Study On The Correlation Between Atorvastatin And Epilepsy After The Conversion Of Intracerebral Hemorrhage After Acute Cerebral Infarction

Objective: The aim of this study was to analyze the incidence of epilepsy to evaluate the safety and effectiveness of atorvastatin in the treatment of intracerebral hemorrhage after acute cerebral infarction.Methods: This was a retrospective study performed in the Xianyang Hospital Affiliated to Yanan University from January 2012 to January 2017.740 patients were collected who suffered the conversion of intracerebral hemorrhage after acute cerebral infarction firstly,and were admitted to hospital within initial 24 hours after the onset of disease,as well as no history of epilepsy.The data of demographic,underlying disease,whether atorvastatin was received and the dosing regimens of atorvastatin within initial 24 hours after the onset of disease,history of smoking and drinking,the type of the conversion of intracerebral hemorrhage after acute cerebral infarction and epilepsy,score of National Institute of Health stroke scale(NIHSS)and Modified Rankin Scale when admission to hospital were extracted from the hospital information system.660 patients met the inclusion criteria and thus were included in the analysis eventually.We divided patients into 4 groups according to whether atorvastatin(H20051984)was received simultaneously and the dosing regimens of atorvastatin(non-atorvastatin,groups of atorvastatin 10 mg/d,20 mg/d and 40 mg/d).Episode time,incidence and types of epilepsy,and adverse reaction were recorded with 2 years after cerebral stroke in all groups.Results: 1.In the 660 patients with the conversion of intracerebral hemorrhage after acute cerebral infarction,28 patients suffered epilepsy after cerebral stroke.For the patients in non-atorvastatin taken group,12(7.2%)patients suffered epilepsy,and earlyand late-onset epilepsy both accounted for 6(3.6%).In the group of atorvastatin 10 mg/d,9(5.4%)patients suffered epilepsy,among which 4(2.4%)patients were early-onset epilepsy and 5(3.0%)patients were late-onset epilepsy.In the group of atorvastatin 20 mg/d,5(3.0%)patients occurred epilepsy,and 2(1.2%)and 3(1.8%)patients had earlyand late-onset epilepsy,respectively.In the group of atorvastatin 40 mg/d,only 2(1.2%)patients occurred epilepsy,and early-and late-onset epilepsy both accounted for 1(0.6%).Although there was no obvious difference between the incidence of early-onset and late-onset epilepsy,significant higher percentage of epilepsy was found in the atorvastatin groups compared with non-atorvastatin taken group.As doses atorvastatin increased from 10 mg/d to 40 mg/d,the incidence of epilepsy decreased from 5.5% to 1.2% after the conversion of intracerebral hemorrhage after acute cerebral infarction,indicating that atorvastatin is associated with lower incidence of epilepsy after the conversion of intracerebral hemorrhage after acute cerebral infarction and shows a dose-response relationship.In the non-atorvastatin taken and atorvastatin taken group,the incidence of early-onset and late-onset epilepsy after the conversion of intracerebral hemorrhage after acute cerebral infarction both decreased from 3.6% to 0.6%(P >0.05).2.In the 28 patients who occurred epilepsy after cerebral stroke,13(1.9%)were early-onset epilepsy,among which 7(53.8%)were generalized tonic-clonic seizure;1(7.7%)was status epilepticus;1(7.7%)was pure focal seizure;4(30.8%)were complex focal seizure.15(2.3%)were late-onset epilepsy,among which generalized tonic-clonic seizure,status epilepticus,pure focal and complex focal seizure were 9(60.0%),1(6.7%),2(13.3%)and 3(20.0%),respectively.No significance was observed among different groups.Generalized tonic-clonic seizure was the main type in both early-onset and late-onset epilepsy after the conversion of intracerebral hemorrhage after acute cerebral infarction.3.In the non-atorvastatin taken group,no symptomatic hemorrhagic transformation(SHT),no aggravated cerebral edema,no abnormal hepatic and renal function(alanine aminotransferase,aspartate aminotransferase ?3 fold of standard value,creatinine ?176 ?mol/L),and no abnormal creatine kinase(?10 fold of standard value)were observed.In the group of atorvastatin 10 mg/d,no SHT,no aggravated cerebral edema,and no abnormal creatine kinase were observed,while 1(0.6%)patient occurred serious abnormal hepatic and renal function.In the group of atorvastatin 20 mg/d,no aggravated cerebral edema was observed;however,1(0.6%)patients occurred SHT,2(1.2%)patients occurred serious abnormal hepatic and renal function,and 1(0.6%)patient occurred abnormal creatine kinase.In the group of atorvastatin 40 mg/d,no aggravated cerebral edema was observed;1(0.6%),3(1.8%)and 2(1.2%)patients occurred SHT,serious abnormal hepatic and renal function,and abnormal creatine kinase,respectively.There was no significant difference in the incidence of SHT,aggravated cerebral edema,abnormal hepatic and renal function,and abnormal creatine kinase.No deadly SHT was observed.Conclusion: Taking atorvastatin with within initial 24 hours after the onset of disease might reduce the risk of epilepsy after the conversion of intracerebral hemorrhage after acute cerebral infarction.In the certain doses range of atorvastatin(0-40 mg/d),lower incidence of epilepsy after cerebral stroke correlates with higher doses,and all the dosing regimens are relatively safe.