Post-stroke Epilepsy and its Association with Stroke Location – Systematic review and Meta-analysis

Abstract Objective There have been several meta-analytic studies that investigated potential risk factors for post-stroke epilepsy (PSE) 1,2 . Cortical location is known to be associated with increased risk of PSE. However, relationship between the involvement of specific lobe with stroke and PSE has not been evaluated in a meta-analysis due to unavailability of relevant data. To the best of our knowledge, this is the first meta-analysis on this subject matter. Methods The PubMed and Embase databases were comprehensively assessed and searched for studies that evaluated the association between the involvement of different lobes with PSE. Studies that evaluated post-stroke epilepsy or recurrent post-stroke seizure were included, and acute symptomatic seizure was excluded. Following search strategy was used, “post-stroke” OR “stroke” OR “intracerebral hemorrhage” AND “epilepsy” OR “seizure” AND “lobe” OR “territory” OR “location”. Joanna Briggs Institute appraisal tool was utilized to perform quality assessment of the included studies. A random effects model was used to estimate pooled odds ratio of the selected outcomes with 95 percent confidence intervals (CIs), and the study heterogeneity was analyzed. Results Nine studies 3-11 were identified with 1328 stroke patients. 9/9 studies showed association of frontal lobe involvement with higher likelihood of PSE (OR=2.10, 95% CI=1.37-3.21, p-value=0.0007). All studies showed association of parietal stroke with increased likelihood of PSE (OR=2.85, 95% CI=1.93-4.22, p-value<0.00001). Previous temporal lobe stroke was associated with increased risk of PSE (OR=3.55, 95% CI=1.95-6.45, p-value<0.00001). In contrast, association between occipital lobe involvement and PSE was not statistically significant (OR=1.37, 95% CI=0.95-1.96, p-value<0.09), and this remained true when subgroup analysis was performed. Discussion Our meta-analysis shows that PSE is associated with frontal, parietal, and temporal involvement of previous stroke. There was no statistically significant association between occipital lobe involvement and PSE. Further high quality studies are needed to investigate if stroke in one lobe/territory can be more epileptogenic than those in others. Key Points Cerebrovascular disease is the most common etiology of newly diagnosed epilepsy Prior stroke involving the frontal, temporal, or parietal lobe is associated with increased risk of post-stroke epilepsy Occipital lobe stroke is not associated with increased risk of post-stroke epilepsy, regardless of the age group.