Abstracts

Rationale: There have been many reports of the statins' neuroprotective qualities in a range of CNS disorders. One quarter of all new onset seizures occur in those aged 65 and older, with this number set to double by 2020. Statin and aspirin use is common in this age group, however their role in epilepsy in the elderly has not been well studied. Methods: Following IRB approval, a retrospective review was performed identifying all patients age 65 y or older seen at our institution between 1/2013 and 7/2014, utilizing billing codes to identify those patients seen for seizures/epilepsy (ICD-9 345&780). Of these patients, 100 were randomly selected and detailed collection of demographic and clinicopharmocologic data was performed. Patients with unconfirmed diagnosis of epilepsy or psychogenic nonepileptic seizures were excluded. Age of onset of seizures was identified, and patients were stratified into Geriatric Onset Epilepsy (GOE; onset 60 y or older) and non-GOE (age of onset less than 60 y). Univariable and multivariable models assessing seizure frequency were constructed which included aspirin use, statin use and number of antiepileptic drugs (AEDs) required for seizure control. Results: A total of 89 patients were identified for analysis. No difference in gender was noted (45 women, 51%). Mean age was 73y (65-92y). A total of 49 patients (55%) were identified to have GOE. Sixty-eight percent of GOE and 66% in non-GOE groups had a seizure frequency of 1 per year or less (p=1.0, no difference). Seizure control was achieved with significantly less AED in the GOE group, with 77% controlled with monotherapy, versus 38% in the non-GOE group (p=0.0004). On univariable analysis, number of AEDs was associated with lower seizure frequency in the non-GOE group (p<0.0001), but not the GOE group. In the GOE group, statin use was associated with significantly decreased seizure frequency with 88% of those on statins exhibiting 1 seizure or less per year vs 50% in the non-statin group (p=0.03). In the GOE group, those taking ASA were noted to have decreased seizure frequency, though this was not significant (77% vs 62% with 1 seizure or less per year, P=0.47). No such decrease in seizure frequency was seen in the non-GOE group with either statin or ASA use. A multivariable model including statin use, ASA use, and number of AEDs was used to predict seizure frequency. In the non-GOE group, only number of AEDs were noted to be predictive of seizure frequency (p=0.0001). However, in the GOE group, only statin use remained a predictor of frequency (p=0.0235). Conclusions: In general, good seizure control is obtained in patients over 65 years of age. However in geriatric patients with new onset epilepsy, fewer AEDs are required relative to those with established epilepsy. ASA use does not appear to affect seizure frequency. In GOE, statin use is associated with better seizure control, a finding not seen in non-GOE patients. Further studies are needed to elucidate the underlying pathophysiologic mechanism of this anitepileptogenesis.