Attenuating the Post-Stroke Epilepsy Using the Si-Miao-Yong-An Decoction for Treatment
International Journal of Chinese Medicine
Volume 4, Issue 3, September 2020, Pages: 54-60
Received: Jul. 7, 2020;
Accepted: Jul. 27, 2020;
Published: Aug. 20, 2020
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Shisheng Jiang, Institute of Clinical Research, Hunan Academy of Traditional Chinese Medicine, Changsha, China
Mukut Sharma, Renal Research Laboratory, and the Midwest Veterans’ Biomedical Research Foundation (MVBRF), VA Medical Center, Kansas City, USA
Yuming Han, Institute of Clinical Research, Hunan Academy of Traditional Chinese Medicine, Changsha, China
Hongmei Wang, Institute of Clinical Research, Hunan Academy of Traditional Chinese Medicine, Changsha, China
Feizhou He, Shuangteng Rehabilitation Hospital of TCM, Loudi, China
Shuangteng He, Institute of Clinical Research, Hunan Academy of Traditional Chinese Medicine, Changsha, China; Shuangteng Rehabilitation Hospital of TCM, Loudi, China; Stroke Research Laboratory, VA Medical Center, Kansas City, USA
Objective: To observe the clinical efficacy of Si-Miao-Yong-An decoction (SMYAD) in the treatment of post-stroke epilepsy. Methods: 112 patients with post-stroke epilepsy were randomly assigned to either the control or the treatment group (56 subjects in each group). Patients in the control group received oral levetiracetam (LEV) combined with other conventional Western medicine treatment (s), while the treatment group received SMYAD only. Outcome measures were the duration for seizure remission, remission rates at one year, changes in electroencephalogram (EEG), scores of National Institutes of Health Stroke Scale (NIHSS), and adverse events in the two groups. Results: The numbers of patients who completed treatment were 41 and 55 in the LEV group and SMYAD group, respectively (P<0.01). After 12 months of treatment, epilepsy was controlled in 35 patients in LEV group and 47 in SMYAD group (P=0.990). Seizure remission was achieved in 15.1 days in LEV group and 8.7 days in SMYAD group (P<0.01). Relapse of epilepsy was observed in 19 cases in the LEV group and 11 in SMYAD group (P<0.01). Abnormal EEG patterns persisted in 32 patients in LEV group and 29 patients in SMYAD group (P<0.01). The NIHSS score decreased from 12.2 to 9.4 in LEV group, and from 12.5 to 5.8 in SMYAD group (P<0.01). Adverse effects of treatment were observed in 28 cases in LEV group and 6 patients in SMYAD group (P<0.01). The most common adverse events reported were rash, fatigue, somnolence, headache, and dizziness in LEV group, and diarrhea in SMYAD group. Adverse effects caused withdrawal of 8 patients from LEV group but none from SMYAD group (P<0.01). Conclusion: SMYAD is an effective and well tolerated remedy for post-stroke epilepsy. Further large scale randomized controlled trials are needed to establish the efficacy and tolerability.
Attenuating the Post-Stroke Epilepsy Using the Si-Miao-Yong-An Decoction for Treatment, International Journal of Chinese Medicine.
Vol. 4, No. 3,
2020, pp. 54-60.
Camilo O, Goldstein LB. (2004) Seizures and epilepsy after ischemic stroke. Stroke. 35 (7): 1769-1775.
Sykes L, Wood E, Kwan J. (2014) Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. Cochrane Database Syst Rev. 1: CD005398.
Jung S, Schindler K, Findling O, Mono ML, Fischer U, Gralla J, El-Koussy M, Weck A, Galimanis A, Brekenfeld C, Schroth G, Mattle HP, Arnold M. (2012) Adverse effect of early epileptic seizures in patients receiving endovascular therapy for acute stroke. Stroke. 43 (6): 1584-1590.
Nicolo JP, O'Brien TJ, Kwan P. Role of cerebral glutamate in post-stroke epileptogenesis. Neuroimage Clin. 2019; 24: 102069.
Consoli D, Bosco D, Postorino P, Galati F, Plastino M, Perticoni GF, Ottonello GA, Passarella B, Ricci S, Neri G, Toni D; EPIC Study. (2012) Levetiracetam versus carbamazepine in patients with late poststroke seizures: a multicenter prospective randomized open-label study (EpIC Project). Cerebrovasc Dis. 34 (4): 282-289.
Szaflarski JP, Rackley AY, Kleindorfer DO, Khoury J, Woo D, Miller R, Alwell K, Broderick JP, Kissela BM. (2008) Incidence of seizures in the acute phase of stroke: a population-based study. Epilepsia. 49 (6): 974-981.
