Outcomes of patients with post-stroke epilepsy: A scoping review on quality of life, readmissions, costs, seizure recurrence, and medication adherence.

objectivePost-stroke epilepsy (PSE) affects ≈10% of patients with stroke and is associated with adverse health and economic outcomes. We aimed to review published literature on health and economic outcomes for patients with PSE, with a specific focus on quality of life, hospital readmissions, healthcare costs, seizure recurrence, and medication adherence.

methodsA protocol was developed and registered in the Open Science Framework (OSF). Ovid Medline, Embase, Scopus, and Web of Science databases were searched from database inception until January 5, 2026. One human reviewer and an AI-assisted reviewer independently screened the titles and abstracts for eligibility (92.9% agreement), with disagreements resolved by a second human reviewer. Full-text review was undertaken independently by two human reviewers. Data were extracted from each study and entered into a standardized proforma and qualitatively synthesized.

resultsOf the 3557 studies screened, 103 passed to full-text review and 61 were included. The majority of studies were from the United States (n = 11) followed by China (n = 9). The follow-up duration ranged from time at hospital discharge to 16 years post-discharge. Outcomes reported included: quality of life (n = 14), hospital readmission (n = 8), healthcare costs (n = 2), seizure recurrence (n = 38), and medication adherence (n = 6). PSE was associated with reduced quality of life and greater healthcare costs compared to stroke survivors without epilepsy. Seizure recurrence was more likely in younger adults. No clear sex differences were noted for any outcomes. Compared to enzyme-inducing antiseizure medications, non-enzyme inducing medications were associated with fewer recurrent seizures and readmissions and less medication discontinuation. SIGNIFICANCE: PSE was associated with poorer quality of life compared to stroke survivors who did not develop epilepsy. Additional studies are needed to definitively establish the association between PSE and other outcomes. Understanding the burden of PSE, including long-term outcomes, is critical to guide future research, incentivize earlier diagnosis, and optimize treatment. PLAIN LANGUAGE SUMMARY: This review comprehensively examined the current evidence on health and economic outcomes for patients with PSE, covering important outcomes such as quality of life, hospital readmission, healthcare costs, seizure recurrence, and medication adherence. Across studies, those with PSE had a reduced quality of life than stroke survivors without epilepsy. The use of newer antiseizure medications was linked with fewer recurrent seizures, readmissions, and medication discontinuations compared to older antiseizure medications. The findings of this study can help guide further research and practice improvement to reduce the immense health and economic burden of PSE.