Statin use and risk of remote seizure after first new onset status epilepticus

Preclinical evidence supports the role of statins as antiepileptogenic agents. In this study, we investigated the risk of remote unprovoked seizures (RS) according to the use of statin therapy in a cohort of first-ever status epilepticus (SE) survivors.

Retrospective analysis was made of adult patients (age ≥ 14 years) with a first SE who were consecutively and prospectively admitted to the Modena Academic Hospital, Italy (September 2015-December 2023) and included in the Modena Status Epilepticus Registry. Kaplan-Meier survival analyses were used to calculate the probability of RS following the index SE event, whereas Cox proportional hazard and competing risk regression models were used to assess predictors of RS occurrence.

A total of 314 patients were included (mean age = 70 years, 63% females). The statin-exposed cohort included both patients already receiving statins before SE (n = 68) and patients in whom statin administration was started during the hospitalization (n = 18). Atorvastatin (69/86, 80%) was the most frequently prescribed statin. Overall, 67 patients (21.3%) developed RS (mean follow-up = 31.5 months). Cumulative probability of RS occurrence was 16%, 23%, and 32% at 12 months, 2 years, and 5 years after SE, respectively. Median time from index event to first RS was 6.9 months (interquartile range = 11.6 months). Cumulative probability of RS was significantly lower in statin users compared to nonusers (log-rank p = .038). After adjusting for confounders, the risk of RS was lower for those patients who used statins after the index event (hazard ratio = .48, 95% confidence interval [CI] = .26-.90, p = .023).

The overall risk of RS was moderate and temporally confined within a few years from the index event. Statin exposure was associated with a lower incidence of RS. Our findings expand knowledge regarding a possible antiepileptogenic role of statins after SE and support further studies in this field.