Chen TC, Chen YY, Cheng PY, Lai CH. (2012) The incidence rate of post-stroke epilepsy: a 5-year follow-up study in Taiwan. Epilepsy Res. 102 (3): 188-194.
Krakow K, Sitzer M, Rosenow F, Steinmetz H, Foerch C; Arbeitsgruppe Schlaganfall Hessen. (2010) Predictors of acute poststroke seizures. Cerebrovasc Dis. 30 (6): 584-589.
D'Alessandro R, Tinuper P, Ferrara R, Cortelli P, Pazzaglia P, Sabattini L, Frank G, Lugaresi E. (1982) CT scan prediction of late post-traumatic epilepsy. J Neurol Neurosurg Psychiatry. 45 (12): 1153-1155.
Faught E, Peters D, Bartolucci A, Moore L, Miller PC. (1989) Seizures after primary intracerebral hemorrhage. Neurology. 39 (8): 1089-1093.
Willmore, L. J. and Ueda, Y. (2009) Posttraumatic epilepsy: hemorrhage, free radicals and the molecular regulation of glutamate. Neurochem Res. 34, 688-697.
Willmore LJ, Sypert GW, Munson JV, Hurd RW. (1978) Chronic focal epileptiform discharges induced by injection of iron into rat and cat cortex. Science. 200 (4349): 1501-1503.
Sharma V, Babu PP, Singh A, Singh S, Singh R. (2007) Iron-induced experimental cortical seizures: electroencephalographic mapping of seizure spread in the subcortical brain areas. Seizure. 16 (8): 680-690.
Engström ER, Hillered L, Flink R, Kihlström L, Lindquist C, Nie JX, Olsson Y, Silander HC. (2001) Extracellular amino acid levels measured with intracerebral microdialysis in the model of posttraumatic epilepsy induced by intracortical iron injection. Epilepsy Res. 43 (2): 135-144.
Park UJ1, Lee YA, Won SM, Lee JH, Kang SH, Springer JE, Lee YB, Gwag BJ. (2011) Blood-derived iron mediates free radical production and neuronal death in the hippocampal CA1 area following transient forebrain ischemia in rat. Acta Neuropathol. 121 (4): 459-473.
Lipscomb DC1, Gorman LG, Traystman RJ, Hurn PD. (1998) Low molecular weight iron in cerebral ischemic acidosis in vivo. Stroke. 29 (2): 487-492.
Wagener, F. A., Volk, H. D., Willis, D., Abraham, N. G., Soares, M. P., Adema, G. J., and Figdor, C. G. (2003) Different faces of the heme-heme oxygenase system in inflammation. Pharmacol Rev. 55, 551-571.
Figueiredo, R. T., Fernandez, P. L., Mourão-As, D. S., Porto, B. N., Dutra, F. F., Alves, L. S., Oliveira, M. F., Oliveira, P. L., Graça-Souza, A. V., and Bozza, M. T. (2007) Characterization of heme as activator of Toll-like receptor 4. J Biol Chem. 282, 20221–20229.
Lin, S., Yin, Q., Zhong, Q., Lv, F. L., Zhou, Y., Li, J. Q., Wang, J. Z., Su, B. Y., and Yang, Q. W. (2012) Heme activates TLR4-mediated inflammatory injury via MyD88/TRIF signaling pathway in intracerebral hemorrhage. J Neuroinflammation. 9, 46.
Devi PU, Manocha A, Vohora D. (2008) Seizures, antiepileptics, antioxidants and oxidative stress: an insight for researchers. Expert Opin Pharmacother. 9 (18): 3169-3177.
Vezzani A, Friedman A, Dingledine RJ. (2013) The role of inflammation in epileptogenesis. Neuropharmacology. 69: 16-24.
Naidech AM, Garg RK, Liebling S, Levasseur K, Macken MP, Schuele SU, Batjer HH. (2009) Anticonvulsant use and outcomes after intracerebral hemorrhage. Stroke. 40 (12): 3810-3815.
Messé SR, Sansing LH, Cucchiara BL, Herman ST, Lyden PD, Kasner SE; CHANT investigators. (2009) Prophylactic antiepileptic drug use is associated with poor outcome following ICH. Neurocrit Care. 11 (1): 38-44.
Zubkov AY1, Wijdicks EF. (2008) Antiepileptic drugs in aneurysmal subarachnoid hemorrhage. Rev Neurol Dis. 5 (4): 178-181.
