Early predictors and prevention for post-stroke epilepsy: changes in neurotransmitter levels

Abstract

Abstract Background: The purpose of this study was to identify predictors and preventative treatments for post-stroke epilepsy (PSE). Methodology: Eighty-four patients who had suffered a cerebrovascular insult (within 72 hours) were recruited and divided into two groups: an EP group (patients with seizures after stroke) and a NEP group (patients without seizures after stroke). The NEP group was then subdivided into three groups: a control group, a GABA (γ-aminobutiric acid) group (received GABA orally), and a CCB group (received calcium channel blocker nimodipine orally). Patient groups were compared by gender, age, past medical history, stroke type, number of lesions, and position and stroke severity (using Scandinavian stroke scale, SSS). Forearm venous blood was sampled, and high performance liquid chromatography (HPLC) was used to measure plasma levels of neurotransmitters and Ca2+. Patients then received 14 days of drug intervention. One month after drug withdrawal, GABA, glutamate (Glu) and Ca2+ concentrations in plasma were measured again. Results: The number of previous strokes, size of infarction, presence of multiple lesions, localization to the cortex, and SSS were statistically significant between the two groups (P < 0.05). In the EP group, the Glu concentration was greater and the Ca2+ concentration was lower than in the NEP group (P < 0.05). The results obtained after 1 month of therapy showed a reduction in Glu levels and an increase in GABA levels in the GABA group relative to the control NEP group (P < 0.05), while the CCB group showed a decrease in the concentration of Glu and an increase in the concentrations of GABA and Ca2+ relative to the NEP control group (P < 0.05). Conclusions: We identified susceptibility factors for PSE and demonstrated that GABA and calcium antagonists may have a therapeutic use in the early prevention of PSE.