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Yu Y, Chen Z, Yang Y, Zhang J, Wang Y. Development and validation of an interpretable machine learning model for predicting post-stroke epilepsy. Epilepsy Res 2024; 205:107397. [PMID: 38976953 DOI: 10.1016/j.eplepsyres.2024.107397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Epilepsy is a serious complication after an ischemic stroke. Although two studies have developed prediction model for post-stroke epilepsy (PSE), their accuracy remains insufficient, and their applicability to different populations is uncertain. With the rapid advancement of computer technology, machine learning (ML) offers new opportunities for creating more accurate prediction models. However, the potential of ML in predicting PSE is still not well understood. The purpose of this study was to develop prediction models for PSE among ischemic stroke patients. METHODS Patients with ischemic stroke from two stroke centers were included in this retrospective cohort study. At the baseline level, 33 input variables were considered candidate features. The 2-year PSE prediction models in the derivation cohort were built using six ML algorithms. The predictive performance of these machine learning models required further appraisal and comparison with the reference model using the conventional triage classification information. The Shapley additive explanation (SHAP), based on fair profit allocation among many stakeholders according to their contributions, is used to interpret the predicted outcomes of the naive Bayes (NB) model. RESULTS A total of 1977 patients were included to build the predictive model for PSE. The Boruta method identified NIHSS score, hospital length of stay, D-dimer level, and cortical involvement as the optimal features, with the receiver operating characteristic curves ranging from 0.709 to 0.849. An additional 870 patients were used to validate the ML and reference models. The NB model achieved the best performance among the PSE prediction models with an area under the receiver operating curve of 0.757. At the 20 % absolute risk threshold, the NB model also provided a sensitivity of 0.739 and a specificity of 0.720. The reference model had poor sensitivities of only 0.15 despite achieving a helpful AUC of 0.732. Furthermore, the SHAP method analysis demonstrated that a higher NIHSS score, longer hospital length of stay, higher D-dimer level, and cortical involvement were positive predictors of epilepsy after ischemic stroke. CONCLUSIONS Our study confirmed the feasibility of applying the ML method to use easy-to-obtain variables for accurate prediction of PSE and provided improved strategies and effective resource allocation for high-risk patients. In addition, the SHAP method could improve model transparency and make it easier for clinicians to grasp the prediction model's reliability.
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Affiliation(s)
- Yue Yu
- Affiliated Hospital of Qingdao University, Qingdao, China; Qingdao Municipal Hospital, Qingdao, China
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yong Yang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Yan Wang
- Affiliated Hospital of Qingdao University, Qingdao, China.
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2
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Ryu HU, Kim HJ, Shin BS, Kang HG. Clinical approaches for poststroke seizure: a review. Front Neurol 2024; 15:1337960. [PMID: 38660095 PMCID: PMC11039895 DOI: 10.3389/fneur.2024.1337960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Poststroke seizure is a potential complication of stroke, which is the most frequent acute symptomatic seizure in adults. Patients with stroke may present with an abnormal or aggressive behavior accompanied by altered mental status and symptoms, such as hemiparesis, dysarthria, and sensory deficits. Although stroke manifestations that mimic seizures are rare, diagnosing poststroke seizures can be challenging when accompanied with negative postictal symptoms. Differential diagnoses of poststroke seizures include movement disorders, syncope, and functional (nonepileptic) seizures, which may present with symptoms similar to seizures. Furthermore, it is important to determine whether poststroke seizures occur early or late. Seizures occurring within and after 7 d of stroke onset were classified as early and late seizures, respectively. Early seizures have the same clinical course as acute symptomatic seizures; they rarely recur or require long-term antiseizure medication. Conversely, late seizures are associated with a risk of recurrence similar to that of unprovoked seizures in a patient with a focal lesion, thereby requiring long-term administration of antiseizure medication. After diagnosis, concerns regarding treatment strategies, treatment duration, and administration of primary and secondary prophylaxis often arise. Antiseizure medication decisions for the initiation of short-term primary and long-term secondary seizure prophylaxis should be considered for patients with stroke. Antiseizure drugs such as lamotrigine, carbamazepine, lacosamide, levetiracetam, phenytoin, and valproate may be administered. Poststroke seizures should be diagnosed systematically through history with differential diagnosis; in addition, classifying them as early or late seizures can help to determine treatment strategies.
