Incidence and relevant factors for seizures after spontaneous intracerebral hemorrhage: A systematic review and meta-analysis

Abstract

Objective: To identify the incidence and relevant factors for seizures after spontaneous intracerebral hemorrhage (sICH) by performing a systematic review and meta-analysis.

Methods: We systematically searched PubMed, EMBASE, and Cochrane Library from inception to 14 August 2021 for studies investigating relevant factors associated with seizures after sICH. A meta-analysis of all included studies was performed by using Stata version 12.0 software.

Results: In total, 22 studies with 32,162 participants were included. The meta-analysis showed a 9.5% incidence of seizures after sICH. We identified 6 factors that increased the risk of seizures after sICH, including alcohol consumption(RR (95% CI) =1.26 (1.07, 1.48) , I²= 44.40%, p < 0.01), cortical involvement (RR (95% CI)= 3.22 (2.29, 4.53), I²= 80.00%, p <0.01), lobar location (RR (95% CI)= 2.99 (2.14, 4.18), I²= 75.40%, p < 0.01), large hematoma volume (SMD (95% CI)= 0.59 (0.17, 1.00) , I²= 95.40%, p < 0.01), hematoma evacuation (RR (95% CI)= 2.38 (1.08, 5.25), I²= 86.60%, p = 0.03), and treatment with anti-seizure medication (ASM) (RR (95% CI)= 2.77 (1.91, 4.03), I²= 0.00%, p < 0.01). Conversely, old age (SMD (95% CI)= -0.27 (-0.37, -0.16), I²= 66.80%, p < 0.01), a high Glasgow Coma Scale (GCS) score at presentation (SMD (95% CI)= -1.62 (-2.91, -0.34), I²= 99.70%, p = 0.01), and hypertension (RR (95% CI)= 0.84 (0.76, 0.94), I²= 25.90%, p < 0.01) were associated with a significantly lower probability of seizure occurrence in sICH patients.

Conclusions: The incidence of seizures after ICH is 9.5%. Alcohol consumption, cortical involvement, lobar location, hematoma volume, hematoma evacuation, treatment with ASM, age, GCS score at presentation, and hypertension are closely tied to the occurrence of seizures after sICH.

Keywords: ICH; Meta-analysis; Relevant factors; Seizures.