Focal seizures after treatment with fluvastatin in a patient with a history of catastrophic antiphospholipid syndrome

Association of Statin Therapy With Risk of Epilepsy in 2 Propensity Score-Matched Cohorts

BACKGROUND

Studies have suggested that statins may have a neuroprotective effect against epilepsy. However, evidence from rat models and case reports have suggested an opposite effect. Overall data are limited.

OBJECTIVE

To examine the association between statin use and epilepsy risk in a general population and in a healthy population (individuals with no severe comorbidities).

METHODS

Patients were Tricare beneficiaries from October 2003 to March 2012. Based on patients' characteristics during baseline phase (fiscal year [FY] 2004-2005), 2 propensity score (PS)-matched cohorts of statin users and nonusers were formed: (1) a PS-matched general cohort and (2) a PS-matched healthy cohort. Our outcome was defined using inpatient or outpatient ICD-9 codes for epilepsy during the follow-up phase (FY 2006 to March 2012) in the cohorts of statin users and nonusers.

RESULTS

The study included a total of 43 438 patients (13 626 statin users and 29 812 nonusers). The PS-matched general cohort matched 6342 statin users to 6342 nonusers; the odds ratio (OR) of epilepsy in this cohort during follow-up was 0.91; 95% CI = 0.67-1.23. The PS-matched healthy cohort matched 3351 statin users to 3351 nonusers; OR in the PS-matched healthy cohort during follow-up was 1.08; 95% CI = 0.64-1.83.

CONCLUSIONS

This study did not demonstrate a significant beneficial or deleterious effect of statin use on risk of being diagnosed with epilepsy. Clinicians should not withhold statins, whenever indicated, in patients with epilepsy.

Modulation of Immunity and the Inflammatory Response: A New Target for Treating Drug-resistant Epilepsy

Until recently, epilepsy medical therapy is usually limited to anti-epileptic drugs (AEDs). However, approximately 1/3 of epilepsy patients, described as drug-resistant epilepsy (DRE) patients, still suffer from continuous frequent seizures despite receiving adequate AEDs treatment of sufficient duration. More recently, with the remarkable progress of immunology, immunity and inflammation are considered to be key elements of the pathobiology of epilepsy. Activation of inflammatory processes in brain tissue has been observed in both experimental seizure animal models and epilepsy patients. Anti-inflammatory and immunotherapies also showed significant anticonvulsant properties both in clinical and in experimental settings. The above emerging evidence indicates that modulation of immunity and inflammatory processes could serve as novel specific targets to achieve potential anticonvulsant effects for the patients with epilepsy, especially DRE. Herein we review the recent evidence supporting the role of inflammation in the development and perpetuation of seizures, and also discuss the recent achievements in modulation of inflammation and immunotherapy applied to the treatment of epilepsy. Apart from medical therapy, we also discuss the influences of surgery, ketogenic diet, and electroconvulsive therapy on immunity and inflammation in DRE patients. Taken together, a promising perspective is suggested for future immunomodulatory therapies in the treatment of patients with DRE.