Most frequent causes of symptomatic epileptic seizures

1. Big picture

A symptomatic epileptic seizure means a seizure that occurs because the brain is being irritated by an identifiable cause. In exams, the most important point is to separate:

1. Acute symptomatic / provoked seizure A seizure occurring during an acute insult, for example fever, hypoglycemia, hyponatremia, alcohol withdrawal, acute stroke, encephalitis, trauma. This is not automatically epilepsy.

2. Remote symptomatic epilepsy / secondary epilepsy Recurrent unprovoked seizures caused by a previous or ongoing brain lesion, for example old stroke scar, traumatic brain injury, cortical malformation, hippocampal sclerosis, brain tumor. This is epilepsy if seizures recur unprovoked or recurrence risk is high.

The examiner usually wants you to say: “Do not diagnose epilepsy just because one seizure happened. First search for a provoking cause.”