Risk factors for post-stroke epilepsy and seizures among stroke survivors: a qualitative aggregate analysis of more than 82 000 cases.

Abstract

Background: Post-stroke seizures and epilepsy can affect patients' quality of life, increase mortality in stroke patients, affect patient outcomes, and are associated with higher medical expenditures. However, little is known about the risk factors that influence the onset post-stroke seizures and epilepsy.

Aim: We aimed to summarize and assess the credibility of evidence of potential risk factors for seizures and epilepsy after stroke.

Design: Qualitative synthesis in random-effects model and evidence appraisal using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.

Methods: Pubmed, Embase, and the Cochrane Library were searched from inception to March 31, 2023. Random-effects models were used to estimate the pooled crude or adjusted relative risks (RRs) with 95% confidence intervals (CIs).

Results: We screened 51 991 citations, selecting 15 publications with 82 829 stroke survivors encompassing 6970 seizures and epilepsy events. Risk factors assessed included patient demographic factors, stroke characteristics, medical pre-existing history, and other clinical factors. Independent risk factors identified from pooled analyses included imaging indicators of cortical location (RR, 1.62; 95% CI, 1.23-2.12), cortical involvement (RR, 3.34; 95% CI, 1.67-6.66), early seizure (RR, 4.84; 95% CI, 2.16-10.85), and stroke severity (Scandinavian Stroke Scale [SSS]-score: <30 vs. >30. RR, 5.45; 95% CI, 2.42-12.24). Based on the quality of the evidence or GRADE criteria, there was high (Class I) to very low (Class IV) confidence in the pooled effect estimates.

Conclusion: This meta-analysis identifies several risk factors for post-stroke seizures and epilepsy among stroke survivors. The findings enhance clinical awareness for early identification of high-risk individuals and may guide interventions to improve outcomes.

Registration: PROSPERO (CRD42023434348). Key Messages What is already known on this topic  Post-stroke seizures and epilepsy are common neurological complications of stroke, significantly affecting survivors' quality of life and clinical outcomes. Although several studies have suggested potential risk factors, including stroke severity, cortical involvement, and early seizures, no comprehensive systematic review or meta-analysis has previously been conducted to summarize and appraise the strength of evidence for these factors. What this study adds  This study provides the first comprehensive synthesis of evidence, identifying significant risk factors for post-stroke epilepsy and seizures among stroke survivors. Key findings include that cortical involvement, imaging indicators of cortical location, early seizures, and stroke severity are associated with increased risk. The study also evaluates the strength of evidence for each factor using GRADE criteria, offering a clearer understanding of their clinical relevance. How this study might affect research, practice, or policy  The findings can guide clinicians in identifying stroke survivors at high risk for seizures and epilepsy, allowing for earlier interventions and personalized care strategies. This study underscores the need for further high-quality prospective research to refine our understanding of modifiable risk factors, potentially influencing preventive strategies and healthcare policies related to stroke rehabilitation.