Late epileptic seizures following cerebral venous thrombosis: a systematic review and meta-analysis

Abstract

Background: Identifying late epileptic seizures (LS) following cerebral venous thrombosis (CVT) can be useful for prognosis and management. We systematically reviewed the literature to identify risk factors for LS due to CVT.

Methods: We systematically searched PubMed, Scholar, and Scopus databases (May 2021) to identify studies reporting data on prevalence and risk factors for CVT-LS. The methodological quality was assessed with the Ottawa-Newcastle Scale. The risk of developing CVT-LS was summarized in meta-analyses and expressed as odds ratio (OR) and corresponding 95% confidence intervals (CIs) using random-effects models.

Results: Out of the 332 records retrieved, four studies were eventually included with a total of 1309 patients with CVT and 142 (11%) with CVT-LS. The most relevant predictors of CVT-LS were symptomatic seizures (OR 5.66, 95% CI 3.83-8.35), stupor/coma (OR 6.81, 95% CI 1.18-39.20), focal neurologic signs (OR 6.81, 95% CI 1.18-39.2), hemorrhagic component (OR 3.52, 95% CI 2.45-5.06), and superior sagittal sinus involvement (OR 1.52, 95% CI 1.04-2.21).

Conclusion: There are several risk factors for CVT-LS that should be considered in clinical practice. Further high-quality studies are warranted to develop predictive models for individualized risk stratification and prediction of CVT-LS.

Keywords: Cerebral venous thrombosis; Epilepsy; Focal signs; Hemorrhage; Predictors.

Fig. 1

PRISMA flow chart for inclusion and exclusion of studies

Fig. 2

Forest plot (acute symptomatic seizures)

Fig. 3

Forest plot (prophylaxis with anti-seizure medications)

Fig. 4

Forest plot (impairment of consciousness)

Fig. 5

Forest plot (focal neurological signs)

Fig. 6

Forest plot (hemorrhagic component)

Fig. 7

Forest plot (involvement of superior sagittal sinus)