| Key points |
Are patients with post-stroke seizures (PSS) at increased risk of mortality, poor functional outcomes, recurrent strokes, and dementia compared to patients without PSS? Findings This systematic review and meta-analysis of 71 studies and 20,110 patients with PSS suggests that PSS are associated with an increased risk of mortality, poor functional outcomes, disability, and dementia. This study also identifies limitations in existing research on PSS, for example, lack of common data elements, relevant outcome definitions, and reporting standards. Meaning The findings highlight that PSS are a public health problem and warrant important research efforts to prevent post-stroke epileptogenesis. |
Cerebrovascular disease is the leading cause of new-onset epilepsy in older adults, accounting for nearly 50% of cases.
Stroke mortality rates have decreased due to advances in treatments for hyperacute stroke, including intravenous thrombolysis or endovascular thrombectomy, patient care in a stroke unit, and risk management. As a result, these patients live longer. The older adult population is also expanding, resulting in an increase in the number of stroke survivors.
Since stroke is the most common cause of new-onset epilepsy in older people, the burden of post-stroke seizures (PSS) is also likely to increase. PSS impair quality of life because they require patients to take antiseizure medications with associated cognitive and other adverse effects, carry the risk of injury and sudden death from unexpected seizures, and impose restrictions on work, driving, and other aspects of life. daily.
Previous studies have indicated that epileptic seizures negatively affect the functional, neurological, and cognitive outcomes of stroke patients. However, published data are inconsistent and, to our knowledge, have not been systematically evaluated.
Therefore, we conducted a comprehensive systematic review and meta-analysis to investigate the association of outcomes including mortality, poor functional outcome, disability, recurrent stroke, and dementia in patients with PSS compared with patients without PSS. .
| Importance |
Published data on the impact of post-stroke seizures (PSS) on stroke patient outcomes are inconsistent and have not been systematically evaluated, to the authors’ knowledge.
| Aim |
To investigate outcomes in people with PSS compared to people without PSS.
| Data sources |
MEDLINE, Embase, PsycInfo, Cochrane, LILACS, LIPECS and Web of Science, with search years from 1951 to January 30, 2023.
| Study selection |
Observational studies reporting PSS outcomes.
| Data extraction and synthesis |
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to summarize data, and the Joanna Briggs Institute tool was used for risk of bias assessment. Data were reported as odds ratio (OR) and standardized mean difference (SMD) with 95% CI using random-effects meta-analysis.
Publication bias was assessed using funnel plots and Egger’s test. Outlier and meta-regression analyzes were performed to explore the source of heterogeneity. The data was analyzed from November 2022 to January 2023.
| Main results and measures |
Outcomes measured were mortality, poor functional outcome (modified Rankin Scale [mRS] score of 3 to 6), disability (mean mRS score), recurrent stroke, and dementia at patient follow-up.
| Results |
The search returned 71 eligible articles, including 20,110 patients with PSS and 1,166,085 patients without PSS. Of the participants with PSS, 1,967 (9.8%) had early seizures and 10,605 (52.7%) had late seizures.
The risk of bias was high in 5 studies (7.0%), moderate in 35 (49.3%), and low in 31 (43.7%). PSS were associated with risk of mortality (OR, 2.1; 95% CI, 1.8-2.4), poor functional outcome (OR, 2.2; 95% CI, 1.8-2, 8), greater disability (SMD, 0.6; 95% CI, 0.4-0.7) and greater risk of dementia (OR, 3.1; 95% CI, 1.3-7.7) compared to patients without PSS.
In subgroup analyses, early, but not late, seizures were associated with mortality (OR, 2.4; 95% CI, 1.9-2.9 vs. OR, 1.2; 95% CI, 1.9-2.9). %, 0.8-2.0) and ischemic and hemorrhagic stroke subtypes were associated with mortality. (OR, 2.2; 95% CI, 1.8-2.7 vs. OR, 1.4; 95% CI, 1.0-1.8). Besides,
| Conclusions and relevance |
The results of this systematic review and meta-analysis suggest that post-stroke seizures (PSS) were associated with a doubled risk of death and severe disability and therefore constituted a significant burden of disease.
Prevention of PSS is a high clinical and research priority. We also observe significant variation in reporting standards in the published literature and propose future directions for post-stroke seizure (PSS) research.
Collaborative scientific efforts should be directed to address these challenges. The role of stroke severity and lesion location or volume also requires further analysis.
Unraveling these associations is a high clinical and research priority. Trials of interventions to prevent seizures may be warranted.