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Affiliation(s)
- Han Uk Ryu
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hong Jin Kim
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Byoung-Soo Shin
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hyun Goo Kang
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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3
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Stredny C, Rotenberg A, Leviton A, Loddenkemper T. Systemic inflammation as a biomarker of seizure propensity and a target for treatment to reduce seizure propensity. Epilepsia Open 2023; 8:221-234. [PMID: 36524286 PMCID: PMC9978091 DOI: 10.1002/epi4.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
People with diabetes can wear a device that measures blood glucose and delivers just the amount of insulin needed to return the glucose level to within bounds. Currently, people with epilepsy do not have access to an equivalent wearable device that measures a systemic indicator of an impending seizure and delivers a rapidly acting medication or other intervention (e.g., an electrical stimulus) to terminate or prevent a seizure. Given that seizure susceptibility is reliably increased in systemic inflammatory states, we propose a novel closed-loop device where release of a fast-acting therapy is governed by sensors that quantify the magnitude of systemic inflammation. Here, we review the evidence that patients with epilepsy have raised levels of systemic indicators of inflammation than controls, and that some anti-inflammatory drugs have reduced seizure occurrence in animals and humans. We then consider the options of what might be incorporated into a responsive anti-seizure system.
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Affiliation(s)
- Coral Stredny
- Division of Epilepsy and Clinical Neurophysiology, Department of NeurologyBoston Children's HospitalBostonMassachusettsUSA
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Alexander Rotenberg
- Division of Epilepsy and Clinical Neurophysiology, Department of NeurologyBoston Children's HospitalBostonMassachusettsUSA
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Alan Leviton
- Division of Epilepsy and Clinical Neurophysiology, Department of NeurologyBoston Children's HospitalBostonMassachusettsUSA
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of NeurologyBoston Children's HospitalBostonMassachusettsUSA
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
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4
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Yuan M, Zhou X, Lu X, Xiao Z, Zhou H, Wang X. Association between statin use during hospitalisation and mortality in patients with intracerebral haemorrhage: a propensity score-matched cohort study. BMJ Open 2022; 12:e065849. [PMID: 36585154 PMCID: PMC9809250 DOI: 10.1136/bmjopen-2022-065849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We examined the relationship between statin use during hospitalisation and mortality in patients with intracerebral haemorrhage (ICH). DESIGN Retrospective propensity-matched cohort study. SETTING Patients with ICH (≥18 years old) admitted to Beth Israel Deaconess Medical Center (Boston, Massachusetts, USA) from 2001 to 2012 registered in the Medical Information Mart for Intensive Care III database. PARTICIPANTS 1043 patients with ICH (≥18 years) were evaluated for the relationship between statin use during hospitalisation and mortality. INTERVENTIONS Statin use. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was 90-day mortality. We used multivariable Cox regression analyses to calculate the adjusted HR with 95% CI and used propensity score analysis and an inverse probability weighting (IPW) model to ensure the robustness of our findings. RESULTS We included 1043 patients with ICH (362 and 681 were statins and non-statin users, respectively) between 2001 and 2012. The overall 90-day mortality was 29.8% (311/1043); it was 33.3% (227/681) and 23.2% (84/362) for non-statin and statin users, respectively. After adjusted for potential confounders, we found that statin use was associated with 29% lower of 90-day mortality (HR=0.71, 95% CI 0.52 to 0.97, p<0.05). IPW also demonstrated a significantly lower 90-day mortality in statin users. The HR was 0.69 (95% CI 0.54 to 0.88, p<0.01). The results remain stable in subgroup analyses and propensity score matching. CONCLUSION Statin use during hospitalisation may be associated with reduced risk-adjusted mortality in patients with ICH. Further randomised controlled trials are needed to clarify this association.
