Seizures and epilepsy after bariatric surgery: a systematic review of incidence, mechanisms, and management

Bariatric surgery is increasingly performed worldwide, and postoperative neurological complications can occur. Seizures are clinically important because they carry significant morbidity and are often associated with reversible metabolic triggers. This systematic review synthesized evidence on seizures and epilepsy following bariatric surgery. PubMed, Embase, and Web of Science were searched from inception to January 11, 2025. Nineteen studies were included: three retrospective cohort studies and sixteen case reports. Roux-en-Y gastric bypass accounted for most reported cases, with one case following sleeve gastrectomy. Time from surgery to first seizure ranged from 2 to 180 months. Generalized tonic–clonic seizures were most common. Reported causes were mainly metabolic, particularly hypoglycemia and hyperammonemia, with additional cases linked to hypocalcemia, vitamin deficiencies, and stroke. Cohort data suggest an increased postoperative risk of seizures and epilepsy. Further research is needed to clarify mechanisms and absolute risk.