Anti-epileptic Drugs Use and Increased Risk of Stroke: A Systematic Review

Area of Science:

• Neurology
• Pharmacology
• Cardiovascular Research

Background:

• Antiepileptic drugs (AEDs) are widely prescribed for epilepsy, migraine, neuropathic pain, and bipolar disorders.
• AED use is associated with increased risks of stroke, heart attack, and arrhythmia, particularly with enzyme-inducing properties.

Purpose of the Study:

• To systematically review the risk of ischemic stroke in patients using AEDs without a prior history of cerebrovascular accidents.
• To identify specific AEDs associated with increased ischemic stroke risk.

Main Methods:

• A systematic literature search was conducted in PubMed, EMBASE, and Google Scholar (2000-2021).
• Studies reporting the association between AEDs and ischemic stroke risk were included.
• Outcomes assessed included event ratio, hazard ratio, odds ratio, and risk ratio.

Main Results:

• Seven out of eight studies indicated an elevated risk of ischemic stroke with AED use in individuals without prior cardiovascular accidents.
• Phenytoin, sodium valproate, oxcarbazepine, levetiracetam, phenobarbital, and carbamazepine were associated with increased stroke risk.
• Data on the correlation between AED exposure duration and stroke risk was insufficient.

Conclusions:

• AEDs, particularly enzyme-inducing types, pose a significant risk of ischemic stroke.
• The dose dependency of this risk requires further assessment.
• Weighing the risks and benefits of AEDs is crucial for patients, especially those with vascular risk factors, to mitigate ischemic stroke risk.