Risk factors for posttraumatic epilepsy: A systematic review and meta-analysis

Objective: A systematic review and meta-analysis was performed to identify risk factors for posttraumatic epilepsy (PTE). Methods: Two electronic databases (Medline and Embase) were searched to identify studies with a cohort, case control, or cross-sectional design reporting on epidemiologic evidence regarding risk factors for PTE. Results: Men had a higher risk of developing PTE than women [relative ratio (RR), 132; 95% confidence interval (CI), 1.10-1.59]. A history of alcohol abuse (RR, 2.18; 95% Cl, 1.26-3.79), posttraumatic amnesia (RR, 131; 95% CI, 1.12-1.53), focal neurologic signs (RR, 1.42; 95% Cl, 1.16-1.74), and loss of consciousness at initial traumatic brain injury (TBI) (RR, 1.62; 95% Cl, 1.13-232) were associated with a greater risk of PTE. TBI-related abnormal neuroimaging findings, including skull fracture (RR, 227; 95% CI, 1.49-3.44), midline shift (RR, 1.46; 95% Cl, 1.14-1.87), brain contusion (RR, 2.35; 95% CI, 1.69-3.28), subdural hemorrhage (RR, 2.00; 95% CI, 1.33-3.01), and intracranial hemorrhage (RR, 2.65; 95% CI, 1.83-3.82) were strong risk factors for PTE. The risk of developing PTE after skull fracture, mild brain injury, and severe brain injury peaked within the first year after TBI, and then gradually decreased. However, a high risk of PTE was sustained for >10 years. Conclusion: The current meta-analysis identified potential risk factors for PTE. The results may contribute to better prevention strategies and treatments for PTE. (C) 2016 Elsevier Inc. All rights reserved.