Not all seizures are caused by epilepsy. Epilepsy is diagnosed when a person has two or more unprovoked seizures, but many seizures have clear triggers or causes that are not related to this long-term condition.

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Febrile seizures in children

Young children can experience seizures triggered by high fevers, typically during infections. These febrile seizures are usually brief and don't cause lasting harm, but they require immediate medical evaluation to rule out serious infections like meningitis and to provide appropriate care.

Most children who have febrile seizures don't develop epilepsy, though having them does slightly increase the risk of future seizures.

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Metabolic disturbances

The brain requires a stable chemical balance (neurotransmitters) to function properly. Certain metabolic disturbances can trigger seizures, such as:

• Low blood sugar (hypoglycemia) deprives the brain of its primary energy source, potentially triggering seizures. This can happen in people with diabetes who take too much insulin, skip meals, or have other blood sugar management issues.
• Electrolyte imbalances, including low sodium, calcium, or magnesium levels, can disrupt nerve communication and lead to seizures. These imbalances can result from medications, kidney problems, dehydration, or various medical conditions.
• Kidney or liver failure allows toxins to build up in the blood that reach the brain and trigger seizures. These organs normally filter waste products that become dangerous when they accumulate.

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Head trauma and stroke

Brain injuries can cause seizures right away or even months or years after the injury:

Traumatic brain injury from concussions, accidents, or other head trauma can disrupt normal brain electrical activity. Seizures may occur right after the injury or develop months to years later as scar tissue forms.

A stroke, whether caused by a blocked blood vessel or bleeding in the brain, can lead to seizures during the event or while the brain is healing. Damaged brain tissue is more likely to have abnormal electrical activity.

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Medication and substance withdrawal

Stopping some medications suddenly can greatly raise the risk of seizures:

• Anti-seizure medications must be tapered gradually under the supervision of a medical professional. Abrupt discontinuation, even missing a few doses, can cause breakthrough seizures that may be more severe than the original condition.
• Other medications, including antidepressants, anxiety medications, and some sleep aids, affect brain chemistry in ways that require gradual withdrawal to prevent seizures.
• Alcohol and drug withdrawal can trigger seizures as the brain rebounds from chronic suppression. This includes withdrawal from alcohol, benzodiazepines, barbiturates, and other substances that affect brain activity.

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Infections affecting the brain

Several types of infections can trigger seizures by causing brain inflammation:

• Meningitis involves inflammation of the protective membranes around the brain and spinal cord, often causing seizures along with fever, headache, and neck stiffness.
• Encephalitis is the inflammation of brain tissue, usually caused by viral infections, that can lead to seizures, confusion, and other neurological symptoms.
• Brain abscesses are localized infections that can trigger focal seizures and require immediate antibiotic treatment or surgical drainage.
• Systemic infections with high fevers can sometimes trigger seizures, especially in people who are already susceptible.

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Medications that lower the seizure threshold

Some medicines can make seizures more likely, especially for people who already have a higher risk:

‍Certain antibiotics, including penicillin, cephalosporins, and fluoroquinolones, can lower the seizure threshold, particularly at high doses or in individuals with kidney impairment.‍

Antidepressants, particularly tricyclics and bupropion, can increase seizure risk, especially when combined with other risk factors.‍

Stimulant medications and drugs of abuse, including cocaine, amphetamines, and synthetic drugs, can trigger seizures through various mechanisms.

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Non-epileptic seizures (NES)

These episodes seem like seizures, but they are caused by psychological factors instead of changes in brain electricity. NES can happen because of:

Trauma responses are when the body reacts to psychological stress in ways that mimic seizures. These are involuntary responses, not conscious behaviors.

Dissociative episodes, where psychological distress manifests as physical symptoms that resemble seizures.

Mental health conditions, including PTSD, anxiety disorders, and conversion disorders, can sometimes present with seizure-like episodes.

About 25-35% of people first diagnosed with epilepsy are later found to have NES instead.

About 10–30% of patients diagnosed with NES also have comorbid epilepsy. Conversely, about 5–20% of patients with epilepsy may also experience NES at some point. This illustrates why it is crucial to consult a specialist who understands both conditions for an accurate diagnosis.

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Other medical causes

• Eclampsia is a condition in pregnancy where very high blood pressure can cause seizures. This is an emergency that requires prompt treatment to ensure the safety of both mother and baby.
• Brain tumors can cause seizures by creating pressure, disrupting normal tissue, or irritating surrounding brain areas. These seizures may be the first sign of a tumor.
• Autoimmune conditions in which the immune system attacks brain tissue can cause seizures, along with other neurological symptoms.
• Severe sleep deprivation can lower the seizure threshold and trigger seizures, especially in people with underlying susceptibility.

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When to seek immediate help

If someone experiences a seizure for the first time, they should seek emergency medical attention. Even if the seizure ends quickly, doctors need to determine the cause and treat it.

Call 911 immediately if:

• The seizure lasts longer than 5 minutes.
• Multiple seizures occur without full recovery between them.
• The person is experiencing difficulty breathing or has been injured.
• The seizure occurs in water.
• The person has diabetes, is pregnant, or has other serious medical conditions.

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Getting the right evaluation

After emergency stabilization, follow up with a neurologist for a comprehensive evaluation. This typically includes:

• Detailed medical history and seizure description
• EEG to measure brain electrical activity
• Brain imaging (MRI or CT scan)
• Blood tests to check for metabolic causes
• Review of medications and substances

Getting the right diagnosis is very important because treatment depends on what is causing the seizures. Treatments for epilepsy may not work for other types of seizures, and some causes need urgent, special care.

If you have had a seizure or are worried about your risk, our seizure disorder specialists at Neura can help. We will work with you to find the cause, tell the difference between epileptic and non-epileptic seizures, and create a care plan that fits your needs. Book a visit to discuss your concerns and receive expert support.

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