Selective Serotonin Reuptake Inhibitors and Poststroke Epilepsy: A Population-Based Nationwide Study

Chien-Chen Chou; Der-Jen Yen; Yung-Yang Lin; Yu-Chiao Wang; Cheng-Li Lin; Chia-Hung Kao

doi:10.1016/j.mayocp.2016.10.011

Selective Serotonin Reuptake Inhibitors and Poststroke Epilepsy: A Population-Based Nationwide Study

Mayo Clin Proc. 2017 Feb;92(2):193-199. doi: 10.1016/j.mayocp.2016.10.011.

Authors

Chien-Chen Chou¹, Der-Jen Yen¹, Yung-Yang Lin², Yu-Chiao Wang³, Cheng-Li Lin³, Chia-Hung Kao⁴

Affiliations

¹ Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
² Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
³ College of Medicine, China Medical University, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
⁴ Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.

PMID: 28160872
DOI: 10.1016/j.mayocp.2016.10.011

Abstract

Objective: To investigate the effects of selective serotonin reuptake inhibitors (SSRIs) on poststroke epilepsy in a population-based nationwide study.

Patients and methods: The SSRI group included patients who received a stroke diagnosis from January 1, 2000, through December 31, 2009, and were prescribed SSRIs after stroke. The non-SSRI group enrolled patients with stroke who were not prescribed SSRIs from the Taiwan National Health Insurance Research Database and used propensity score matching based on the index year, duration time, sex, age, type of stroke, and duration of hospitalization. Cox proportional hazards models were used to estimate the risk of epilepsy between the SSRI and comparison groups.

Results: A total of 4688 patients with stroke (2344 in each of the SSRI and non-SSRI cohorts) were enrolled. The cumulative incidence of epilepsy in the SSRI group was significantly higher than that in the comparison group (log-rank P<.001). In the SSRI group, the risk of poststroke epilepsy increased 2.45-fold (95% CI, 1.69- to 3.57-fold) compared with that in the comparison group. Furthermore, the risk of poststroke epilepsy increased with the defined daily dose of SSRIs. For patients with ischemic stroke, SSRIs users had a 2.74-fold higher risk of epilepsy than non users (95% CI, 1.79- to 4.22-fold).

Conclusion: In this study, SSRI users had a higher risk of poststroke epilepsy than nonusers. Further study is warranted to investigate the causal relationship between SSRI exposure and poststroke epilepsy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Comorbidity
Dose-Response Relationship, Drug
Epilepsy / epidemiology
Epilepsy / etiology*
Female
Humans
Incidence
Inpatients / statistics & numerical data
Insurance Claim Review / statistics & numerical data
Kaplan-Meier Estimate
Male
Middle Aged
Propensity Score
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Selective Serotonin Reuptake Inhibitors / adverse effects*
Selective Serotonin Reuptake Inhibitors / therapeutic use*
Stroke / complications*
Stroke / drug therapy
Stroke / etiology
Taiwan / epidemiology

Substances

Serotonin Uptake Inhibitors