Background: Post-traumatic epilepsy (PTE) is a major long-term complication of traumatic brain injury (TBI), contributing substantially to global neurological morbidity. Reported incidence varies widely, and the relative contribution of clinical and radiological predictors remains uncertain. Aim: To estimate the pooled incidence of PTE following TBI and identify its major predictors. Methodology: A systematic review and meta-analysis was conducted in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed, Scopus, Web of Science, and Embase were searched from inception to December 2024. Twenty-two studies involving over 170,000 participants met inclusion criteria. Data extraction and risk-of-bias assessment using the Newcastle–Ottawa Scale were performed independently by two reviewers. A random-effects model was used to pool incidence estimates and risk ratios (RRs) for key predictors. Results: The pooled global incidence of PTE following TBI was 12.4% (95% confidence interval (CI) 9.8-15.6). Severe TBI significantly increased risk (risk ratio (RR) 4.18, 95% CI 2.90-6.02). Other strong predictors included subdural hemorrhage (RR 2.82), intracerebral hemorrhage (RR 1.95), depressed skull fracture (RR 2.67), and neurosurgical intervention (RR 1.74). Early post-traumatic seizures were the strongest predictor (RR 3.42, 95% CI: 2.56-4.58). Incidence was higher in penetrating injuries and studies with longer follow-up durations. Conclusion: Approximately one in eight individuals with TBI develop PTE. Severe injury, hemorrhagic lesions, skull fractures, neurosurgical intervention, and early seizures markedly increased risk. These findings support targeted surveillance and risk-stratified follow-up, particularly in high-risk and resource-limited settings.
Onyebuchi et al. (2026) studied this question.