From the Guidelines
Seizures are primarily caused by abnormal electrical activity in the brain, with the most common causes including epilepsy, head trauma, brain infections, stroke, brain tumors, and high fever, as well as other potential triggers such as alcohol or drug withdrawal, certain medications, genetic disorders, and metabolic abnormalities. The classification of seizures is operational and not based on fundamental mechanisms, with seizures being classified as focal onset, generalized onset, or unknown onset 1. Focal seizures arise within networks of a single cerebral hemisphere and may remain localized or become more widely distributed, while generalized seizures rapidly affect both hemispheres and both sides of the body 1.
Some key causes of seizures include:
- Epilepsy, a chronic neurological disorder
- Head trauma, such as traumatic brain injury (TBI)
- Brain infections like meningitis or encephalitis
- Stroke
- Brain tumors
- High fever, particularly in children
- Alcohol or drug withdrawal
- Certain medications
- Genetic disorders
- Developmental disorders
- Metabolic abnormalities, such as low blood sugar, sodium imbalances, or kidney or liver failure
According to the most recent evidence, the management of seizures depends on the underlying cause and may include anticonvulsant medications, such as levetiracetam (Keppra), carbamazepine (Tegretol), or valproic acid (Depakote), as well as identifying and avoiding personal triggers, maintaining regular sleep patterns, and regular medical follow-up 1. In patients with drug-resistant focal epilepsy, epilepsy surgery is a promising option, with approximately 65% of patients becoming seizure-free 1.
It is essential to note that the brain normally functions through coordinated electrical signals between neurons, and seizures occur when these signals become excessive or synchronous, disrupting normal brain function. The development of molecular neuroimaging with interictal [18 F]fluorodeoxyglucose ([18 F] FDG) positron emission tomography (PET), ictal perfusion SPECT, or ictal subtraction perfusion SPECT has influenced and impacted the presurgical management of epilepsy patients 1.
In terms of diagnosis, the International League Against Epilepsy (ILAE) defines epilepsy as having at least two unprovoked seizures occurring more than 24 hours apart, one unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures, or diagnosis of an epilepsy syndrome 1. The classification of seizures by the ILAE was last revised in 2017, and it is essential for etiologic diagnosis, appropriate treatment, and accurate prognostication 1.
Overall, the management of seizures requires a comprehensive approach, including accurate diagnosis, appropriate treatment, and regular medical follow-up, to improve morbidity, mortality, and quality of life outcomes 1.
From the Research
Causes of Seizures
- Seizures are a common neurological condition in which abnormal electrical discharges from the brain cause recurrent unprovoked seizures 2
- The causes of seizures can be related to various factors, including the type of seizure, with focal onset seizures and generalized onset tonic-clonic seizures having different underlying causes 2, 3
- Epilepsy is a condition that can cause seizures, and it is believed that with effective drug treatment, up to 70% of individuals with active epilepsy have the potential to become seizure-free and go into long-term remission shortly after starting drug therapy with a single antiepileptic drug (AED) in monotherapy 2
Risk Factors for Seizures
- Key risk factors for recurrence of seizures in adults include two unprovoked seizures occurring more than 24 hours apart, epileptiform abnormalities on electroencephalography, abnormal brain imaging, nocturnal seizures, or an epileptic syndrome associated with seizures 4
- In children, key risk factors for recurrence of seizures include abnormal electroencephalography results, an epileptic syndrome associated with seizures, severe head trauma, and cerebral palsy 4
Antiepileptic Drugs and Seizures
- Antiepileptic drugs (AEDs) are used to treat seizures, and the choice of AED depends on the type of seizure and the individual's medical history 3, 5
- AEDs can have adverse effects, and the risk of adverse effects should be considered when selecting a treatment 4
- Some AEDs, such as carbamazepine and valproate, may be associated with a higher risk of adverse cardiovascular events compared to other AEDs, such as lamotrigine 6