Olivia Liu – Department of Neuroscience
Epilepsy is a disorder characterized by recurrent seizures. While numerous anti-epileptic options exist, there is no known way to prevent epilepsy from developing altogether. However, research has shown potential for one particular medication class that providers are familiar with: Angiotensin Receptor Blockers (ARBs). Previous animal analyses, as well as a 2022 German study, showed that ARBs diminished the risk of epilepsy development, possibly by decreasing vascular inflammation. A group of researchers sought to replicate the German project on a larger scale. Over 2.2 million Americans on either ARBs, ACE inhibitors, beta-blockers, or CCBs between 2010 and 2017 were sampled from a de-identified database for a retrospective cohort study. Using propensity score matching, patients on ARBs were compared to appropriate counterparts on different antihypertensives. Results showed a surprising 30% risk reduction for developing epilepsy, with Losartan being a specific agent highlighted [1]. Notably, this difference in new-onset epilepsy was observed in those without preexisting stroke or cardiovascular disease, two known precipitants of epilepsy. As such, we can conclude that the medication itself is responsible for the results, rather than a reduction in comorbid conditions.
This is a significant finding that utilized both a large and diverse population of patients. The theory behind Losartan decreasing the risk of epilepsy development is that it suppresses an albumin-induced TGF-beta signaling cascade, decreasing the activation of astrocytes, and thus protecting the blood-brain barrier’s permeability. With that being said, there are components to this cohort study that should be questioned, as comparing ARBs to CCBs did not show any significant results. Similarly, when comparing ARBs to ACE inhibitors, the percentage risk reduction was only noted in female patients. Nevertheless, a double-blind randomized control trial will be a step in the right direction to solidify ARBs as potential epilepsy preventive agents.
References:
Wen X, Otoo MN, Tang J, et al. Angiotensin Receptor Blockers for Hypertension and Risk of Epilepsy. JAMA Neurol. Published online June 17, 2024. doi:10.1001/jamaneurol.2024.1714
Edited by Aarti Palaniappan - Explorative Section Editor
