Antiepileptic drugs boost stroke risk in Alzheimer’s patients

Antiepileptic drugs (AEDs), regardless of brand or type, increase risk of stroke in seniors diagnosed with Alzheimer’s disease (AD), according to research published in the Journal of the American Heart Association.

Around 1 percent of the population needs chronic antiepileptic control to mitigate their risk of seizures, first author Tatyana Sarycheva, MD, MSc, and colleagues said in JAHA, and past research has found patients with Alzheimer’s are more likely to use those drugs than individuals without the disease. 

“People with AD are more likely to experience stroke than those without AD,” Sarycheva and co-authors at the University of Eastern Finland wrote. “This may be due to higher prevalence of vascular risk factors or drugs acting on the central nervous system, which are commonly used by people with Alzheimer’s disease.”

The researchers looked into whether incident antiepileptic drug use was associated with any kind of elevated stroke risk in people with Alzheimer’s, considering the risk of hemorrhagic and ischemic strokes separately. The research pool included 70,718 Finnish AD patients enrolled in the MEDALZ cohort, 5,617 of whom were using AEDs at the study’s baseline.

Sarycheva et al. found that compared with non-use, using AEDs was associated with a 37 percent higher relative risk of stroke, with risk strongest during the first three months of AED use (HR: 2.36). Probability of stroke was marginally higher for hemorrhagic events, due in part, the authors said, to a smaller sample size.

“The association was more evident with ischemic strokes than hemorrhagic ones, partly because of the low number of hemorrhagic strokes in our cohort,” they wrote.

The team didn’t find any risk differences between older and newer AEDs.

“This study provides unique information on AED use-associated adverse events in people with Alzheimer’s disease, as they are often excluded from randomized controlled trials because of comorbidities and concomitant drug use,” Sarycheva and co-authors said. “The pathological changes in AD may increase the susceptibility to the adverse events of AEDs, and careful clinical consideration is needed before prescribing them to a person with Alzheimer’s disease.”