Epilepsy Causation

Epilepsy is often a symptom of disease rather than a disease itself. The approach to investigation depends on knowledge of potential causes:

75% No cause found

2% Drugs & alcohol 2% Anoxia ' 2% Neoplasms 4% Congenital disorders * 5% Head trauma

5% Vascular disease

5% CNS infection

Where no obvious cause is found there is often an increase in 'risk factors' - family history, febrile convulsion or difficult delivery.

Partial seizures with or without secondary generalisation

Age of onset gives a clue to causation. Each list is in order of frequency.

5% Vascular disease

5% CNS infection

Newborn

Asphyxia

Intracranial haemorrhage Hypocalcaemia Hypoglycaemia Hyperbilirubinaemia Water intoxication Inborn errors of metabolism Trauma

Adolescence and early adulthood

Trauma CNS Infection Tumours

Arteriovenous malformation Drugs and alcohol

Infancy

Febrile convulsions CNS Infection Trauma

Congenital defects Inborn errors of metabolism

Childhood

Trauma CNS Infection

Arteriovenous malformations Congenital defects Tumours

Late Adult

Drugs and alcohol Trauma Neoplasms Vascular disease Degenerative disease CNS infection

Other general or systemic disorders may be associated with seizures e.g. metabolic disease and collagen vascular disorder. Seizures may rarely occur in multiple sclerosis. Some drugs may cause seizures. Antidepressants, antipsychotics, sympathomimetics, antineoplastics and certain general anaesthetic agents have all been incriminated.

Generalised epilepsies

There appears to be no clearly definable cause. Genetic factors play a role; concordance in monozygote twins is 75% for petit mal. An autosomal dominant gene would appear responsible for spike and wave abnormalities seen in the EEGs of parents and siblings of patients with generalised epilepsy. The defect is assumed to be metabolic though its nature is unknown.

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