Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers usage is associated with a reduced risk of seizures and epilepsy after ischemic stroke.

BACKGROUND

Ischemic stroke is the leading cause of epilepsy in the elderly. Various antihypertensive drugs have shown potential anti-epileptic effects and are widely used in cerebrovascular disease for the comorbidity of hypertension. However, it remains unknown whether they can reduce the occurrence of seizures and epilepsy after ischemic stroke.

OBJECTIVE

To examine the effect of antihypertensive drugs on reducing the risk of post-stroke early-onset seizures (ES) and post-stroke epilepsy (PSE).

DESIGN

A retrospective cohort study.

METHODS

In this retrospective cohort study, we enrolled patients who experienced a first-ever acute ischemic stroke and had no history of epilepsy prior to the stroke. With a mean follow-up period of 3.5 years, we identified occurrences of ES and PSE. Logistic regression analyses were employed to assess the potential efficacy of antihypertensive drugs in reducing the incidence of ES and PSE.

RESULTS

Out of 888 enrolled patients, 19 (2.1%) developed ES and 27 (3.0%) developed PSE. The use of antihypertensive drugs was associated with a reduced risk of ES (OR 0.37, 95% CI 0.14-0.99, p = 0.047). Specifically, the use of renin-angiotensin system inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), was associated with a 68% of decreased risk of PSE (OR 0.29, 95% CI 0.11-0.94), the significance remained after adjustment.

CONCLUSIONS

The use of antihypertensive drugs potentially decreases the risk of ES/PSE. Specifically, among all antihypertensive drugs, ACEI/ARBs could lower the likelihood of developing PSE.