While there is a slight increase in seizure frequency following COVID-19 vaccination in patients with epilepsy, the rates are considerably lower than those reported for COVID-19 infection.

Worsening seizures following the administration of COVID-19 vaccines contribute significantly to vaccine hesitancy among individuals with epilepsy, leading to reduced vaccination rates. This study systematically examined events related to seizure activity in epilepsy-affected people following COVID-19 vaccination.

A thorough search of Cochrane Library, Scopus, PubMed, and Web of Science was carried out until 31 January 2023, and included articles that reported events of seizure activity in epilepsy patients receiving COVID-19 vaccination. The study outcomes focused on the pooled incidence proportions of  (1)increased seizure frequency, (2) status epilepticus, and (3) alteration in type of seizure.

Out of 2207 studies, 16 were included in the meta-analysis. The pooled occurrence proportion of elevated seizure frequency (16 studies, 3245 epilepsy patients) was found to be 5% (95% CI: 3%-7%, I2 = 52%). There was no vital difference witnessed between mRNA and viral vector vaccines in terms of raised  frequency of seizure (Odds ratio [OR]: 1.11, 95% CI: 0.49-2.52, I2 = 0%), as well as between mRNA and inactivated virus vaccines (OR: 1.60, 95% CI: 0.27-9.37; I2 = 0%).

The pooled occurrence proportion of status epilepticus (15 studies, 2387 epilepsy sufferers) was 0.08% (95% CI: 0.02%-0.33%, I2 = 0%). Ultimately, the pooled occurrence proportion of alteration in seizure type (7 studies, 1172 people having epilepsy) was 1% (95% CI: 1%-2%, I2 = 0%). The meta-analysis indicated a 5% greater frequency of seizure in epilepsy patients post-COVID-19 vaccination, with no vital difference between mRNA and viral vector or inactivated virus vaccines. Additionally, incidence proportions of 0.08% for post-vaccination status epilepticus and 1% for changes in seizure type were observed.

The findings emphasized the importance of vaccination in evading the potentially more severe consequences of COVID-19 in persons with epilepsy.