Incidence and relevant factors for seizures after spontaneous intracerebral hemorrhage: A systematic review and meta-analysis

Objective: To identify the incidence and relevant factors for seizures after spontaneous intracerebral hemorrhage (sICH) by performing a systematic review and meta-analysis. Methods: We systematically searched PubMed, EMBASE, and Cochrane Library from inception to 14 August 2021 for studies investigating relevant factors associated with seizures after sICH. A meta-analysis of all included studies was performed by using Stata version 12.0 software. Results: In total, 22 studies with 32,162 participants were included. The meta-analysis showed a 9.5% incidence of seizures after sICH. We identified 6 factors that increased the risk of seizures after sICH, including alcohol consumption(RR (95% CI) =1.26 (1.07, 1.48), I-2 = 44.40%, p < 0.01), cortical involvement (RR (95% CI)= 3.22 (2.29, 4.53), I-2 = 80.00%, p <0.01), lobar location (RR (95% CI)= 2.99 (2.14, 4.18), I-2 = 75.40%, p < 0.01), large hematoma volume (SMD (95% CI)= 0.59 (0.17, 1.00), I-2 = 95.40%, p < 0.01), hematoma evacuation (RR (95% CI)= 2.38 (1.08, 5.25), I-2 = 86.60%, p = 0.03), and treatment with anti-seizure medication (ASM) (RR (95% CI)= 2.77 (1.91, 4.03), I-2 = 0.00%, p < 0.01). Conversely, old age (SMD (95% CI)= -0.27 (-0.37, -0.16), I-2 = 66.80%, p < 0.01), a high Glasgow Coma Scale (GCS) score at presentation (SMD (95% CI)= -1.62 (-2.91, -0.34), I-2 = 99.70%, p = 0.01), and hypertension (RR (95% CI)= 0.84 (0.76, 0.94), I-2 = 25.90%, p < 0.01) were associated with a significantly lower probability of seizure occurrence in sICH patients. Conclusions: The incidence of seizures after ICH is 9.5%. Alcohol consumption, cortical involvement, lobar location, hematoma volume, hematoma evacuation, treatment with ASM, age, GCS score at presentation, and hypertension are closely tied to the occurrence of seizures after sICH.