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Initial evaluation of seizure.
Initial evaluation of seizure.
It is important to obtain a good history and physical on each patient you see for a new onset seizure. As the data often demonstrates, the frequency of different causes can vary wildly based on the patient's age, geographical location, and local prevalence of certain factors such as CNS infections. In general, a patient with a new onset seizure should have basic lab evaluation, brain imaging, and EEG. Additional studies such as lumbar puncture can be considered based on the individual patient's presentation.
General Etiology of Adult-Onset Seizures
General Etiology of Adult-Onset Seizures
Most common causes (vary across studies):
Stroke: 23–44%
Idiopathic: 16–51%
CNS infections: 21–38%
Metabolic causes: 10–26%
Brain tumors: ~4–8%
Neurocysticercosis: Up to 50% in endemic areas (e.g., Mexico)
Variation in prevalence depends on:
Age distribution
Geographic location
Sample size
Endemicity of CNS infections
Etiology by Seizure Type
Etiology by Seizure Type
Generalized Seizures
Most common cause: Idiopathic (33.9%)
Other causes:
Metabolic (10.8–20.3%)
CNS infections (16.9–29.7%)
Stroke (10.2–29.7%)
Tumors (~2.7%)
Focal Seizures
Most common cause: Stroke (27.3–41.5%)
Other causes:
CNS infections (5.5–52.7%)
Brain tumors (5.4–22.2%)
Encephalomalacia with gliosis (up to 9.8%)
Idiopathic (4.9–33.3%)
MS, trauma (minor causes)
Status Epilepticus
Most common cause: Metabolic (35.3%)
Other causes: Stroke (17.5%), CNS infections (11.8%), brain tumors (11.8%)
Age-Wise Etiology
<20 years: Idiopathic most common (44.4%)
<40 years:
CNS infections most prevalent
All cases of cortical venous thrombosis occurred in this group
>40 years:
Stroke becomes the dominant cause (95.6% of stroke-related seizures occur in this group)
Brain tumors: Equally distributed across age groups
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