Risk Factors and Causes of Seizures
Seizures are caused by a wide range of factors including hypoxic ischemic injury, intracranial hemorrhage, metabolic disturbances, infections, genetic disorders, and structural brain abnormalities, with the specific etiology varying significantly by age group and clinical context. 1, 2
Primary Causes of Seizures
Acute Symptomatic Causes
Metabolic disturbances:
Toxic/Medication-related:
Structural brain abnormalities:
Infections:
Unprovoked Seizures/Epilepsy
- Genetic factors 1, 7
- Remote symptomatic causes (brain insult that occurred >7 days in the past) 1
- Idiopathic epilepsy syndromes 2
Age-Specific Risk Factors
Neonates (0-29 days)
- Hypoxic ischemic injury (46-65% of cases) 1
- Intracranial hemorrhage (10-12%) 1
- Perinatal ischemic stroke (10-12%) 1
- Infection (particularly after 7 days of life) 1
- Genetic disorders 1
- Malformations of cortical development 1
Children
- Febrile seizures (affect 2-4% of children, most commonly between 6 months and 2 years) 1
- Genetic epilepsy syndromes 2
- Metabolic disorders 1
- Developmental brain abnormalities 1
Adults
- Alcohol or sedative withdrawal 4
- Medication effects 4, 3
- Stroke 6
- Brain tumors 6
- Traumatic brain injury 6
- Metabolic derangements 6
Risk Factors for Developing Seizures
Patient-Specific Factors
- Previous history of seizures or epilepsy 3
- Age extremes: childhood, elderly, and very elderly 3
- Blood-brain barrier dysfunction 3, 5
- Renal impairment (leading to drug accumulation) 3, 5
- Hepatic impairment (affecting drug metabolism) 3
- Fever 3
- Cancer 3
- Concomitant neurological diseases 3
- Mental disorders 3
Medication-Related Factors
- Polypharmacy (especially combinations of drugs that lower seizure threshold) 3
- High drug concentrations in blood 3
- Lipophilic drugs that easily cross the blood-brain barrier 3
- Rapid administration or high doses of seizure-inducing medications 3
Important Clinical Considerations
When to Activate Emergency Medical Services
Immediate medical attention is needed for seizures with any of the following characteristics 1:
- First-time seizure
- Seizure lasting >5 minutes
- Multiple seizures without return to baseline between episodes
- Seizure with traumatic injuries
- Seizure with choking or difficulty breathing
- Seizure occurring in water
- Seizure in an infant <6 months of age
- Seizure in a pregnant person
- Failure to return to baseline within 5-10 minutes after seizure stops
Common Pitfalls in Seizure Management
- Misdiagnosis: Many conditions can mimic seizures, including pseudoseizures, syncope, migraine, cerebrovascular events, movement disorders, and sleep disorders 7
- Inappropriate restraint: Patients should never be restrained during a seizure 1
- Placing objects in mouth: Nothing should be put in the mouth of someone having a seizure 1
- Administering antipyretics for febrile seizures: These do not prevent subsequent seizures 1
- Medication interactions: Certain antibiotics (carbapenems, macrolides) can interact with antiepileptic drugs, potentially leading to breakthrough seizures 5
- Failure to recognize nonconvulsive status epilepticus: Particularly in patients on cephalosporins who present with altered consciousness 5
Understanding these risk factors and causes is essential for proper diagnosis, management, and prevention of seizures across different age groups and clinical scenarios.