Post-stroke epilepsy and risk of all-cause mortality: A systematic review and meta-analysis of cohort studies

Post-stroke epilepsy (PSE) has been suggested as a predictor of poor prognosis. We aimed to evaluate the association between PSE and all-cause mortality via a meta-analysis.Relevant cohort studies were identified by search of electronic databases including PubMed, Embase, and Web of Science. Two authors independently performed database search, data collection, and study quality evaluation. A randomized-effect model incorporating the possible between-study heterogeneity was used to pool the results.Overall, ten cohort studies including 177,929 patients with stroke contributed to the meta-analysis. Of them, 15,836 (8.9%) had PSE during a mean follow-up of 4 years. Compared to stroke survivors without PSE, patients with PSE had a significantly increased risk of all-cause death (odds ratio [OR]: 1.68, 95% confidence interval: 1.51-1.87, p < 0.001; I2 = 80%). Subgroup analyses showed consistent association in patients with ischemic and hemorrhagic stroke, in prospective and retrospective studies, in PSE diagnosed as unprovoked seizure occurred more than 7 days and 14 days after stroke, in studies with follow-up durations within or over 5 years, and in studies with different quality scores (p for subgroup effect all < 0.05). The Galbraith plot identified three outlier studies which may contribute to the heterogeneity of the meta-analysis, and all of the three studies were database-linked studies. The between-study heterogeneity was significantly reduced after removing the three database-linked studies (OR: 1.39, 95% CI: 1.18-1.62, p < 0.001; I2 = 0%).PSE was associated with a higher risk of all-cause mortality.