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Affiliation(s)
- Min Yuan
- Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Xinhua Zhou
- Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Xiaoqing Lu
- Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhilong Xiao
- Department of Neurology, The Third Hospital of Nanchang, Nanchang, China
| | - Huangyan Zhou
- Department of Blood Transfusion, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Nanchang, China
| | - Xiaohua Wang
- Department of General Practice/General Family Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Poststroke Seizure and Epilepsy: A Review of Incidence, Risk Factors, Diagnosis, Pathophysiology, and Pharmacological Therapies. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:7692215. [PMCID: PMC9629926 DOI: 10.1155/2022/7692215] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/23/2022] [Accepted: 10/08/2022] [Indexed: 11/18/2022]
Abstract
Stroke is the most common cause of epilepsy and ultimately leads to a decrease in the quality of life of those affected. Ischemic and hemorrhagic strokes can both lead to poststroke epilepsy (PSE). Significant risk factors for PSE include age < 65age less than 65 years, stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), cortical involvement, and genetic factors such as TRPM6 polymorphism. The diagnosis of PSE is made by using imaging modalities, blood biomarkers, and prognostic criteria. Electroencephalography (EEG) is currently the gold standard to diagnose PSE, while new combinations of modalities are being tested to increase diagnostic specificity. This literature review uncovers a newly found mechanism for the pathology of poststroke epilepsy. The pathogenesis of early-onset and late-onset is characterized by sequelae of neuronal cellular hypoxia and disruption of the blood-brain barrier, respectively. Interleukin-6 is responsible for increasing the activity of glial cells, causing gliosis and hyperexcitability of neurons. Epinephrine, high-mobility group protein B1, downregulation of CD32, and upregulation of HLA-DR impact the pathology of poststroke epilepsy by inhibiting the normal neuronal immune response. Decreased levels of neuropeptide Y, a neurotransmitter, act through multiple unique mechanisms, such as inhibiting intracellular Ca2+ accumulation and acting as an anti-inflammatory, also implemented in the worsening progression of poststroke epilepsy. Additionally, CA1 hippocampal resonant neurons that increase theta oscillation are associated with poststroke epilepsy. Hypertensive small vessel disease may also have an implication in the temporal lobe epilepsy by causing occult microinfarctions. Furthermore, this review highlights the potential use of statins as primary prophylaxis against PSE, with multiple studies demonstrating a reduction in incidence using statins alone, statins in combination with antiepileptic drugs (AEDs), and statins with aspirin. The evidence strongly suggests that the second generation AEDs are a superior treatment method for PSE. Data from numerous studies demonstrate their relative lack of significant drug interactions, increased tolerability, and potential superiority in maintaining seizure-free status.
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Tako LM, Strzelczyk A, Rosenow F, Pfeilschifter W, Steinmetz H, Golbach R, Schäfer JH, Zöllner JP, Kohlhase K. Predictive Factors of Acute Symptomatic Seizures in Patients With Ischemic Stroke Due to Large Vessel Occlusion. Front Neurol 2022; 13:894173. [PMID: 35711262 PMCID: PMC9196034 DOI: 10.3389/fneur.2022.894173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Acute symptomatic seizures (ASz) after ischemic stroke are associated with increased mortality; therefore, identifying predictors of ASz is important. The purpose of this study was to analyze predictors of ASz in a population of patients with ischemic stroke due to large arterial vessel occlusion (LVO). Materials and Methods This retrospective study examined patients with acute ischemic stroke caused by LVO between 2016 and 2020. Identification of predictive factors was performed using univariate and subsequent multiple logistic regression analysis. In addition, subgroup analysis regarding seizure semiology and time of seizure occurrence (≤ 24 h and > 24 h after stroke) was performed. Results The frequency of ASz among 979 patients was 3.9 % (n = 38). Univariate logistic regression analysis revealed an increased risk of ASz in patients with higher National Institutes of Health Stroke Scale (NIHSS) score at admission or 24 h after admission, hypernatremia at admission ≥ 145 mmol/L, and pneumonia. Further multiple logistic regression analysis revealed that NIHSS 24 h after admission was the strongest predictor of ASz, particularly relating to ASz occurring later than 24 h after stroke. Patients who experienced a seizure within the first 24 h after stroke were more likely to have a generalized tonic-clonic (GTCS) and focal motor seizure; beyond 24 h, seizures with impaired awareness and non-convulsive status epilepticus were more frequent. Conclusion NIHSS score 24 h after admission is a strong predictive factor for the occurrence of ASz in patients with ischemic stroke caused by LVO. The semiology of ASz varied over time, with GTCS occurring more frequently in the first 24 h after stroke.
