Wang JZ, et al. – This meta–analysis intended to examine the incidence and management of seizures after ischemic stroke. Becuase of ischemic stroke, the burden of stroke–related seizures and epilepsy was substantial. To determine risk factors for epilepsy following ischemic stroke and optimal secondary prevention, additional studies were needed.

• The researchers included observational studies that reported incidence of seizures following ischemic stroke and those that reported treatment response to any particular antiepileptic drugs (AEDs).
• They assessed risk of bias by predefined study characteristics.
• They conducted random effects meta-analysis for all studies where data were available for the incidence of early and late stroke-related seizures.
• They measured heterogeneity with I² statistic and sensitivity analyses were performed using prespecified variables.
• They performed a qualitative synthesis of studies reporting use of AEDs for stroke-related seizures.

• The researchers identified 41 studies from 10,554 articles; 35 studies reported the incidence of stroke-related seizures and 6 studies reported effects of specific AEDs.
• In this meta–analysis, most studies were of low to moderate quality.
• While the incidence of late seizures or epilepsy was 18 per 1,000 person-years (95% confidence interval 1.5–2.2, I2 = 94.1%), rate of early seizures was 3.3% (95% confidence interval 2.8%–3.9%, I2 = 92.8%).
• From the sensitivity analyses, the high degree of heterogeneity could not be explained.
• No single AED was found to be more effective over others for management of stroke-related seizures, though newer AEDs were associated with fewer side effects.