The influence of statins on the risk of post-stroke epilepsy
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ORIGINAL ARTICLE
The influence of statins on the risk of post-stroke epilepsy Bruno Kusznir Vitturi 1
&
Rubens José Gagliardi 1
Received: 9 August 2019 / Accepted: 13 February 2020 # Fondazione Società Italiana di Neurologia 2020
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. Keywords Statins . Stroke . Post-stroke epilepsy . Epilepsy . Ischemic stroke
Introduction Stroke is associated with an increased risk of subsequent seizures and epilepsy. Cerebrovascular lesions are the most commonly identified cause of acquired epilepsy. The incidence of post-stroke epilepsy (PSE) is variable and can range from 3 to 12% [1, 2]. PSE is far from being a benign condition. Under ischemic conditions, seizures may exacerbate secondary injury and can affect long-term functional outcomes [3]. Patients with PSE also have higher mortality rates [4] and more reduced quality of life [5] compared with seizure-free stroke survivors. In recent years, few large-scale clinical trials have evaluated the efficacy and safety of statins for stroke prevention. Positive results in secondary prevention led to an increase in the use of statins for ischemic stroke patients despite the fact that the precise benefits of statin therapy have not been completely understood yet. Long-term treatment with statins
* Bruno Kusznir Vitturi [email protected] 1
Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil
reduces the risk of ischemic stroke, even though hypercholesterolemia is not a strong risk factor for stroke [6]. An explanation for this apparent paradox is becoming clear as the role of statins on neuroprotection is being elucidated. In addition to their cholesterol lowering properties, statin reduces inflammation and stroke-induced excitotoxicity, slows carotid arterial diseas
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