Risk Factors for Epilepsy

Epilepsy arises from diverse factors, including those which may be genetic, structural, infectious, metabolic or immune. Genetic causes range from common polygenic variants with small additive effects to rare monogenic conditions, such as developmental and epileptic encephalopathies, often caused by de novo variants. Structural abnormalities such as malformations of cortical development, brain tumours, and strokes are significant contributors, with clinical presentations influenced by specific lesion types and underlying pathophysiological mechanisms. Infectious causes include bacterial meningitis, encephalitis, neurocysticercosis and malaria, which particularly affect low- and middle-income countries. Immune-mediated epilepsy involves autoantibodies, with higher epilepsy risk for disorders in which the antigens are intracellular. Metabolic causes encompass a range of acquired and inborn errors, the recognition of which is critical, as many are treatable. Neurodegenerative disorders, including Alzheimer's and Down syndrome, also increase epilepsy risk, likely via genetic mechanisms. Despite advancements in diagnostics, the underlying causes remain unknown in many individuals, underscoring the importance of ongoing research to elucidate these causes and enhance treatment strategies.