Risk factors for post-stroke seizures: a systematic review and meta-analysis

Purpose: To perform a systematic review and meta-analysis to identify risk factors associated with early seizure (ES) or late seizure (LS) onset in adults following stroke.

Data sources: Electronic databases (MEDLINE and EMBASE), archives of stroke or epilepsy patients, and bibliographies of relevant articles, which were written in English.

Study selection: We included studies published since 1990 that reported the stroke and seizure outcomes of adult patients during follow-up. We independently performed title, abstract and full-text screening and resolved disagreements through discussion.

Data extraction: Two authors performed the data extraction. We recorded all possible risk factors predictive of seizure onset.

Data synthesis: We used odds ratios (ORs) or the mean difference (MD) to compare the pooled rates of seizure onset between the exposed group and the non-exposed group. All meta-analyses were performed with Review Manager Software.

Results: Intracerebral hemorrhage (OR=1.88, 95% CI=1.43-2.47), cerebral infarction with hemorrhagic transformation (OR=3.28, 95% CI=2.09-5.16), stroke severity (OR=3.10, 95% CI=2.00-4.81, p<0.01, I(2)=0%; MD=3.98, 95% CI=1.06-6.90, p<0.01), and alcoholism (OR=1.70, 95% CI=1.23-2.34, p<0.01) were associated with a significantly greater probability of ES occurrence. There were significant effects of cortical involvement (OR=2.50, 95% CI=1.93-3.23) and stroke severity (MD=5.72, 95% CI=4.23-7.22, p<0.01, I(2)=0) on LS onset. However, there was no significant difference in the probability of single LS episode between patients with intracerebral hemorrhage and infarction stroke (OR=1.20, 95% CI=0.92-1.55).

Conclusions: Evidence suggests that cortical involvement, stroke subtypes and stroke severity are significant predictors of seizure onset following stroke. However, we did not find a significant difference in the rate of onset of single LS episodes between patients with intracerebral hemorrhage and cerebral infarction.