Use of statins is associated with a lower incidence of remote seizures following a first status epilepticus event, according to a retrospective study.
In a cohort of 314 status epilepticus survivors (mean age 70 years, 63 percent female), remote seizures (ie, an unprovoked seizure occurring >7 days from the acute index event) occurred in 15 percent of statin users vs 24 percent of nonusers (p=0.038) over a mean follow-up of 31.5 months, reported first author Dr Niccolò Orlandi from Azienda Ospedaliera-Universitaria in Modena, Italy, and colleagues. [Epilepsia 2026;doi:10.1002/epi.70503]
Statin use was associated with a 52-percent reduced long-term risk of remote seizures (hazard ratio [HR], 0.48, 95 percent confidence interval [CI], 0.25–0.90; p=0.021).
To account for the impact of death (mortality rate, 41 percent), Orlandi and colleagues conducted competing risk (Fine–Gray) and propensity score-matched sensitivity analyses. The beneficial association between statin use and remote seizure risk persisted across both models, with subhazard ratios of 0.55 (95 percent CI, 0.30–1.01; p=0.05) and 0.49 (95 percent CI, 0.25–0.97; p=0.041), respectively.
“To the best of our knowledge, only a previous study reported that exposure to statins could influence 30-day outcome after an incident status epilepticus. Our results expand this observation, suggesting that exposure to statins might influence long-term outcome after status epilepticus,” Orlandi and colleagues said. [Eur J Neurol 2015;22:402-405]
Remote seizure risk moderate
The study included 314 patients (mean age 70 years, 63 percent female) who had a first status epilepticus event and admitted to an academic hospital. A total of 86 patients (27 percent) were statin users, including 68 who had already been taking statins before the index event and 18 who started taking the medication during the first week of hospitalization. Atorvastatin was the most frequently used statin (80 percent), with a median dose of 20 mg.
Remote seizure post-status epilepticus occurred in 67 patients (21.3 percent) over a mean follow-up of 31.5 months. The cumulative probability of remote seizure occurrence was 16 percent at 12 months, 23 percent at 2 years, and 32 percent 5 years. Median time from index event to first remote seizure occurrence was 6.9 months.
“The risk of seizure recurrence after a first-ever status epilepticus episode was moderate and enclosed within the very first years after the index event,” Orlandi and colleagues noted.
Notably, patients with status epilepticus due to progressive central nervous system disorders had a twofold greater risk of remote seizures (HR, 2.01, 95 percent CI, 1.02–3.94; p=0.043), while those with prominent motor symptoms with evolution into nonconvulsive status epilepticus had a more than threefold risk increase (HR, 3.74, 95 percent CI, 1.79–7.79; p<0.001).
“Interestingly, among statin users, we observed a higher prevalence of remote aetiologies that, besides progressive causes, were significantly associated with an increased risk of remote seizure… Even if an epileptogenic network has presumably already established itself, our data suggest that … exposure to statins may influence long-term outcome,” Orlandi and colleagues pointed out.
“Nonetheless, given the observational design of this study, residual confounding from unmeasured factors cannot be entirely excluded. Therefore, our findings should be interpreted as hypothesis-generating rather than as evidence of a causal, antiepileptogenic effect of statins,” they added.
Orlandi and colleagues called for prospective, ideally randomized, studies to further investigate and validate the association between statins and reduced risk of remote seizures post-status epilepticus.