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

•Stroke severity was a significant predictor for post-stroke seizures.•ICH was a significant predictor for early seizures (ES) after stroke.•Cerebral infarction with hemorrhage transformation could predict ES after stroke.•Cortical involvement was a significant predictor for late post-stroke seizures.•ICH and infarction contribute equally to single late post-stroke seizure onset.

SummaryPurposeTo 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 sourcesElectronic databases (MEDLINE and EMBASE), archives of stroke or epilepsy patients, and bibliographies of relevant articles, which were written in English.Study selectionWe 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 extractionTwo authors performed the data extraction. We recorded all possible risk factors predictive of seizure onset.Data synthesisWe 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.ResultsIntracerebral 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, I2 = 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, I2 = 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).ConclusionsEvidence 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.