Epilepsy following acquired brain injury: A systematic review and meta-analysis

Acquired brain injuries (ABIs) are among the most common causes of neurological morbidity worldwide and are increasingly recognized as important factors in the pathogenesis of epilepsy; however, existing literature on the relationship between different ABI types and subsequent epilepsy remains inconsistent and unclear. As such, this review sought to evaluate the association between four major ABI types-traumatic brain injury (TBI), hemorrhagic brain injury (HBI), ischemic brain injury (IBI), and immune-related brain injury (IrBI)-and subsequent risk of epilepsy.

A comprehensive literature search was conducted across public databases for studies published through March 2026. Eligible studies included observational designs assessing epilepsy incidence following ABI, with a total of 120 studies meeting inclusion criteria.

Meta-analyses of pooled odds ratios (ORs) and 95% confidence intervals (CIs) demonstrated that all four ABI categories were significantly associated with increased epilepsy risk, with subtype-specific variations noted. TBI exhibited a strong relationship (OR: 2.28, 95% CI: 2.14-2.43), with elevated odds across all subtypes. HBI also conferred a significant correlation (OR: 1.53, 95% CI: 1.43-1.63), particularly for intracerebral and unspecified hemorrhagic events. IBI showed the strongest overall association (OR: 2.40, 95% CI: 2.17-2.65), particularly among location-based subclassifications. IrBI was also significantly linked to epilepsy (OR: 1.19, 95% CI: 1.14-1.25), particularly viral encephalitis and brain abscesses.

This meta-analysis provides comprehensive evidence that ABIs are significant correlates of epilepsy with an array of subgroup distinctions, highlighting them as strong markers of elevated risk for long-term seizure disorders and underscoring the need for post-injury surveillance and early neurological intervention to reduce the global burden of ABI-associated epilepsy.