Elevated CRP predicts cognitive impairment in patients with post-stroke epilepsy_Journal of Epilepsy

Authors：

GUO Jian , MU Jie , GUO Yijia , ZHOU Dong ,  HE Li

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

Corresponding author：

HE Li, Email: heli2003new@126.com

Keywords：

C-reactive protein; Cognitive impairment; Epilepsy; Ischemic stroke

DOI：

10.7507/2096-0247.20180061

Video：

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Objectives This study aims to examine the possible association between C-reactive protein (CRP) concentration and cognitive impairment in patients with post-stroke epilepsy. Methods Patients with post-stroke epilepsy admitted to Western China Hospital from January 2010 to June 2016 were consecutively enrolled in our study. CRP levels were assessed within one week of stroke onset, and then correlated with cognitive status assessed two years after stroke using the Six-Item Screener. Results Among the 96 patients with post-stroke epilepsy who included in our study, 24 patients were found to have cognitive impairment during the two years follow-up period. Our data showed a significant association between CRP levels and cognitive performance in these patients (31.5±36.2 vs. 11.9±19.4, P=0.029). In addition, this association persisted even after adjusting for potential confounders［OR=1.021, 95%CI (0.997, 1.206), P=0.037］. Conclusions Following ischemic stroke, higher CRP levels is associated with subsequent cognitive decline in patients with epilepsy. Association and prospective studies in larger sample size are needed in order to validate our findings, especially studies in which baseline CRP level and CRP level during follow-up are closely monitored.

Citation： GUO Jian, MU Jie, GUO Yijia, ZHOU Dong, HE Li. Elevated CRP predicts cognitive impairment in patients with post-stroke epilepsy. Journal of Epilepsy, 2018, 4(5): 377-380. doi: 10.7507/2096-0247.20180061 Copy

1.	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(3): 224-229.
2.	Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: A systematic review and meta-analysis. Lancet Neurol, 2009, 8(11): 1006-1018.
3.	郭毅佳, 郭建, 周沐科, 等. 卒中后癫痫再发的影响因素分析. 癫痫杂志, 2017, 3(6): 465-469.
4.	Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke: A prospective multicenter study. Arch Neurol, 2000, 57(11): 1617-1622.
5.	Burneo JG, Fang J, Saposnik G, et al. Impact of seizures on morbidity and mortality after stroke: A canadian multi-centre cohort study. Eur J Neurol, 2010, 17(1): 52-58.
6.	孙立超, 吕晓民, 林卫红. 癫痫合并认知功能障碍研究进展. 癫痫杂志, 2017, 3(1): 56-59.
7.	初凤娜, 何林崔. 卒中后癫痫特点的临床研究. 癫痫杂志, 2016, 2(2): 106-108.
8.	Narasimhalu K, Lee J, Leong YL, et al. Inflammatory markers and their association with post stroke cognitive decline. Int J Stroke, 2015, 10(4): 513-518.
9.	Guo J, Su W, Fang J, et al. Elevated CRP at admission predicts post-stroke cognitive impairment in han chinese patients with intracranial arterial stenosis. Neurol Res, 2018, 40(4): 292-296.
10.	郭建, 周沐科, 陈宁, 等. C-反应蛋白与卒中后癫痫发病相关性研究. 癫痫杂志, 2015, 1(2): 139-142.
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.	Chen MR, Guo QH, Cao XY, et al. A preliminary study of the six-item screener in detecting cognitive impairment. Neurosci Bull, 2010, 26(4): 317-321.
13.	Galanopoulou AS, Bojko A, Lado F, et al. The spectrum of neuropsychiatric abnormalities associated with electrical status epilepticus in sleep. Brain Dev, 2000, 22(5): 279-295.
14.	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.
15.	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: 136-140.
16.	Alapirtti T, Waris M, Fallah M, et al. C-reactive protein and seizures in focal epilepsy: A video-electroencephalographic study. Epilepsia, 2012, 53(5): 790-796.
17.	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.
18.	Kuo HK, Yen CJ, Chang CH, et al. Relation of c-reactive protein to stroke, cognitive disorders, and depression in the general population: systematic review and meta-analysis. Lancet Neurol, 2005, 4(6): 371-380.
19.	Rothenburg LS, Herrmann N, Swardfager W, et al. The relationship between inflammatory markers and post stroke cognitive impairment. J Geriatr Psychiatry Neurol, 2010, 23(3): 199-205.
20.	Schmidt R, Schmidt H, Curb JD, et al. Early inflammation and dementia: A 25-year follow-up of the honolulu-asia aging study. Ann Neurol, 2002, 52(2): 168-174.
21.	Wang CH, Li SH, Weisel RD, et al. C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle. Circulation, 2003, 107(13): 1783-1790.
22.	McGeer PL, McGeer EG, Yasojima K. Alzheimer disease and neuroinflammation. J Neural Transm Suppl, 2000, 59: 53-57.
23.	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.
24.	Kushner I, Rzewnicki D, Samols D. What does minor elevation of c-reactive protein signify?. Am J Med, 2006, 119(2): 166e17-28.

