Post-stroke seizures in malignant middle cerebral artery infarction treated with decompressive hemicraniectomy: A meta-analysis of predictive factors and clinical outcomes

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2026-03-01 Epub Date: 2026-01-01 DOI:10.1016/j.jocn.2025.111835

Kaike Lobo , Felipe Moraes Costa , Rafael Reis de Oliveira , Ruan Pablo da Silva Gomes , Giovana Pereira Lobato Brito , Enzo Gabriel Lacerda Rodrigues , Janilzo de Jesus Mendes Costa Júnior , Ana Luíza Mendonça de Almeida , Yurie Lima Yamada , Yasmin Lamas Medeiros , M Ali Aziz-Sultan

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引用次数: 0

Abstract

Background

Decompressive hemicraniectomy (DHC) is a life-saving intervention for malignant middle cerebral artery (MCA) infarction. However, the additional factors which further increase seizure risk within this high-risk population remain unclear. This meta-analysis aimed to evaluate incremental risk factors for seizure development after DHC in malignant MCA infarction and to assess the association between seizures and clinical outcomes.

Methods

We systematically searched PubMed, Embase, and Cochrane Library for studies evaluating risk factors for seizure development after DHC for malignant MCA infarction. Odds ratios (ORs) and mean differences were computed for dichotomous and continuous outcomes, respectively, using 95% confidence intervals (CIs) under a random-effects model. Heterogeneity was assessed with I² statistics.

Results

Five retrospective cohort studies were included, comprising a total of 456 patients, of whom 195 (42.76 %) developed seizures, and 261 (57.24 %) did not. No significant differences between groups were observed for age, female gender, hypertension, diabetes, dyslipidemia, alcohol consumption, history of previous ischemic event, stroke etiology, hemispheric laterality, presence of reperfusion therapy, stroke limited to MCA territory, hemorrhagic transformation, NIH Stroke Scale scores on admission, and time to craniectomy. However, there was a significantly higher proportion of modified Rankin Scale scores ≤ 3 and a lower mortality rate in patients with seizures when compared with those without.

Conclusion

In conclusion, none of the variables analyzed were identified as independent risk factors for seizure development, although there was an increased rate of good functional outcome and lower mortality in patients with seizures, possibly reflecting a time-dependent factor of seizure detection.

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降压半脑切除术治疗恶性大脑中动脉梗死卒中后癫痫发作：预测因素和临床结果的荟萃分析

背景：减压半脑切除术（DHC）是恶性大脑中动脉（MCA）梗死的救命干预措施。然而，在这一高危人群中进一步增加癫痫发作风险的其他因素仍不清楚。本荟萃分析旨在评估恶性MCA梗死DHC后癫痫发作的增量危险因素，并评估癫痫发作与临床结果之间的关系。方法系统地检索PubMed、Embase和Cochrane文库中评估恶性MCA梗死DHC后癫痫发作危险因素的研究。在随机效应模型下，使用95%置信区间（ci）分别计算二分类和连续结局的优势比（ORs）和平均差异。采用I2统计量评估异质性。结果纳入5项回顾性队列研究，共纳入456例患者，其中195例（42.76%）发生癫痫发作，261例（57.24%）未发生癫痫发作。在年龄、女性、高血压、糖尿病、血脂异常、饮酒、既往缺血性事件史、卒中病因、半球偏侧、存在再灌注治疗、仅限于MCA区域的卒中、出血转化、入院时NIH卒中量表评分和开颅时间等方面，组间无显著差异。然而，与没有癫痫发作的患者相比，有癫痫发作的患者改良Rankin量表评分≤3分的比例明显更高，死亡率也更低。结论：所有分析的变量均未被确定为癫痫发作发展的独立危险因素，尽管癫痫发作患者的良好功能结局率增加，死亡率降低，这可能反映了癫痫发作检测的时间依赖性因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.