Objective  To systematically evaluate the efficacy and safety of the combination therapy of sodium valproate and edaravone in the treatment of post-stroke epilepsy (PSE).

Methods  The Cochrane Library, PubMed, Embase, Web of Science, CNKI, Wanfang database, and VIP databases were searched from the time of inception to May 2023. Randomized controlled trials of edaravone plus valproate versus valproate monotherapy for epilepsy were collected, the risk of bias of the included studies was assessed using the RoB 2 tool, and Meta-analyses were performed using RevMan 5.4 software.

Results  13 studies with a total of 1 092 patients were included. The results showed that the response rate was significantly higher in the combination group than in the sodium valproate group [RR=0.18, 95%CI (0.13 to 0.22), P<0.01]. The incidence of adverse reactions was lower [RR=0.73, 95%CI (0.48 to 1.13), P=0.16]. The seizure frequency [MD=-0.30, 95%CI (-0.43, -0.11), P<0.01] and duration of seizures [MD=- 0.81, 95%CI (-0.89, -0.72), P<0.01] in the combined treatment group were significantly lower than those in the sodium valproate group. The inflammatory factors tumor necrosis factor-α [MD=- 8.00, 95%CI (-9.15, -6.84), P<0.01], interleukin-2 [MD=-10.19, 95%CI (-14.61, -5.78), P<0.01], interleukin-8 [MD=-5.6, 95%CI (-6.48, -4.73), P<0.01] were significantly lower than those in the sodium valproate group. The neuron-specific enolase (NSE) level in patients with epilepsy in the combination treatment group was significantly better than that of the sodium valproate group at 1 month [MD=-4.73, 95%CI (-4.99, -4.46), P<0.01], 3 months [MD= -2.10, 95%CI (-3.26, -0.95), P<0.01], and 6 months after treatment [MD=-1.31, 95%CI (-2.35, -0.27), P<0.01]. There was no significant difference in NSE levels [MD=0.06, 95%CI (-0.07, 0.19), P=0.34] after 12 months.

Conclusion  Edaravone combined with sodium valproate in the treatment of post-stroke epilepsy can improve the epilepsy control rate of patients, shorten the frequency and duration of seizures, reduce the level of inflammatory factors in patients, promote the reduction of NSE levels, and improve their quality of life, which has a certain safety.

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