Statin treatment can reduce incidence of early seizure in acute ischemic stroke: A propensity score analysis

Abstract

A previous study showed early statin administration in patients with acute ischemic stroke (AiS) was associated with a lower risk of early-onset seizure (ES), which is a high risk of epilepsy, but this retrospective study design may not have eliminated confounding factor effects. We aimed to verify the determinants and prognostic significance of ES and clarify the effects of statin administration. Consecutive AIS patients without a history of epilepsy were enrolled. The relationship between ES (within 7 days of index-stroke) and statin treatment was assessed using multivariate and propensity scores (PS). Of 2,969 patients with AIS, 1,623 (54.6%) were treated with statin, and 66 (2.2%) developed ES. In logistic regression models, cortical stroke lesion [odds ratio (OR), 2.82; 95% confidence interval (CI), 1.29-7.28) and pre-morbid modified Rankin Scale (per 1 point) (OR, 1.39; 95% CI, 1.18-1.65) were higher risks for ES, while statin significantly reduced the risk of ES (OR, 0.44; 95% CI, 0.24-0.79). In accordance with PS-matching, statin treatment produced consistent results for ES after adjusting by inverse probability of treatment-weighting PS (OR, 0.41; 95% CI, 0.22-0.75). In conclusion, as previously, statin treatment was independently associated with a lower risk of ES in AIS.

Statin use and the risk of post-stroke seizures: A meta-analysis

“…Of the 205 unduplicated records that were identified during our initial search, the full texts of 26 articles were reviewed. A total of 7 articles including 53,579 subjects met our inclusion criteria and were finally included in this systematic review [13,14,16,17,[22][23][24]. A flow chart of the selection procedure is demonstrated in Fig.…”

“…1. Of 7 studies, 5 were from the China [14,16,17,23,24], 1 from Japan [13], and 1 from Brazil [22]. Five studies had retrospective designs and two had prospective designs.…”

“…The mean age of enrolled patients of the included studies ranged from 57.4 to 74.0 years. For stroke subtype, 5 studies included patients with IS [13,16,17,22,23], 1 study included HS [24], and 1 study included any stroke without reporting the stroke subtype [14]. For statin subtypes, atorvastatin, rosuvastatin, fluvastatin, simvastatin, pitavastatin, pravastatin, and lovastatin were the most commonly prescribed among the included studies.…”

“…For statin subtypes, atorvastatin, rosuvastatin, fluvastatin, simvastatin, pitavastatin, pravastatin, and lovastatin were the most commonly prescribed among the included studies. For endpoints of included studies, 6 studies [14,16,17,[22][23][24] explored the association between statin use and risk of PSE; 3 studies [13,17,23] explored the association between statin use and risk of early PSS. The study characteristics are summarized in Table 1.…”

“…Moreover, the optimal timing of statin use for PSS remains controversial. Recently, several new studies [13,14] regarding this issue have been published. Therefore, the aim of this a comprehensive systematic review and meta-analysis was to evaluate the association between statin use and the risks of PSS and post-stroke epilepsy (PSE).…”