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Affiliation(s)
- Lisa Marie Tako
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Helmuth Steinmetz
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Rejane Golbach
- Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan Hendrik Schäfer
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Johann Philipp Zöllner
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
| | - Konstantin Kohlhase
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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Do PT, Chen LY, Chan L, Hu CJ, Chien LN. Risk Factors for Postischemic Stroke Epilepsy in Young Adults: A Nationwide Population-Based Study in Taiwan. Front Neurol 2022; 13:880661. [PMID: 35669871 PMCID: PMC9163822 DOI: 10.3389/fneur.2022.880661] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe incidence of ischemic stroke has been increasing in the young population over the past 20 years. Poststroke epilepsy (PSE) is a common complication after stroke. However, few population-based studies with sufficient follow-up have investigated factors associated with PSE, especially factors related to comorbidities and unhealthy lifestyles in the modern young population. Accordingly, this study aimed to determine the long-term incidence and these risk factors for PSE young adults.MethodsThis cohort study was conducted using data from the Taiwan National Health Insurance Research Database (NHIRD) from 2002 to 2018. All patients aged between 19 and 44 years and diagnosed with ischemic stroke from 2002 to 2015 were retrospectively enrolled with a follow-up of at least 3 years. Multivariable Cox regression models were performed to identify predictors of PSE, including patients' demographics, baseline conditions, stroke severity, etiologies, comorbidities, and unhealthy behaviors.ResultsAmong 6,512 ischemic stroke patients, 402 cases (6.2%) developed PSE who were with a mean follow-up period of 8.3 years (SD = 4.3 years). During the overall follow-up, stroke severity and manifestations were associated with PSE, including National Institutes of Health Stroke Scale (NIHSS) score ≥10 (aHR, 1.98; 95% CI, 1.50–2.61), seizure at first stroke admission [adjusted hazard ratio (aHR), 57.39; 95% confidence interval (CI), 43.02–76.55], length of hospital stay ≥14 days (aHR, 1.60; 95% CI, 1.26–2.02), recurrent stroke (aHR, 2.32; 95% CI, 1.85–2.90), aphasia (aHR, 1.77; 95% CI, 1.20–2.60), and malignancy (aHR, 2.05; 95% CI, 1.30–3.24). Furthermore, stroke patients with drug abuse were 2.90 times more likely to develop PSE than those without (aHR, 2.90; 95% CI, 1.53–5.50). By contrast, statin use (aHR, 0.62; 95% CI, 0.48–0.80) was associated with a lower risk of PSE. The risk factors at 1-year and 5-year PSE were similar to that of an overall follow-up.ConclusionsStroke severity, aphasia, malignancy, and drug abuse were associated increased risk of PSE and statin use may protect against PSE in young adults. Reducing the severity of stroke, statin use and controlling unhealthy behaviors might be able to decrease the development of PSE. Since PSE is associated with poor outcomes, early identification or intervention of PSE based on the risk factors might reduce the harmful effects of PSE.
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Affiliation(s)
- Phuong Thao Do
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Pediatrics, Hanoi Medical University, Hanoi, Vietnam
| | - Li-Ying Chen
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Lung Chan
- Department of Neurology and Stroke Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- PhD Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology and Stroke Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- PhD Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Chaur-Jong Hu
| | - Li-Nien Chien
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
- Li-Nien Chien
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Hufthy Y, Bharadwaj M, Gupta S, Hussain D, Joseph PJS, Khan A, King J, Lahorgue P, Jayawardena O, Rostami-Hochaghan D, Smith C, Marson A, Mirza N. Statins as antiepileptogenic drugs: analysing the evidence and identifying the most promising statin. Epilepsia 2022; 63:1889-1898. [PMID: 35582761 PMCID: PMC9541605 DOI: 10.1111/epi.17303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
Many brain insults and injuries are “epileptogenic”: they increase the risk of developing epilepsy. It is desirable to identify treatments that are “antiepileptogenic”: treatments that prevent the development of epilepsy, if administered after the occurrence of an epileptogenic insult. Current antiepileptic drugs are not antiepileptogenic, but evidence of antiepileptogenic efficacy is accumulating for a growing number of other compounds. From among these candidate compounds, statins are deserving of particular attention because statins are reported to be antiepileptogenic in more published studies and in a wider range of brain insults than any other individual or class of compounds. Although many studies report the antiepileptogenic effect of statins, it is unclear how many studies provide evidence that statins exhibit the following two essential features of a clinically viable antiepileptogenic drug: the drug must exert an antiepileptogenic effect even if it is initiated after the epileptogenic brain insult has already occurred, and the antiepileptogenic effect must endure even after the drug has been discontinued. In the current work, we interrogate published preclinical and clinical studies, to determine if statins fulfill these essential requirements. There are eight different statins in clinical use. To enable the clinical use of one of these statins for antiepileptogenesis, its antiepileptogenic effect will have to be established through future time‐ and resource‐intensive clinical trials. Therefore, it is desirable to review the published literature to determine which of the statins emerges as the most promising candidate for antiepileptogenic therapy. Hence, in the current work, we also collate and analyze published data—clinical and pre‐clinical, direct and indirect—that help to answer the question: Which statin is the most promising candidate to take forward into an antiepileptogenesis clinical trial?
