Neuropsychiatric Disease and Treatment (Dec 2023)
Risk Factors Associated with Epilepsy Related to Cerebrovascular Disease: A Systematic Review and Meta-Analysis
Abstract
Ana Paula Mafla-Mendoza,1,* Esteban David Paredes-Urbano,1,* Enrique Gea-Izquierdo1– 3 1Pontifical Catholic University of Ecuador, Faculty of Medicine, Quito, Ecuador; 2Department of Medical Specialties and Public Health, Rey Juan Carlos University, Madrid, Spain; 3María Zambrano Program, European Union, Rey Juan Carlos University, Madrid, Spain*These authors contributed equally to this workCorrespondence: Enrique Gea-Izquierdo, Pontifical Catholic University of Ecuador, Faculty of Medicine, Quito, Ecuador, Email [email protected] and Objective: Stroke is one of the most frequent neurological syndromes in the adult population and the cause of 10% of all diagnosed epilepsies. It is attributed to the origin of up to 50% of them in adults > 60 years of age. Although a few risk factors have been described and considered when modeling predictive tools, this aspect is still clinically complex. The objective of this study is to describe and compare predictor scales of post stroke epilepsy (PSE) in adult patients with better performance.Methods: A systematic review and meta-analysis were performed of studies published between 2010 and 2020 and found in PubMed, Scopus, EMBASE, LILACS, BVS, Google Scholar, and CENTRAL databases. Sixteen studies were included with a total of 298,694 patients with a diagnosis of stroke, 5590 presented late seizures (LS).Results: Hemorrhage, cortical involvement, and early seizure were the elements most associated with the risk of presenting late seizures. The SeLECT score demonstrated a low risk of bias with a high predictive ability in patients with ischemic stroke (AUC: 0.77 [95% CI: 0.71– 0.82]). In patients with hemorrhagic stroke, the CAVE score demonstrated adequate predictive ability (AUC: 0.81 [95% CI: 0.76– 0.86]), but an uncertain risk of bias. Research has established risk factors for post ictal epilepsy; however, the numerous ways of assessing data in studies and the difference in their designs make the task of producing a predictive scale that covers the most important risk factors and is reliable for application in the clinical setting, regardless of stroke etiology, very arduous.Conclusion: Hemorrhage, cortical involvement, and early seizure are associated with an increased risk of post ictal epilepsy. Also, elements such as age, traditional vascular risk factors, and functional assessment failed to reflect statistical significance. Finally, further research is required to refine the available predictive tools.Keywords: cerebrovascular event, seizures, post stroke epilepsy, predictive model, systematic review
