The Difference of Lymphocyte, hs-CRP, and Electroencephalogram with and without Simvastatin in Acute Ischemic Stroke

Chairil Amin Batubara, Aldy Safruddin Rambe, Nindia Sugih Arto

Abstract


Mortality and morbidity due to stroke rank the highest in Indonesia (15.4%), and most types of stroke are ischemic (87%). Inflammation has a role in the pathophysiology of both ischemic stroke and also inhibits acute symptomatic epileptic seizures (3-6%) in the first 7 days after stroke. Statins have been used for the treatment of dyslipidemia in stroke patients. Some studies showed that statins reduced the inflammatory response after a stroke and prevented the recovery of epileptic seizures. This study aimed to determine the differences in lymphocytes, hs-CRP, Electroencephalogram (EEG) with and without Simvastatin in acute ischemic stroke. This research was an experimental study with a double-blind, randomized control trial design consisting of two groups, a group given Simvastatin 20 mg/day, and a group given a placebo for seven days. The difference in lymphocytes, hs-CRP, EEG, and epileptic seizures between the two groups were then analyzed. The sample was 26 people, consisting of 17 (65.4%) males and 9 (34.6%) females with an average age of 59±5.8 years. Chi-Square and Fisher's test showed a significant difference in hs-CRP (p=0.005) and epileptic seizures (p=0.015), but no significant difference in lymphocytes (p=0.336) and EEG (p=0.42) between groups given Simvastatin 20 mg/day and those given placebo. There was a significant difference in hs-CRP and epileptic seizures, but no significant difference in lymphocyte count and EEG between the two groups with and without Simvastatin administration.


Keywords


Lymphocytes, hs-CRP, EEG, epileptic seizure, acute ischemic stroke

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References


Riskesdas (Riset Kesehatan Dasar). Jakarta, Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan Republik Indonesia, 2013; 123-126.

Go AS, Mozaffarian D, Roger V L, Benjamin E J, Berry J D, Borden W B, et al. Heart disease and stroke statistics 2013 update: A report from the american heart association, Circulation, 2013; 127: e6-e245.

Batubara CA, Ritarwan K, Rambe AS. Effectiveness differences of Ranitidine and Omeprazole in prevention of stress ulcer and its effect on pneumonia occurrence and outcome of acute stroke patients. IOP conference series: Earth and environmental science, 2018; 125: 012205.

Holtkamp M, Beghi E, Benninger F, Kalviainen R, Rocamora R, Christensen H. European Stroke Organisation guidelines for the management of post-stroke seizures and epilepsy. European Stroke Journal, 2017; 2(2): 103–115.

Kim BS, Sila C. Seizures in ischemic stroke. In: Koubeissi MZ, Alshekhlee A, Mehndiratta P (Eds.). Seizures in cerebrovascular disorders, a clinical guide. New York: Springer, 2015; 17-29.

Tokgoz S, Kayrak M, Akpinar Z, Seyithano A, Guney F, Betigul Yuruten B. Neutrophil lymphocyte ratio as a predictor of stroke. J Stroke Cerebrovasc Dis, 2013; 22(7): 1169-74.

Dambach H, Hinkerohe D, Prochnow N, Stienen MN, Moinfar Z, Haase CG, et al. Glia and epilepsy: Experimental investigation of antiepileptic drugs in an astroglia/microglia co-culture model of inflammation. Epilepsia, 2014; 55(1): 184–192.

Bentes C, Peralta AR, Martins H, Casimiro C, Morgado C, Franco AC, et al. Seizures, electroencephalographic abnormalities, and outcome of ischemic stroke patients. Epilepsia Open, 2017; 2(4): 441–452.

Segel GB, Halterman MW, Lichtman MA. The paradox of the neutrophil’s role in tissue injury. J. Leukoc. Biol. 2011; 89: 359–372.

Putri TL, Ganie RA, Rambe AS. Neutrophil-lymphocyte ratio and high sensitivity c-reactive protein as ischemic stroke outcome predictor. Indonesian Journal of Clinical Pathology and Medical Laboratory, 2017; 23(3): 240–245.

Ishikawa N, Kobayashi Y, Fujii Y, Kobayashi M. Increased interleukin-6 and high-sensitivity C-reactive protein levels in pediatric epilepsy patients with frequent, refractory generalized motor seizures. Seizure, 2015; 25: 136–140.

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2018; 49: e63-e71.

Guo J, Guo J, Li J, Zhou M, Qin F, Zhang S, et al. Statin treatment reduces the risk of post-stroke seizures. Neurology, 2015; 85: 1–7.

Zhao J, Zhang X, Dong L, Wen Y, Cui L. The many roles of statin in ischemic stroke. Current Neuropharmacology, 2014; 12: 564-574.

Gunadharma S, Kusumastuti K, Bintoro AC. EEG pada epilepsi. Dalam: Kumastuti K, Gunadharma S, Kustiowati E. (Ed.). Pedoman tatalaksana epilepsi. Surabaya, Airlangga University Press, 2014; 85-91.

Hansson, GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med, 2005; 352(16): 1685-95.

Ridker PM. C-reactive protein: A simple test to help predict risk of heart attack and stroke. Circulation, 2003; 108: e81-e85.

Hillyard DZ, Cameron AJM, McDonald KJ, Thomson J, MacIntyre A, Shiels PG. Simvastatin inhibits lymphocyte function in normal subjects and patients with cardiovascular disease. Atherosclerosis, 2004; 175: 305–313.

Kitagawa K, Hosomi N, Nagai Y, Kagimura T, Ohtsuki T, Origasa H. Reduction in high-sensitivity C-reactive protein levels in patients with ischemic stroke by statin treatment: Hs-CRP sub-study in J-STARS. J Atheroscler Thromb, 2017; 24: 1039-1047.

Citraro R, Chimirri S, Aiello R, Gallelli L, Trimboli F, Britti D, et al. Protective effects of some statins on epileptogenesis and depressive-like behavior in WAG/Rij rats, a genetic animal model of absence epilepsy. Epilepsia, 2014; 55(8): 1284–1291. 2014.




DOI: http://dx.doi.org/10.24293/ijcpml.v26i3.1592

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