Key result
AF is linked to ~109% higher poststroke epilepsy risk but not overall poststroke seizures.
Why the study?
AF is an established stroke risk factor and poststroke seizures are a known complication, but whether AF increases poststroke seizure likelihood or seizures link to later AF remained unclear.
Is atrial fibrillation associated with an increased risk of poststroke seizures in patients with ischemic and hemorrhagic strokes?
Meta-Analysis
Is atrial fibrillation associated with an increased risk of poststroke seizures in patients with ischemic and hemorrhagic strokes?
Atrial fibrillation is significantly associated with poststroke epilepsy and poststroke seizures in Asian populations, though not with overall poststroke seizures.
Answers are grounded in this paper and cite their sources.
No change to poststroke seizure risk stratification by AF status; leaves open subgroup associations in ischemic stroke and Asian populations.
Background and Purpose Atrial fibrillation (AF) is an established risk factor for stroke. Poststroke seizures (PSS) are a known complication after stroke. This review aimed to explore whether AF increases the likelihood of seizures after stroke and whether seizures might also be linked to the later development of AF. Methods We reviewed 11 observational studies involving patients with ischemic and hemorrhagic strokes, with substantial representation from Asian populations. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for both directions of association. Subgroup analyses were conducted based on stroke subtype, region, epilepsy-specific outcomes, sex, and age. Results AF was not significantly associated with the overall odds of PSS (OR = 1.00, P = .93). In ischemic stroke, AF showed a non-significant trend toward increased odds of PSS (OR = 1.28, P = .16), while no association was observed in hemorrhagic stroke (OR = 0.96, P = .80). A significant association was identified when focusing on poststroke epilepsy (OR = 2.09, P < .001). Studies from Asia demonstrated a stronger association (OR = 1.94, P < .001). Two studies examining PSS after AF found a significant association (OR = 2.87, P < .01). Female sex was slightly more common in patients with seizures (OR = 1.08, P = .02), particularly in ischemic stroke (OR = 1.11, P < .01). Patients with seizures were also marginally younger (Hedges’ g = −0.15, 95% CI: −0.20 to −0.11, P < .001). Conclusions AF may be associated with PSS, especially in epilepsy-focused and region-specific contexts. More studies are needed to understand the biological pathways behind these findings.
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Ramadan et al. (2026) conducted a meta-analysis in Ischemic and hemorrhagic strokes. Atrial fibrillation vs. No atrial fibrillation was evaluated on Overall odds of poststroke seizures (OR 1.00, p=.93). Atrial fibrillation was not associated with the overall odds of poststroke seizures, but was associated with poststroke epilepsy.
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