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The incidence of epilepsy has 2 peaks: early in life and after the age of 50.1 The causes of epilepsy in older adults are not well-established, but include cerebrovascular disease,2 brain tumors, and Alzheimer disease. The National General Practice Study of Epilepsy found that vascular disease accounted for 15% of newly diagnosed epilepsy in all participants, but nearly 50% in older age groups.3 That study predated the MRI era; in more recent research, more than 1 in 10 asymptomatic elderly have covert cerebral infarcts,4 suggesting an underestimate of vascular pathology in late-life epilepsy. Risk factors for seizures after ischemic stroke include the severity of neurologic disability, cortical stroke location, and hippocampal damage, with less certainty about risk factors after hemorrhagic stroke.5
Statins, blockbuster drugs for hyperlipidemia, may lower the incidence of stroke, prompting Etminan and colleagues,6 in this issue of Neurology®, to explore a novel hypothesis, that statins reduce the risk of developing epilepsy in the elderly. The biologic plausibility of this idea has been tested in rodent models: high-dose atorvastatin reduced the frequency of clonic …
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