What are the causes of seizures in adolescents?

From the Guidelines

Seizures in adolescence are primarily caused by underlying neurological conditions, infections, trauma, metabolic abnormalities, and other factors, as highlighted in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The causes of seizures in adolescence can be multifaceted, including:

• Genetic epilepsy syndromes that emerge or continue from childhood
• Structural brain abnormalities, such as tumors, malformations, or previous injuries
• Infections affecting the brain, like meningitis or encephalitis
• Metabolic disturbances, including electrolyte imbalances and hypoglycemia
• Toxins or substance use, such as alcohol withdrawal or recreational drugs
• Head trauma, which can be a significant risk factor for seizures in adolescents According to the guidelines, seizures can occur as a result of various factors, including infections, trauma, poisonings, lack of oxygen, and metabolic abnormalities 1. It is essential to consider the potential triggers of seizures in susceptible adolescents, such as stress, sleep deprivation, and hormonal changes during puberty. Some adolescents may experience reflex epilepsies triggered by specific stimuli like flashing lights or video games. When evaluating an adolescent with new-onset seizures, a comprehensive approach, including a detailed history, neurological examination, EEG, and brain imaging, is crucial, as emphasized in the guidelines 1. Treatment typically involves anti-seizure medications tailored to the specific seizure type and underlying cause, with consideration for side effects particularly relevant to teenagers, such as cognitive effects, weight changes, or cosmetic concerns.

From the FDA Drug Label

In pediatric patients experiencing partial onset seizures, levetiracetam is associated with somnolence, fatigue, and behavioral abnormalities. A total of 37. 6% of the levetiracetam-treated patients experienced behavioral symptoms (reported as agitation, anxiety, apathy, depersonalization, depression, emotional lability, hostility, hyperkinesia, nervousness, neurosis, and personality disorder), compared to 18.6% of placebo patients.

The causes of seizures in adolescence are not directly addressed in the provided drug label. The label discusses the adverse effects of levetiracetam, including behavioral abnormalities, but does not provide information on the causes of seizures in adolescence. 2

From the Research

Causes of Seizures in Adolescence

• Seizures in adolescence can be caused by various factors, including epilepsy, which affects up to 1% of children and adolescents 3
• Idiopathic generalized epilepsies (IGEs) are a common cause of seizures in adolescence, accounting for 15-20% of all epilepsies 4
• IGEs can manifest as typical absences, myoclonic jerks, and generalized tonic-clonic seizures, alone or in combination 4
• Hormonal changes during adolescence, such as those experienced during puberty, may also play a role in seizure frequency, with estrogen potentially activating epileptiform activity and testosterone decreasing seizure activity 5
• Other potential causes of seizures in adolescence include head trauma, infections, and genetic factors 3, 5

Epilepsy Syndromes in Adolescence

• Juvenile myoclonic epilepsy (JME) is the most common form of idiopathic generalized epilepsy in adolescence 4, 5
• Other epilepsy syndromes that may begin in adolescence include juvenile absence epilepsy, epilepsy with generalized tonic-clonic seizures, and progressive myoclonic epilepsies 4, 5
• Temporal lobe epilepsy associated with hippocampal sclerosis may also have its origin in childhood, but often presents in adolescence or young adulthood 5

Diagnosis and Treatment

• Accurate diagnosis of epilepsy syndromes in adolescence is crucial for effective treatment and prognosis 6, 5
• Emerging evidence suggests that patients with IGE may go undiagnosed or misdiagnosed with focal epilepsy if EEG or semiology have asymmetric or focal features 7
• Treatment options for seizures in adolescence may include medication, surgery, and neuromodulatory interventions 7, 5