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

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.