Introduction
One of the major causes of epilepsy is stroke and the incidence of the newly diagnosed, post-stroke epilepsy (PSE) has been found to be 3%−45% in elderly patients. Previous studies have suggested that statin therapy may result in a lower incidence of epilepsy.
Objective
To evaluate the efficacy of double-dose statins in the treatment and prevention of early seizures (ES) and post-stroke epilepsy (PSE).
Patients and Methods
A prospective hospital-based non-randomized single blind comparative study comprising of 1033 patients with newly diagnosed ischemic stroke. The patients were divided into:
- Group A: Standard-dose (Oral 20 mg atorvastatin or 10 mg rosuvastatin daily)
- Group B: Double-dose (Oral 40 mg atorvastatin or 20 mg rosuvastatin daily)
Outcome
Primary Outcome Measures:
- Occurrence of ES, late seizure (LS) and PSE
Secondary Outcome Measures:
- Site of stroke and lesion area in PSE
- Time of episode for ES, LS and PSE
Results
- Double-dose led to lower incidence of PSE compared to the standard-dose group.
- The incidence of PSE was higher in males and in patients <65 years of age.
- Amongst the 21 patients who had PSE, there were two cases of focal aware seizures (FAS), five cases of focal impaired awareness seizures (FIAS), five cases of focal to bilateral tonic clonic (FBTCS) and nine cases of generalized tonic clonic seizures (GTCS).
- All three cases of ES occurred within the first 24 hours after the onset of stroke, among which one patient had FAS and two patients had FBTCS.
- Amongst those treated with standard dose statin, 0.25% had ES, 2.79% had LS and 2.54% had PSE.
- 0.41% had ES, 0.82% had LS and 0.41% had PSE in in the double-dose statin group.
- In 85.71% of the patients with PSE, stroke was found in the cerebral cortex and subcortical structures while in the others, stroke was located only in the subcortical structures.
- 38.1% of patients with PSE had lesions in a single lobe while 61.9% had lesions in multiple lobes.
- Amongst the 23 cases of LS, 3 occurred in the first six-month period, 18 cases occurred in the second six – month period and 2 cases occurred in the third six-month period.
- Amidst the ones who had PSE, 3 patients developed it during the first six-month period after stroke onset, 17 patients developed it during the second six-month period and 1 patient developed it during the third six – month period.
Conclusion
The preventative effect of statins on the occurrence of PSE was found to be dose-dependent and increasing its dose during the acute phase of ischemic stroke reduces the incidence of PSE.