The use of statins may decrease the risk of epilepsy, according to an article in the October 26 Neurology.
Mahyar Etminan, PharmD, Assistant Professor of Medicine at the University of British Columbia, Canada, and colleagues investigated statin use among 217 patients with epilepsy and 2,170 controls matched by age and cohort entry time. All participants were 65 or older and had undergone a coronary revascularization procedure. The researchers identified participants’ statin prescriptions before the index date and analyzed the associations between statin use and epilepsy using three models: one that controlled for age, sex, several illnesses, and various drugs; one that estimated a patient’s probability of receiving a statin based on baseline covariates; and one that used nonstatin cholesterol-lowering drugs, beta blockers, and angiotensin-converting enzyme inhibitors as control drugs.
The adjusted rate ratio (ARR) for epilepsy was 0.65 among patients who had received a statin within 30 days of the index date, indicating a significant benefit. The benefit for patients who had received a statin prescription more than 30 days before the index date was not significant, however, at 0.72. The control drugs did not show any benefit.
In addition, statins’ inverse association with epilepsy appeared to be dose-dependent. Compared with nonusers, patients who used a cumulative high dose of statins had a 0.54 ARR for epilepsy and patients who used a cumulative low dose of statins had a 0.72 ARR for the disease. Every gram of atorvastatin used annually reduced the risk of epilepsy by 5% in an adjusted dose-response analysis.
Although most anticonvulsants work through voltage-regulated calcium or sodium channels or activation of g-aminobutyric acid receptors, statins may prevent epilepsy through their anti-inflammatory properties, the researchers suggested. “Despite the introduction of newer antiepileptic medications in recent years, a third of those using drug therapy have recurrent seizures,” they wrote.
“While intriguing, these results do not justify starting statin therapy in patients who do not meet currently established criteria for disease risk,” cautioned Rohit R. Das, MD, MPH, Assistant Professor of Neurology at the University of Louisville School of Medicine, and Susan T. Herman, MD, Assistant Professor of Neurology at Beth Israel Deaconess Medical Center in Boston, in an accompanying editorial. They recommended that future research focus on whether statins have a seizure or epilepsy-modifying effect in animal models of stroke, traumatic brain injury, or brain tumor—and then move on to randomized clinical trials.