Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Post-stroke seizures in malignant middle cerebral artery infarction treated with decompressive hemicraniectomy: A meta-analysis of predictive factors and clinical outcomes.
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Lobo Kaike, Moraes Costa Felipe, de Oliveira Rafael Reis, da Silva Gomes Ruan Pablo, Lobato Brito Giovana Pereira, Lacerda Rodrigues Enzo Gabriel, de Jesus Mendes Costa Júnior Janilzo, Mendonça de Almeida Ana Luíza, Lima Yamada Yurie, Lamas Medeiros Yasmin, Aziz-Sultan M Ali
Аннотация
BACKGROUND: Decompressive hemicraniectomy (DHC) is a life-saving intervention for malignant middle cerebral artery (MCA) infarction. However, the additional factors which further increase seizure risk within this high-risk population remain unclear. This meta-analysis aimed to evaluate incremental risk factors for seizure development after DHC in malignant MCA infarction and to assess the association between seizures and clinical outcomes.
METHODS: We systematically searched PubMed, Embase, and Cochrane Library for studies evaluating risk factors for seizure development after DHC for malignant MCA infarction. Odds ratios (ORs) and mean differences were computed for dichotomous and continuous outcomes, respectively, using 95% confidence intervals (CIs) under a random-effects model. Heterogeneity was assessed with I2 statistics.
RESULTS: Five retrospective cohort studies were included, comprising a total of 456 patients, of whom 195 (42.76 %) developed seizures, and 261 (57.24 %) did not. No significant differences between groups were observed for age, female gender, hypertension, diabetes, dyslipidemia, alcohol consumption, history of previous ischemic event, stroke etiology, hemispheric laterality, presence of reperfusion therapy, stroke limited to MCA territory, hemorrhagic transformation, NIH Stroke Scale scores on admission, and time to craniectomy. However, there was a significantly higher proportion of modified Rankin Scale scores ≤ 3 and a lower mortality rate in patients with seizures when compared with those without.
CONCLUSION: In conclusion, none of the variables analyzed were identified as independent risk factors for seizure development, although there was an increased rate of good functional outcome and lower mortality in patients with seizures, possibly reflecting a time-dependent factor of seizure detection.
METHODS: We systematically searched PubMed, Embase, and Cochrane Library for studies evaluating risk factors for seizure development after DHC for malignant MCA infarction. Odds ratios (ORs) and mean differences were computed for dichotomous and continuous outcomes, respectively, using 95% confidence intervals (CIs) under a random-effects model. Heterogeneity was assessed with I2 statistics.
RESULTS: Five retrospective cohort studies were included, comprising a total of 456 patients, of whom 195 (42.76 %) developed seizures, and 261 (57.24 %) did not. No significant differences between groups were observed for age, female gender, hypertension, diabetes, dyslipidemia, alcohol consumption, history of previous ischemic event, stroke etiology, hemispheric laterality, presence of reperfusion therapy, stroke limited to MCA territory, hemorrhagic transformation, NIH Stroke Scale scores on admission, and time to craniectomy. However, there was a significantly higher proportion of modified Rankin Scale scores ≤ 3 and a lower mortality rate in patients with seizures when compared with those without.
CONCLUSION: In conclusion, none of the variables analyzed were identified as independent risk factors for seizure development, although there was an increased rate of good functional outcome and lower mortality in patients with seizures, possibly reflecting a time-dependent factor of seizure detection.