Objective To investigate the clinical features and related risk factors of patients with epilepsy secondary to acute cerebral infarction to provide more reference for early detection of high-risk groups of secondary epilepsy and guiding the formulation of clinical prevention and treatment plans.Methods A total of 203 patients with acute ischemic stroke were retrospectively chosen in the period from January 2019 to December 2022. All patients were divided into epileptic group (33 cases) and non-epileptic group (170 cases) according to whether they had secondary epilepsy. The demographic data, combined underlying diseases, infarct lesions and laboratory examination indicators were compared between the two groups, and the independent risk factors of secondary epilepsy after acute ischemic stroke were evaluated by multifactor method with logistic regression model.Results Thirty-three cases had secondary epilepsy accounting for 16.26% in all 203 patients with acute ischemic stroke. There were significant differences in infarct range, local blood volume, local blood flow, white blood cell count, neutrophil count and soluble interleukin-2 receptor level between the two groups (P<0.05). Logistic regression model was used for multivariate analysis. The results showed that cortical infarction, low local blood volume, low local blood flow, high white blood cell count, high neutrophil count and high soluble interleukin-2 receptor level were independent risk factors for secondary epilepsy after acute ischemic stroke (P<0.05).Conclusion The secondary epilepsy of acute ischemic stroke is related to the infarct scope, cerebral blood perfusion and laboratory indexes related to immune inflammation. Patients with cortical infarction, low local blood volume, low local blood flow, high white blood cell count, high neutrophil count and high soluble interleukin-2 receptor level were more likely to have secondary epilepsy.