1. 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(3): 224-229.
2. Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: A systematic review and meta-analysis. Lancet Neurol, 2009, 8(11): 1006-1018.
3. 郭毅佳, 郭建, 周沐科, 等. 卒中后癫痫再发的影响因素分析. 癫痫杂志, 2017, 3(6): 465-469.
4. Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke: A prospective multicenter study. Arch Neurol, 2000, 57(11): 1617-1622.
5. Burneo JG, Fang J, Saposnik G, et al. Impact of seizures on morbidity and mortality after stroke: A canadian multi-centre cohort study. Eur J Neurol, 2010, 17(1): 52-58.
6. 孙立超, 吕晓民, 林卫红. 癫痫合并认知功能障碍研究进展. 癫痫杂志, 2017, 3(1): 56-59.
7. 初凤娜, 何林崔. 卒中后癫痫特点的临床研究. 癫痫杂志, 2016, 2(2): 106-108.
8. Narasimhalu K, Lee J, Leong YL, et al. Inflammatory markers and their association with post stroke cognitive decline. Int J Stroke, 2015, 10(4): 513-518.
9. Guo J, Su W, Fang J, et al. Elevated CRP at admission predicts post-stroke cognitive impairment in han chinese patients with intracranial arterial stenosis. Neurol Res, 2018, 40(4): 292-296.
10. 郭建, 周沐科, 陈宁, 等. C-反应蛋白与卒中后癫痫发病相关性研究. 癫痫杂志, 2015, 1(2): 139-142.
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. Chen MR, Guo QH, Cao XY, et al. A preliminary study of the six-item screener in detecting cognitive impairment. Neurosci Bull, 2010, 26(4): 317-321.
13. Galanopoulou AS, Bojko A, Lado F, et al. The spectrum of neuropsychiatric abnormalities associated with electrical status epilepticus in sleep. Brain Dev, 2000, 22(5): 279-295.
14. 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.
15. 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: 136-140.
16. Alapirtti T, Waris M, Fallah M, et al. C-reactive protein and seizures in focal epilepsy: A video-electroencephalographic study. Epilepsia, 2012, 53(5): 790-796.
17. 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.
18. Kuo HK, Yen CJ, Chang CH, et al. Relation of c-reactive protein to stroke, cognitive disorders, and depression in the general population: systematic review and meta-analysis. Lancet Neurol, 2005, 4(6): 371-380.
19. Rothenburg LS, Herrmann N, Swardfager W, et al. The relationship between inflammatory markers and post stroke cognitive impairment. J Geriatr Psychiatry Neurol, 2010, 23(3): 199-205.
20. Schmidt R, Schmidt H, Curb JD, et al. Early inflammation and dementia: A 25-year follow-up of the honolulu-asia aging study. Ann Neurol, 2002, 52(2): 168-174.
21. Wang CH, Li SH, Weisel RD, et al. C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle. Circulation, 2003, 107(13): 1783-1790.
22. McGeer PL, McGeer EG, Yasojima K. Alzheimer disease and neuroinflammation. J Neural Transm Suppl, 2000, 59: 53-57.
23. 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.
24. Kushner I, Rzewnicki D, Samols D. What does minor elevation of c-reactive protein signify?. Am J Med, 2006, 119(2): 166e17-28.

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