POSTSTROKE EPILEPSY IN ADULT PATIENTS: A COMPREHENSIVE REVIEW OF INCIDENCE, PREDICTORS, PROPHYLACTIC STRATEGIES, AND LONG-TERM NEUROLOGICAL OUTCOMES

Abstract

Background: The principal cause of new-onset epilepsy in older persons is poststroke epilepsy (PSE), one of the most prevalent long-term neurological sequelae after stroke. The increasing number of stroke survivors has increased the burden of epilepsy, leading to impaired functional recovery, cognitive decline, and a lower quality of life, even though improvements in acute stroke therapy have improved survival. Improving long-term neurological outcomes requires a thorough understanding of the epidemiology, pathophysiology, risk factors, and preventive techniques of PSE. Methods: A systematic review was conducted using the PRISMA 2020 principles. The electronic databases PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar were searched for publications between January 2000 and June 2025. Randomized controlled trials, cohort studies, systematic reviews, and meta-analyses were all considered if they investigated the incidence, risk factors, pathophysiological mechanisms, and neurological outcomes of poststroke epilepsy in an adult population. The Newcastle‒Ottawa Scale, Cochrane Risk of Bias 2, and AMSTAR 2 checklist were used to assess methodological quality. Results: Ten studies met the inclusion criteria and were included in the results. Poststroke epilepsy occurred in approximately 7-10% of adult stroke survivors and was significantly more common after hemorrhagic stroke (12-18%) than ischemic stroke (5-8%). The majority of epilepsy cases develop during the first 6-24 months following stroke. The major pathways implicated in the epileptogenic process were neuroinflammation, blood‒brain barrier disruption, gliosis, oxidative stress, and synaptic remodelling. Early poststroke seizures, severe neurological deficits, cortical involvement, younger age, atrial fibrillation, hypertension, diabetes mellitus and alcohol consumption were consistently identified as important predictors. The SeLECT, SeLECT-S, CAVE, and CAVE-S models had good predictive ability when identifying high-risk patients. Levetiracetam had the best safety profile of any antiseizure drug, but there is no current evidence to recommend routine use of antiseizure drugs for all patients with stroke, highlighting the need for physician selection based on individual patient risk profiles. Conclusion: Epilepsy continues to be an important lasting morbidity after cerebrovascular disease. At this time, there is support for the use of validated clinical prediction models for comprehensive risk stratification instead of universal prophylactic antiseizure therapy. Future studies are needed to validate biomarkers, improve prediction models, and identify disease-modifying treatments to prevent the establishment of seizures. These improvements could significantly enhance the recovery of neurological functions, independence and quality of life for people who have had a stroke.