Elevated C-reactive protein levels are associated with a higher risk of post-stroke seizures_Journal of Epilepsy

Authors：

 GUOJian , ZHOUMuke , CHENNing , ZHOUDong ,  HELi

Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, China;

Corresponding author：

HELi, Email: heli2003new@126.com

Keywords：

C-reactive protein; Epilepsy; Seizures; Stroke

DOI：

10.7507/2096-0247.20150021

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective This study aims to examine the possible association between C-reactive protein (CRP) concentration and post-stroke seizures. Methods Patients with a first-ever ischemic stroke and no history of epilepsy before stroke who admitted to Western China Hospital were consecutively enrolled in our study. CRP levels were assessed within one week of stroke onset. After a mean follow-up period of 2.5 years, a follow-up assessment was performed to identify post-stroke epilepsy. Logistic regression and Cox regression analyses were used to assess the relationship between CRP levels and post-stroke early-onset seizures or post-stroke epilepsy. Results Among the 1, 116 patients included in our study, 36 (3.2%) patients had post-stroke early-onset seizures and 65 (5.8%) patients had post-stroke epilepsy. Elevated CRP levels were associated with a higher risk of post-stroke early-onset seizures (51.4±49.2 vs 15.9±12.9, P=0.023). This correlation was persisted even after adjusting for potential confounders[OR=1.008, 95%CI (1.003, 1.018); P=0.003]. No association was observed between CRP levels and post-stroke epilepsy. Conclusions Elevated CRP levels may be associated with higher risk of post-stroke seizures. However, because of the observational nature of the study, more studies are needed to confirm the results.

Citation： GUOJian, ZHOUMuke, CHENNing, ZHOUDong, HELi. Elevated C-reactive protein levels are associated with a higher risk of post-stroke seizures. Journal of Epilepsy, 2015, 1(2): 139-142. doi: 10.7507/2096-0247.20150021 Copy

1.	Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke:a prospective multicenter study. Arch Neurol, 2000, 57(11): 1617-1622.
2.	Labovitz DL, Hauser WA, Sacco RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology, 2001, 57(2): 200-206.
3.	Annegers JF, Hauser WA, Lee JR, et al. Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984. Epilepsia, 1995, 36(4):327-333.
4.	Forsgren L, Bucht G, Eriksson S, et al. Incidence and clinical characterization of unprovoked seizures in adults:a prospective population-based study. Epilepsia, 1996, 37(2):224-229.
5.	Arboix A, Comes E, Massons J, et al. Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease. Neurology, 1996, 47(8):1429-1435.
6.	Burneo JG, Fang J, Saposnik G. Investigators of the Registry of the Canadian Stroke N. Impact of seizures on morbidity and mortality after stroke:a Canadian multi-centre cohort study. Eur J Neurol, 2010, 17(5):52-58.
7.	Drake C, Boutin H, Jones MS, et al. Brain inflammation is induced by co-morbidities and risk factors for stroke. Brain Behav Immun, 2011, 25(6):1113-1122.
8.	Wang Z, Hoy WE. C-reactive protein and the risk of developing type 2 diabetes in aboriginal australians. Diabetes Res Clin Pract, 2007, 76(12):37-43.
9.	Ishikawa N, Kobayashi Y, Fujii Y, et al. Increased interleukin-6 and high-sensitivity C-reactive protein levels in pediatric epilepsy patients with frequent, refractory generalized motor seizures. Seizure, 2015, 25(11):136-140.
10.	Alapirtti T, Waris M, Fallah M, et al. C-reactive protein and seizures in focal epilepsy:a video-electroencephalographic study. Epilepsia, 2012, 53(7):790-796.
11.	Beghi E, D'Alessandro R, Beretta S, et al. Incidence and predictors of acute symptomatic seizures after stroke. Neurology, 2011, 77(20):1785-1793.
12.	Corso G, Bottacchi E, Brusa A, et al. Is there a prognostic role for C-reactive protein in ischemic stroke? Acta Neurol Scand, 2010, 122(3):209-216.
13.	den Hertog HM, van Rossum JA, van der Worp HB, et al. C-reactive protein in the very early phase of acute ischemic stroke:association with poor outcome and death. J Neurol, 2009, 256(5):2003-2008.
14.	Rajeshwar K, Kaul S, Al-Hazzani A, et al. C-reactive protein and nitric oxide levels in ischemic stroke and its subtypes:correlation with clinical outcome. Inflammation, 2012, 35(3):978-984.
15.	Vezzani A, Aronica E, Mazarati A, et al. Epilepsy and brain inflammation. Exp Neurol, 2013, 244(6):11-21.
16.	Zwaka TP, Hombach V, Torzewski J. C-reactive protein-mediated low density lipoprotein uptake by macrophages:implications for atherosclerosis. Circulation, 2001, 103(9):1194-1197.
17.	Winbeck K, Poppert H, Etgen T, et al. Prognostic relevance of early serial C-reactive protein measurements after first ischemic stroke. Stroke, 2002, 33(10):2459-2464.
18.	Mintzer S, Skidmore CT, Abidin CJ, et al. Effects of antiepileptic drugs on lipids, homocysteine, and C-reactive protein. Ann Neurol, 2009, 65(4):448-456.

1. Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke:a prospective multicenter study. Arch Neurol, 2000, 57(11): 1617-1622.
2. Labovitz DL, Hauser WA, Sacco RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology, 2001, 57(2): 200-206.
3. Annegers JF, Hauser WA, Lee JR, et al. Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984. Epilepsia, 1995, 36(4):327-333.
4. Forsgren L, Bucht G, Eriksson S, et al. Incidence and clinical characterization of unprovoked seizures in adults:a prospective population-based study. Epilepsia, 1996, 37(2):224-229.
5. Arboix A, Comes E, Massons J, et al. Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease. Neurology, 1996, 47(8):1429-1435.
6. Burneo JG, Fang J, Saposnik G. Investigators of the Registry of the Canadian Stroke N. Impact of seizures on morbidity and mortality after stroke:a Canadian multi-centre cohort study. Eur J Neurol, 2010, 17(5):52-58.
7. Drake C, Boutin H, Jones MS, et al. Brain inflammation is induced by co-morbidities and risk factors for stroke. Brain Behav Immun, 2011, 25(6):1113-1122.
8. Wang Z, Hoy WE. C-reactive protein and the risk of developing type 2 diabetes in aboriginal australians. Diabetes Res Clin Pract, 2007, 76(12):37-43.
9. Ishikawa N, Kobayashi Y, Fujii Y, et al. Increased interleukin-6 and high-sensitivity C-reactive protein levels in pediatric epilepsy patients with frequent, refractory generalized motor seizures. Seizure, 2015, 25(11):136-140.
10. Alapirtti T, Waris M, Fallah M, et al. C-reactive protein and seizures in focal epilepsy:a video-electroencephalographic study. Epilepsia, 2012, 53(7):790-796.
11. Beghi E, D'Alessandro R, Beretta S, et al. Incidence and predictors of acute symptomatic seizures after stroke. Neurology, 2011, 77(20):1785-1793.
12. Corso G, Bottacchi E, Brusa A, et al. Is there a prognostic role for C-reactive protein in ischemic stroke? Acta Neurol Scand, 2010, 122(3):209-216.
13. den Hertog HM, van Rossum JA, van der Worp HB, et al. C-reactive protein in the very early phase of acute ischemic stroke:association with poor outcome and death. J Neurol, 2009, 256(5):2003-2008.
14. Rajeshwar K, Kaul S, Al-Hazzani A, et al. C-reactive protein and nitric oxide levels in ischemic stroke and its subtypes:correlation with clinical outcome. Inflammation, 2012, 35(3):978-984.
15. Vezzani A, Aronica E, Mazarati A, et al. Epilepsy and brain inflammation. Exp Neurol, 2013, 244(6):11-21.
16. Zwaka TP, Hombach V, Torzewski J. C-reactive protein-mediated low density lipoprotein uptake by macrophages:implications for atherosclerosis. Circulation, 2001, 103(9):1194-1197.
17. Winbeck K, Poppert H, Etgen T, et al. Prognostic relevance of early serial C-reactive protein measurements after first ischemic stroke. Stroke, 2002, 33(10):2459-2464.
18. Mintzer S, Skidmore CT, Abidin CJ, et al. Effects of antiepileptic drugs on lipids, homocysteine, and C-reactive protein. Ann Neurol, 2009, 65(4):448-456.

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