Risk Factors Associated With Post-stroke Epilepsy: A Narrative Review

TL;DR

This review explores risk factors for post-stroke epilepsy, aiming to improve prediction and prevention strategies.

Contribution

The study identifies a comprehensive range of risk factors and highlights the need for unified assessment tools.

Findings

Risk factors include demographics, stroke features, and biomarkers like blood proteins and miRNAs.

Early interventions like hematoma evacuation may reduce PSE risk.

Deep grey matter loss and asymmetrical perivascular spaces are linked to higher PSE risk.

Abstract

Post-stroke epilepsy (PSE) is a condition that impacts a notable portion of stroke survivors and is linked to worse health outcomes, such as increased risk of death and longer disability. PSE refers to seizures that occur unexpectedly after the first week following a stroke and result from several biological processes, including inflammation and damage from overactive nerve signaling. Existing prediction tools help identify high-risk patients but can be limited by inconsistent evaluation of risk factors. Twenty-seven studies were selected from databases including PubMed, Cochrane Library, and EBSCO using Medical Subject Headings (MeSH) terms and keywords related to stroke, epilepsy, and risk factors. Studies published between 2020 and 2025 were included based on predefined eligibility criteria. During the analysis, a wide range of risk factors were identified, including patient demographics (age, sex, comorbidities, genetic predisposition), stroke features (cortical involvement, lesion size, acute symptomatic seizures), diagnostic findings (early electroencephalogram abnormalities, structural changes on magnetic resonance imaging), and biochemical markers (blood proteins, microRNAs, TNFSF-14). Early interventions, such as hematoma evacuation and thrombectomy, also show potential in reducing PSE risk, while emerging biomarkers, including specific blood proteins and miRNAs, offer promise for early diagnosis. It is recognized that both the occurrence and the timing of early seizure activity may be important for patient outcomes. Interestingly, deep grey matter loss and asymmetrical perivascular spaces were also associated with a higher risk of PSE. Despite these advances, considerable variability remains a challenge across studies. Together, these insights highlight the need for a unified approach to develop better tools for assessing PSE risk, with the ultimate goal of preventing this complication during stroke care.

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