2018) Statin use associated with lower risk of epilepsy after intracranial haemorrhage: a population-based cohort study. Br J Clin Pharmacol 84(9):1970–1979. https://doi.org/10.1111/bcp.13626

    Article  CAS  PubMed Central  Google Scholar 

  22. Guo J, Guo J, Li J, Zhou M, Qin F, Zhang S, Wu B, He L, Zhou D (2015) Statin treatment reduces the risk of poststroke seizures. Neurology. 85(8):701–707. https://doi.org/10.1212/wnl.0000000000001814

    Article  CAS  Google Scholar 

  23. Pande SD, Lwin MT, Kyaw KM, Khine AA, Thant AA, Win MM, Morris J (2018) Post-stroke seizure—do the locations, types and managements of stroke matter? Epilepsia Open 3(3):392–398. https://doi.org/10.1002/epi4.12249

    Article  PubMed Central  Google Scholar 

  24. Tramacere I, Boncoraglio GB, Banzi R, del Giovane C, Kwag KH, Squizzato A, Moja L (2019) Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis. BMC Med 17(1):67. https://doi.org/10.1186/s12916-019-1298-5doi:10.1186/s12916-019-1298-5

    Article  PubMed Central  Google Scholar 

  25. Prinz V, Endres M (2011) Statins and stroke: prevention and beyond. Curr Opin Neurol 24(1):75–80. https://doi.org/10.1097/WCO.0b013e3283424c53

    Article  CAS  Google Scholar 

  26. de Oliveira CV, Grigoletto J, Canzian JM et al (2018) Effect of atorvastatin on behavioral alterations and neuroinflammation during epileptogenesis. Epilepsy Behav 78:109–117. https://doi.org/10.1016/j.yebeh.2017.10.021

    Article  Google Scholar 

  27. Sehar N, Agarwal NB, Vohora D, Raisuddin S (2015) Atorvastatin prevents development of kindling by modulating hippocampal levels of dopamine, glutamate, and GABA in mice. Epilepsy Behav 42:48–53. https://doi.org/10.1016/j.yebeh.2014.11.011

    Article  Google Scholar 

  28. Xie C, Sun J, Qiao W, Lu D, Wei L, Na M, Song Y, Hou X, Lin Z (2011) Administration of simvastatin after kainic acid-induced status epilepticus restrains chronic temporal lobe epilepsy. PLoS One 6(9):e24966. https://doi.org/10.1371/journal.pone.0024966

    Article  CAS  PubMed Central  Google Scholar 

  29. Sierra S, Ramos MC, Molina P, Esteo C, Vázquez JA, Burgos JS (2011) Statins as neuroprotectants: a comparative in vitro study of lipophilicity, blood-brain-barrier penetration, lowering of brain cholesterol, and decrease of neuron cell death. J Alzheimers Dis 23(2):307–318. https://doi.org/10.3233/JAD-2010-101179

    Article  CAS  Google Scholar 

  30. De Simoni MG, Perego C, Ravizza T et al (2000) Inflammatory cytokines and related genes are induced in the rat hippocampus by limbic status epilepticus. Eur J Neurosci 12(7):2623–2633. https://doi.org/10.1046/j.1460-9568.2000.00140.x

    Article  Google Scholar 

  31. Vivanco-Hidalgo RM, Elosua R, Gómez González A et al (2017) People with epilepsy receive more statins than the general population but have no higher cardiovascular risk: results from a cross-sectional study. Eur J Neurol 24(2):419–426. https://doi.org/10.1111/ene.13222

    Article  CAS  Google Scholar 

  32. Ní Chróinín D, Asplund K, Åsberg S, Callaly E, Cuadrado-Godia E, Díez-Tejedor E, di Napoli M, Engelter ST, Furie KL, Giannopoulos S, Gotto AM Jr, Hannon N, Jonsson F, Kapral MK, Martí-Fàbregas J, Martínez-Sánchez P, Milionis HJ, Montaner J, Muscari A, Pikija S, Probstfield J, Rost NS, Thrift AG, Vemmos K, Kelly PJ (2013) Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials. Stroke. 44(2):448–456. https://doi.org/10.1161/STROKEAHA.112.668277

    Article  CAS  Google Scholar 

  33. Chróinín DN, Callaly EL, Duggan J et al (2011) Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: the North Dublin population stroke study. Stroke 42(4):1021–1029. https://doi.org/10.1161/STROKEAHA.110.596734

    Article  CAS  Google Scholar 

  34. Kusznir Vitturi B, Barreto Cabral F, Mella CC (2019) Outcomes of pregnant women with refractory epilepsy. Seizure. 69:251–257. https://doi.org/10.1016/j.seizure.2019.05.009

    Article  Google Scholar 

  35. Colivicchi F, Bassi A, Santini M, Caltagirone C (2007) Discontinuation of statin therapy and clinical outcome after ischemic stroke. Stroke. 38(10):2652–2657. https://doi.org/10.1161/STROKEAHA.107.487017

    Article  CAS  Google Scholar 

  36. Kusznir Vitturi B, José GR (2019) The role of statins in cardioembolic stroke. J Clin Neurosci (19):31774–31776. https://doi.org/10.1016/j.jocn.2019.12.028

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Authors and Affiliations

  1. Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo, 01221-020, Brazil

    Bruno Kusznir Vitturi & Rubens José Gagliardi

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  1. Bruno Kusznir Vitturi
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  2. Rubens José Gagliardi
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Correspondence to Bruno Kusznir Vitturi.

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Vitturi, B.K., Gagliardi, R.J. The influence of statins on the risk of post-stroke epilepsy. Neurol Sci 41, 1851–1857 (2020). https://doi.org/10.1007/s10072-020-04298-5

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