In comparison with western anti-epileptic drugs alone, western anti-epileptic drugs + removal of blood stasis and resolution of phlegm remarkably improved clinical efficacy and safety in epilepsy patients complicated with cognitive impairment.

In order to assess the therapeutic effectiveness and safety of eliminating blood stasis and clearing phlegm in the management of epilepsy with cognitive decline, a systematic review and meta-analysis was conducted.

This investigation was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Utilizing databases such as Cochrane Library, Embase, Pubmed, Wanfang Database, Chinese Journal Full Text Database (CNKI), CQVIP Database (CQVIP), and Cochrane Library, relevant literature was searched. Utilizing Rev Man5.3 software, pertinent data were collected for meta-analysis. A total of 1198 patients were included from 14 randomized controlled studies and segregated into the control group (n = 601) and the treatment/experimental group (n = 597).

Treating epilepsy with cognitive impairment in combination with the method of eliminating blood stasis and clearing phlegm could profoundly improve the clinical effectiveness of epilepsy, according to meta-analysis results, when compared to treatment of epilepsy with cognitive impairment with western anti-epileptic drugs alone (odds ratio [OR] = 3.41).

The Traditional Chinese Medicine symptom score was improved (OR = 3.99). The rate of electroencephalogram improvement was accelerated (risk ratio [RR] = 1.39). Cognitive performance and Montreal Cognitive Assessment (MOCA) score (mean difference [MD] = 3.54) were enhanced. The cognitive function score on the 31-item quality of life questionnaire in epilepsy (QOLIE-31) and mental capacity (MD = 7.22) was improved. The frequency of side effects (RR = 0.50) was decreased.

Combination of traditional Chinese and western anti-epileptic agents is superior than western anti-epileptic agents alone for the management of epilepsy and cognitive deficit.