Clinical Profile and Changes of Serum Lipid Levels in Epileptic Patients after Cerebral Infarction

Ikeda, Ken; Sawada, Masahiro; Morioka, Harumi; Kyuzen, Maya; Ebina, Junya; Nagasawa, Junpei; Yanagihashi, Masaru; Miura, Ken; Ishikawa, Yuichi; Hirayama, Takehisa; Takazawa, Takanori; Kano, Osamu; Kawabe, Kiyokazu; Iwasaki, Yasuo

doi:10.1016/j.jstrokecerebrovasdis.2016.11.011

Cited by 8 publications

(9 citation statements)

References 36 publications

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“…Therefore, the increased death risk in phenytoin user may be contributed from its influences on the circulatory systems. Phenytoin was associated with a higher risk of hyperlipidemia [ 22 , 23 ], increased homocysteine and high sensitivity C-reactive protein [ 24 ], and increased atherosclerosis measured as intima media thickness [ 24 ]. Phenytoin is a sodium channel blocker.…”

Section: Discussionmentioning

confidence: 99%

Effects of long-term anti-seizure medication monotherapy on all-cause death in patients with post-stroke epilepsy: a nationwide population-based study in Taiwan

et al. 2021

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Objective We aim to compare the effect of long-term anti-seizure medication (ASM) monotherapy on the risk of death and new ischemic stroke in patients with post-stroke epilepsy (PSE). Patients and methods We identified all hospitalized patients (≥ 20 years) with a primary diagnosis of ischemic or hemorrhagic stroke from 2001 to 2012 using the National Health Insurance Research Database in Taiwan. The PSE cohort were defined as the stroke patients (1) who had no epilepsy and no ASMs use before the index stroke, and (2) who had epilepsy and ASMs use after 14 days from the stroke onset. The patients with PSE receiving ASM monotherapy were enrolled and were categorized into phenytoin, valproic acid, carbamazepine, and new ASM groups. We employed the Cox regression model to estimate the unadjusted and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) of death and new ischemic stroke within 5 years across all groups, using the new ASM group as the reference. Results Of 6962 patients with PSE using ASM monotherapy, 3917 (56 %) were on phenytoin, 1623 (23 %) on valproic acid, 457 (7 %) on carbamazepine, and 965 (14 %) on new ASMs. After adjusting for confounders, compared with new ASM users, phenytoin users had a higher risk of death in 5 years (HR: 1.64; 95 % CI: 1.06–2.55). On the other hand, all ASM groups showed a similar risk of new ischemic stroke in 5 years. Conclusions Among patients with PSE on first-line monotherapy, compared to new ASMs, use of phenytoin was associated with a higher risk of death in 5 years.

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Section: Discussionmentioning

confidence: 99%

Effects of long-term anti-seizure medication monotherapy on all-cause death in patients with post-stroke epilepsy: a nationwide population-based study in Taiwan

et al. 2021

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“…The main harm of triglycerides to the human body is mainly to cause atherosclerosis, block blood vessels and form thrombus. It is closely related to the occurrence of cerebral infarction [23,24]. Our research suggests that the D-dimer, LDL, HDL, and triglycerides can be used as indicators to predict the severity of the NIHSS scores in patients with cerebellar infarction [25].…”

Section: Discussionmentioning

confidence: 72%

“…Existing studies generally support that the increase of D-dimer is a risk factor for cerebral infarction, and it has predictive signi cance for the course of the disease [19][20][21]. Studies have shown that cholesterol carried by LDL is prone to accumulate on the walls of blood vessels and arteries, forming unstable soft plaques, which blocks the cerebral artery and causes a cerebral infarction [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Correlation between the imaging manifestations of cerebellar infarction and the clinical characteristics of patients: a retrospective analysis

