Risk factors of post-stroke epilepsy among pediatric population: a systematic review

Epilepsy is a frequent complication observed among stroke survivors. Post-stroke epilepsy (PSE) is defined as the occurrence of at least two unprovoked seizures beyond 2 weeks of an acute stroke that are not due to any other identifiable cause. PSE constitutes a significant clinical concern in pediatric stroke patients, adversely affecting both short-term and long-term management outcomes. This systematic review aimed to identify patient-related, stroke-related, and seizure-related risk factors associated with the development of PSE in the pediatric population. We included all clinical studies that compared these variables between pediatric stroke patients who developed PSE and those who did not. Studies reporting potential predictors of PSE among children with stroke were incorporated into the analysis. A total of 16 studies comprising 3,198 patients were included. The pooled risk of PSE was 27.6%, with a 95% confidence interval ranging from 19.8 to 37.2% (p < 0.001). Statistically significant associations were observed between younger age at stroke onset (OR 0.838; 95% CI 0.796-0.883; p < 0.001), cortical involvement (OR 3.151; 95% CI 1.132-8.772; p = 0.028), middle cerebral artery involvement (OR 3.541; 95% CI 1.068-11.738; p = 0.039), and increased risk of PSE. Additionally, patients presenting with acute symptomatic seizures (HR 3.924; 95% CI 2.580-5.967; p < 0.001) and those experiencing prolonged acute symptomatic seizures (OR 4.7; 95% CI 2.286-9.662; p < 0.001) demonstrated a higher likelihood of developing PSE. Pediatric patients who are younger at stroke onset and exhibit cortical or middle cerebral artery involvement are at a substantially elevated risk for PSE. Furthermore, the presence of acute symptomatic seizures at stroke onset, particularly when prolonged, markedly increases the probability of subsequent PSE development.