Szaflarski JP, Sangha KS, Lindsell CJ, Shutter LA. (2010) Prospective, randomized, single-blinded comparative trial of intravenous levetiracetam versus phenytoin for seizure prophylaxis. Neurocrit Care. 12 (2): 165-172.
Myint PK, Staufenberg EFA, Sabanathan K. (2006) Post-stroke seizure and post-stroke epilepsy. Postgrad. Med. J. 82 568–572.
Shetty AK. (2013) Prospects of levetiracetam as a neuroprotective drug against status epilepticus, traumatic brain injury, and stroke. Front Neurol. 4: 172.
Woo KM, Yang SY, Cho KT. (2012) Seizures after spontaneous intracerebral hemorrhage. J Korean Neurosurg Soc. 52 (4): 312-319.
Selim M, Yeatts S, Goldstein JN, Gomes J, Greenberg S, Morgenstern LB, Schlaug G, Torbey M, Waldman B, Xi G, Palesch Y, Deferoxamine Mesylate in Intracerebral Hemorrhage Investigators. (2011) Safety and tolerability of deferoxamine mesylate in patients with acute intracerebral hemorrhage. Stroke. 42 (11): 3067-3074.
He S, Jiang S, and He F. (2001) Successful treatment of cerebral abscess with the Decoction of Si Miao Yong An Tang (in Chinese), Chinese Journal of Traditional Chinese Medicine. 41 (12): 552-553.
iang S, He S, Han Y, Xia A, Wang H, Wu C, He F. (2011) The Decoction of Si Miao Yong An on the acute phase of intracerebral hemorrhage. Chinese J. Basic Medicine for Traditional Chinese Medicine. 17 (4): 314-318.
Jiang S, He S, Han Y, Xia A, Wang H, He F. (2011) The effects of Simiao Yongan Decoction on preventing recurrent stroke. J. Emergency of Traditional Chinese Medicine. 20 (11): 1721-1723.
Jiang S, Han Y, Xia A, Wang H, He F, He S. (2016) The effects of Si-Miao-Yong-An decoction in treatment of post-stroke epilepsy: a report of 35 cases. Hunan Journal of Traditional Chinese Medicine. 32 (2): 1-4.
Su C, Wang Q, Zhang H, Jiao W, Luo H, Li L, Chen X, Liu B, Yu X, Li S, Wang W, Guo S. (2019) Si-Miao-Yong-An Decoction Protects Against Cardiac Hypertrophy and Dysfunction by Inhibiting Platelet Aggregation and Activation. Front Pharmacol. 18 (10): 990.
Zhao Y, Jiang Y, Chen Y, Zhang F, Zhang X, Zhu L, Yao X. (2020) Dissection of mechanisms of Chinese medicinal formula Si-Miao-Yong-an decoction protects against cardiac hypertrophy and fibrosis in isoprenaline-induced heart failure. J Ethnopharmacol. 248: 112050.
Ren Y, Chen X, Li P, Zhang H, Su C, Zeng Z, Wu Y, Xie X, Wang Q, Han J, Guo S, Liu B, Wang W. (2019) Si-Miao-Yong-An decoction ameliorates cardiac function through restoring the equilibrium of SOD and NOX2 in heart failure mice. Pharmacol Res. 146: 104318.
Zhang JP, Xu YZ, Li M, Li LJ, Peng L, Zhang GY, Yang C, Zhou YN, 2010. Effect of Simiao Yong’an decoction on oxidative stress and inflammation on atherosclerosis model rabbits. Journal of Traditional Chinese Medicine 51: 72–74. (in Chinese).
Peng L, Li M, Xu YZ, Zhang GY, Yang C, Zhou YN, Li LJ, Zhang JP. (2012). Effect of Si-Miao-Yong-An on the stability of atherosclerotic plaque in a diet-induced rabbit model. J. Ethnopharmacol. 143 (1): 241–248.
Jiang S, Han Y, Wang H, He F, He S. The effects and mechanisms of Si-Miao-Yong-An decoction on decreasing hemin and iron contents in rat brain after intracerebral hemorrhage. Chinese Journal of Traditional Chinese Medicine Pharmacology. 2017; 32 (3): 1044-1049.
Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, Mayberg M, Morgenstern L, Ogilvy CS, Vespa P, Zuccarello M. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007; 38 (6): 2001-2023.
Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T; American Heart Association/American Stroke Association Council on Stroke; Council on Cardiovascular Radiology and Intervention; American Academy of Neurology. (2006) Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Circulation. 113 (10): e409-449.
Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, Engel J, French J, Glauser TA, Mathern GW, Moshé SL, Nordli D, Plouin P, Scheffer IE. (2010) Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 51 (4): 676-685.