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Affiliation(s)
- Yousif Hufthy
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Shubhi Gupta
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Delwar Hussain
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Alizah Khan
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Jessica King
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | | | | | - Chloe Smith
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Anthony Marson
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Nasir Mirza
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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9
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Tröscher AR, Gruber J, Wagner JN, Böhm V, Wahl AS, von Oertzen TJ. Inflammation Mediated Epileptogenesis as Possible Mechanism Underlying Ischemic Post-stroke Epilepsy. Front Aging Neurosci 2021; 13:781174. [PMID: 34966269 PMCID: PMC8711648 DOI: 10.3389/fnagi.2021.781174] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/23/2021] [Indexed: 01/19/2023] Open
Abstract
Post-stroke Epilepsy (PSE) is one of the most common forms of acquired epilepsy, especially in the elderly population. As people get increasingly older, the number of stroke patients is expected to rise and concomitantly the number of people with PSE. Although many patients are affected by post-ischemic epileptogenesis, not much is known about the underlying pathomechanisms resulting in the development of chronic seizures. A common hypothesis is that persistent neuroinflammation and glial scar formation cause aberrant neuronal firing. Here, we summarize the clinical features of PSE and describe in detail the inflammatory changes after an ischemic stroke as well as the chronic changes reported in epilepsy. Moreover, we discuss alterations and disturbances in blood-brain-barrier leakage, astrogliosis, and extracellular matrix changes in both, stroke and epilepsy. In the end, we provide an overview of commonalities of inflammatory reactions and cellular processes in the post-ischemic environment and epileptic brain and discuss how these research questions should be addressed in the future.
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Affiliation(s)
| | - Joachim Gruber
- Neurology I, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.,Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Judith N Wagner
- Neurology I, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.,Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Vincent Böhm
- Neurology I, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.,Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Anna-Sophia Wahl
- Brain Research Institute, University of Zurich, Zurich, Switzerland.,Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Tim J von Oertzen
- Neurology I, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.,Medical Faculty, Johannes Kepler University, Linz, Austria
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10
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Zhao L, Li J, Kälviäinen R, Jolkkonen J, Zhao C. Impact of drug treatment and drug interactions in post-stroke epilepsy. Pharmacol Ther 2021; 233:108030. [PMID: 34742778 DOI: 10.1016/j.pharmthera.2021.108030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/21/2022]
Abstract
Stroke is a huge burden on our society and this is expected to grow in the future due to the aging population and the associated co-morbidities. The improvement of acute stroke care has increased the survival rate of stroke patients, and many patients are left with permanent disability, which makes stroke the main cause of adult disability. Unfortunately, many patients face other severe complications such as post-stroke seizures and epilepsy. Acute seizures (ASS) occur within 1 week after the stroke while later occurring unprovoked seizures are diagnosed as post-stroke epilepsy (PSE). Both are associated with a poor prognosis of a functional recovery. The underlying neurobiological mechanisms are complex and poorly understood. There are no universal guidelines on the management of PSE. There is increasing evidence for several risk factors for ASS/PSE, however, the impacts of recanalization, drugs used for secondary prevention of stroke, treatment of stroke co-morbidities and antiseizure medication are currently poorly understood. This review focuses on the common medications that stroke patients are prescribed and potential drug interactions possibly complicating the management of ASS/PSE.
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Affiliation(s)
- Lanqing Zhao
- Department of Sleep Medicine Center, The Shengjing Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Jinwei Li
- Department of Stroke Center, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Reetta Kälviäinen
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka Jolkkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Chuansheng Zhao
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.
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11
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Statin use for the prevention of seizure and epilepsy in the patients at risk: A systematic review and meta-analysis of cohort studies. Epilepsy Res 2021; 174:106652. [PMID: 33971584 DOI: 10.1016/j.eplepsyres.2021.106652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/26/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Statin use for the prevention of seizure and epilepsy had been suggested but remained controversial. We sought to search existing literature to determine whether prophylactic use of statin reduced the incidence of seizure and epilepsy in the patients at risk. METHODS Three electronic databases were thoroughly searched to identify clinical studies investigating the effects of statin use on patients at the risk of seizure or epilepsy. Regardless of heterogeneity quantified, a random effects meta-analyses were used to synthesize the evidence, to pool odds ratios (ORs) and corresponding 95 % confidence intervals (CIs). RESULTS Seven cohort studies involving 26,042 patients with newly-onset epileptogenic brain insults and no history of seizure and epilepsy before were included. Compared with patients didn't receive statin treatment after epileptogenic brain insults, those treated with statin had a lower risk of epilepsy (5 studies; 22,849 patients; pooled OR, 0.48; 95 % CI, 0.31 to 0.73; p = 0.001) and seizure (4 studies; 6076 subjects; pooled OR, 0.35; 95 % CI, 0.25 to 0.48; p = 0.001). CONCLUSIONS Evidence from this meta-analysis suggested that the use of statin should as primary prevention for patients with risk of seizures and epilepsy. Considering the limited number and quality of available studies, future randomized controlled trials are required to further demonstrate the association between statin use and incident of seizure and epilepsy.
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