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Meta-Analysis
. 2023 Nov;51(11):3000605231213231.
doi: 10.1177/03000605231213231.

Incidence and risk factors of post-stroke seizures and epilepsy: systematic review and meta-analysis

Aathmika Nandan  1 , Yi Mei Zhou  1 , Lindsay Demoe  1 , Adnan Waheed  2 , Puneet Jain  2 , Elysa Widjaja  1   3
Affiliations
Meta-Analysis

Incidence and risk factors of post-stroke seizures and epilepsy: systematic review and meta-analysis

Aathmika Nandan et al. J Int Med Res. 2023 Nov.

Abstract

Objective: Due to variability in reports, the aim of this meta-analysis was to evaluate the incidence and risk factors of post-stroke early seizures (ES) and post-stroke epilepsy (PSE).

Methods: The MEDLINE, EMBASE and Web of Science databases were searched for post-stroke ES/PSE articles published on any date up to November 2020. Post-stroke ES included seizures occurring within 7 days of stroke, and PSE included at least one unprovoked seizure. Using random effects models, the incidence and risk factors of post-stroke ES and PSE were evaluated. The study was retrospectively registered with INPLASY (INPLASY2023100008).

Results: Of 128 included studies in total, the incidence of post-stroke ES was 0.07 (95% confidence interval [CI] 0.05, 0.10) and PSE was 0.10 (95% CI 0.08, 0.13). The rates were higher in children than adults. Risk factors for post-stroke ES included hemorrhagic stroke (odds ratio [OR] 2.14, 95% CI 1.44, 3.18), severe strokes (OR 2.68, 95% CI 1.73, 4.14), cortical involvement (OR 3.09, 95% CI 2.11, 4.51) and hemorrhagic transformation (OR 2.70, 95% CI 1.58, 4.60). Risk factors for PSE included severe strokes (OR 4.92, 95% CI 3.43, 7.06), cortical involvement (OR 3.20, 95% CI 2.13, 4.81), anterior circulation infarcts (OR 3.28, 95% CI 1.34, 8.03), hemorrhagic transformation (OR 2.81, 95% CI 1.25, 6.30) and post-stroke ES (OR 7.24, 95% CI 3.73, 14.06).

Conclusion: Understanding the risk factors of post-stroke ES/PSE may identify high-risk individuals who might benefit from prophylactic treatment.

Keywords: Epilepsy; hemorrhagic stroke; incidence; ischemic stroke; post-stroke; risk factors; seizures.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declare that there are no conflicts of interest.

Figures

Figure 1.
Figure 1.
Prisma flowchart of study selection.
Figure 2.
Figure 2.
Forest plot showing meta-analysis of the incidence of post-stroke early seizures.
Figure 3.
Figure 3.
Funnel plot of standard error by logit event rate for the incidence of post-stroke early seizures.
Figure 4.
Figure 4.
Forest plot showing meta-analysis of the incidence of post-stroke epilepsy.
Figure 5.
Figure 5.
Funnel plot of standard error by logit event rate for the incidence of post-stroke epilepsy.
See this image and copyright information in PMC

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