Wei¹,

Zhang²,

Meng³

et al. 2021

Preprint

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Background The aim of this study was to analyze the correlation between the imaging manifestations of cerebellar infarction and the clinical characteristics of patients. Methods A total of 83 patients with acute cerebellar infarction were included in this analysis. The NIHSS score, TOAST classification, CT and MRI examinations and serum laboratory tests were performed. The statistics of the data were carried out through descriptive statistics, T test and analysis of variance. Results Hyperlipidemia (66.3%), hypertension (77.1%) and carotid atherosclerosis (97.6%) were the main underlying causes of cerebellar infarction. Ataxia (67.5%) and brainstem syndrome (60.2%) were main clinical manifestations. Patients with NIHSS score ≤ 5 accounted for the majority (87.9%) and SAO (43.3%) and LAA (50.6%) were the main TOAST classifications. The cerebellar infarction caused by obstruction of SCA accounted for the majority (69.9%) and there was no statistical difference in the detection ability of CTA and MRA (P > 0.05). The incidence of left hemisphere cerebellar infarction was the highest (56.7%) and MRI showed an absolute advantage in showing the area of cerebellar infarction compared with CT (P < 0.001). The serum concentrations of D-dimer, LDL, and triglycerides were higher in patients with high NIHSS scores than in those with low scores (P < 0.05), while the serum HDL levels were just the opposite (P < 0.05). The serum D-dimer concentrations in patients classified as CE by TOAST were higher than that in patients classified as LAA and SAO (P < 0.05), while the serum concentrations of LDL were just the opposite (P < 0.05). The lesion sizes of cerebellar infarction were negatively related to the patient's serum HDL concentrations (P < 0.05) but it positively correlated with the NIHSS scores (P < 0.05). The patients classified as LAA had larger lesion sizes of cerebellar infarction than those classified as SAO and CE (P < 0.001). Conclusions CTA and MRA are comparable in showing the stenosis and obstruction of the cerebellar artery. However, MRI has an absolute advantage in showing the area of cerebellar infarction. The serum concentrations of D-dimer, HDL, LDL, and triglycerides are correlated with the patient’s NIHSS scores, TOAST classification and infarct sizes, which are helpful in evaluating the condition of the disease.

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“…21 Therefore, the increased death risk in phenytoin user may be contributed from its influences on the circulatory systems. Phenytoin was associated with a higher risk of dyslipidemia, 22,23 increased homocysteine and high sensitivity C-reactive protein, 24 and increased atherosclerosis measured as intima media thickness. 24 Phenytoin is a sodium channel blocker.…”

Section: Discussionmentioning

confidence: 95%

Effects of long-term Antiepileptic Drug Monotherapy on All-cause Death in Patients with Post-Stroke Epilepsy: A Nationwide Population-based Study

Hsu

Cheng

Lee

et al. 2020

Preprint

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Objective We aim to compare the effect of long-term antiepileptic drug (AED) monotherapy on the risk of death and recurrent ischemic stroke in patients with post-stroke epilepsy (PSE). Patients and Methods We identified all hospitalized patients (≥20 years) with a primary diagnosis of ischemic or hemorrhagic stroke from 2001 to 2012 using the National Health Insurance Research Database in Taiwan. The PSE cohorts were defined as the stroke patients (1) who had no epilepsy and no AEDs use before the index stroke, and (2) who had epilepsy and AEDs use after 14 days from the stroke onset. The PSE patients receiving AED monotherapy were enrolled and were categorized into phenytoin, valproic acid, carbamazepine, and new AED groups. We employed the Cox regression model to estimate the unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of death and recurrent ischemic stroke within 5 years across all groups, using the new AED group as the reference. Results Of 6962 PSE patients using AED monotherapy, 3917 (56%) were on phenytoin, 1623 (23%) on valproic acid, 457 (7%) on carbamazepine, and 965 (14%) on new AEDs. After adjusting for confounders, compared with new AED users, phenytoin users had a higher risk of death in 5 years (HR: 1.64; 95% CI: 1.06-2.55). On the other hand, all AED groups showed a similar risk of recurrent ischemic stroke. Conclusion Among PSE patients on first-line monotherapy, compared to new AEDs, use of phenytoin was associated with a higher risk of death in 5 years.

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Clinical Profile and Changes of Serum Lipid Levels in Epileptic Patients after Cerebral Infarction

Cited by 8 publications

References 36 publications

Effects of long-term anti-seizure medication monotherapy on all-cause death in patients with post-stroke epilepsy: a nationwide population-based study in Taiwan

Effects of long-term anti-seizure medication monotherapy on all-cause death in patients with post-stroke epilepsy: a nationwide population-based study in Taiwan

Correlation between the imaging manifestations of cerebellar infarction and the clinical characteristics of patients: a retrospective analysis

Effects of long-term Antiepileptic Drug Monotherapy on All-cause Death in Patients with Post-Stroke Epilepsy: A Nationwide Population-based Study

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