Aetiology varies according to the age of onset. In childhood and adolescence inherited disorders of metabolism, ante- and perinatal complications, infection, migrational errors, and the consequences of febrile convulsions predominate, in middle life trauma and tumour are most common, and in advanced years cerebrovascular disease and degenerative disorders are predominant.

Only one-quarter to one-third of cases of epilepsy are due to known causes. Many others fall into recognizable syndromes about which much is understood. The partial epilepsies are, by definition, due to focal areas of damage and a dysfunctional brain, usually the cortex. However, although the site may be suggested by the seizure semiology, comprehensive investigation may fail to identify any abnormality. Even when it does so, the radiological appearance may lack aetiological specificity. Some generalized seizures may be identified as primary generalized epilepsy syndromes; for example, juvenile myoclonic epilepsy. These are of uncertain aetiology, though genetic factors are considered important; onset is in childhood or adolescence and the prognosis favourable.

In psychiatric practice seizures may arise iatrogenically; they are usually due to pharmacotherapy, less commonly to electroconvulsive therapy. They may result from the overhasty withdrawal of benzodiazepines or to the use of antidepressant or antipsychotic drugs, most of which are epileptogenic. Such seizures are thought to be provoked and do not form grounds for a diagnosis of epilepsy. Adjustment of drug dosage is usually all that is required. Provoked seizures may also occur during alcohol intoxication ('rum fits') or withdrawal; a genetic predisposition may play a part.

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