Impact of epileptic seizures on functional outcome after subdural haematoma: a systematic review and meta-analysis

Epileptic seizures (ES) are a frequent and clinically relevant complication in patients with subdural haematoma (SDH), yet their influence on short-term outcome remains uncertain. This meta-analysis aimed to quantify the association between ES and functional outcome after acute (aSDH) and chronic SDH (cSDH).

A systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and registered in PROSPERO. PubMed, MEDLINE and the Cochrane Library were searched through June 2024. Eligible studies included adult patients with aSDH or cSDH reporting ES or status epilepticus in relation to functional outcome or mortality. Pooled risk ratios (RR) with 95% CIs were calculated using random-effects models. Heterogeneity (I²), sensitivity, influence and publication-bias analyses were performed.

Twelve studies met inclusion criteria, including seven on aSDH, three on cSDH (n=1512) and two on population-based cohorts (>1.6 million patients). In aSDH, ES were significantly associated with poor outcome (RR=1.38, 95% CI 1.10 to 1.73; p<0.001; I^²=83%), whereas in cSDH, only a non-significant trend was observed (RR=1.79, 95% CI 0.79 to 4.09; I^² = 93%). Population-level data showed nearly doubled mortality among seizure-positive cases (RR=1.92, 95% CI 1.76 to 2.08; I^² = 30%). Sensitivity and influence analyses confirmed robustness, with no publication bias.

Seizures are associated with poorer outcomes in aSDH; evidence in cSDH remains limited. These findings emphasise the need for standardised seizure management and prospective studies to clarify causal links between seizures and recovery.

CRD42024583608.