Incidence and Predictors of Epilepsy after Traumatic Brain Injury: A Systematic Review and Meta-Analysis

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 were 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 the 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 develops PTE. Severe injury, hemorrhagic lesions, skull fractures, neurosurgical intervention, and early seizures markedly increased the risk. These findings support targeted surveillance and risk-stratified follow-up, particularly in high-risk and resource-limited settings.