What Causes Epilepsy?

Epilepsy is a neurological disorder that develops as a result of sudden and uncontrolled fluctuations in the brain’s electrical activity. These electrical irregularities may occur in different parts of the brain and typically manifest as recurrent seizures. Epilepsy affects millions of people worldwide and can occur in individuals of all ages, from children to adults and the elderly. The origin of the disease is quite complex and may not be linked to a single cause. In some patients, no direct cause can be identified, while in others structural brain abnormalities, trauma, genetic predisposition, or infections may play a determining role. Understanding why epilepsy develops is extremely important for planning the correct treatment and predicting the future course of the disease.

One of the leading specialists in this field, Prof. Dr. Ömür Günaldı, highlights that identifying the underlying cause of epilepsy is the most critical step in the treatment process. He also emphasizes that determining the cause is especially important in drug-resistant epilepsy cases, as it directly influences surgical planning.

Mechanism of Epilepsy

The basic mechanism of epilepsy involves abnormal communication between brain cells. Nerve cells in the brain communicate with each other through electrical signals. When disruptions occur in these signals, uncontrolled electrical currents may develop, leading to sudden brain activity known as seizures. This activity may remain confined to a small area of the brain or spread throughout the entire brain. Depending on which region of the brain is affected, the severity, duration, and symptoms of seizures may vary.

In some individuals, the source of seizures originates from a specific region of the brain, while in other patients the cause cannot be identified through imaging or diagnostic methods. In such cases, the condition is referred to as idiopathic epilepsy, meaning epilepsy with an unknown cause. However, with the advancement of modern imaging techniques, many causes that previously could not be detected can now be identified more clearly.

Causes of Epilepsy

The causes of epilepsy cannot be categorized under a single heading. Many different conditions and risk factors may contribute to the development of the disease. Below are the most common causes of epilepsy explained in detail.

Genetic Predisposition

Genetic factors are among the important causes of epilepsy. Individuals with a family history of epilepsy have a higher risk of developing the disease. Some types of epilepsy are known to be hereditary and may be passed down through generations within families. Genetic predisposition is often associated with abnormalities in ion channels responsible for transmitting chemical signals in the brain. Therefore, genetic factors play a significant role in some cases of epilepsy that begin during childhood.

Brain Development Disorders

Abnormalities in brain development during pregnancy may predispose individuals to epilepsy. Infections during pregnancy, alcohol or harmful substance use by the mother, genetic mutations, or structural brain anomalies are among the main causes. These structural abnormalities in the brain may lead to epilepsy beginning in childhood or early adulthood.

Complications During Birth

Oxygen deprivation during birth, trauma, intracranial bleeding, or complicated delivery processes may cause damage to brain tissue. This damage can lead to epilepsy later in life. When oxygen deficiency affects sensitive regions of the brain, communication between nerve cells may be disrupted, resulting in epileptic activity.

Brain Injuries

Brain injuries caused by accidents, falls, impacts, or vehicle collisions are among the most common causes of epilepsy. After trauma, brain tissue may develop bruising, swelling, or scar tissue. These structural changes can disrupt the brain’s normal electrical activity and trigger seizures. Post-traumatic epilepsy may not appear immediately and can develop months or even years after the injury.

Brain Tumors

Brain tumors are among the most serious causes of epilepsy. Tumors may create pressure on brain tissue, disrupt the functioning of surrounding nerve cells, and lead to irregular electrical activity. Epilepsy is particularly common in tumors located in the frontal and temporal lobes. Prof. Dr. Ömür Günaldı states that surgical intervention is the most effective treatment option for controlling seizures caused by tumors and that seizures decrease significantly in many patients after surgery.

Stroke and Vascular Diseases

Stroke occurs when blood flow to the brain is interrupted or when blood vessels become blocked. Brain damage caused by stroke may lead to epilepsy. A significant proportion of epilepsy cases in older adults develop after a stroke. Areas of dead tissue or bleeding in the brain can trigger seizure activity.

Brain Infections

Brain infections such as meningitis and encephalitis are also important causes of epilepsy. These infections may cause inflammation, swelling, and permanent damage in brain tissue, disrupting the function of nerve cells. Epilepsy related to infections may sometimes develop years after the infection has resolved.

Metabolic and Systemic Diseases

Metabolic disorders such as diabetes, liver failure, electrolyte imbalances, and high fever may contribute to the development of epilepsy. In children, high fever may cause febrile seizures, which in some cases may increase the risk of epilepsy later in life.

Drug and Substance Use

Certain medications, alcohol, or addictive substances can disrupt the chemical balance of the brain and trigger epilepsy. In individuals who consume alcohol heavily, seizures may occur especially when alcohol is suddenly withdrawn. Stimulant substances may overstimulate brain cells and trigger epileptic activity.

Risk Factors

Epilepsy may occur more frequently in individuals with certain risk factors. These include:

Family history of epilepsy
Difficult or traumatic birth
Premature birth or low birth weight
Febrile seizures during childhood
Previous brain hemorrhage or brain surgery
Alcohol or substance dependence
Advanced age and history of stroke

Having one or more of these risk factors may increase the likelihood of developing epilepsy, but it does not necessarily mean that the disease will occur.

Why Is Identifying the Cause of Epilepsy Important?

Determining the cause of epilepsy is extremely important for planning the correct treatment strategy. Treatment success rates are higher in epilepsy cases where the cause is known. For example, in epilepsy caused by brain tumors, surgical intervention may completely eliminate seizures, while epilepsy related to metabolic disorders can often be controlled with appropriate treatment.

In particular, identifying the cause in drug-resistant epilepsy cases plays a crucial role in determining whether a patient is a candidate for surgery. During this process, advanced imaging methods, video EEG monitoring, and neuropsychological evaluations are performed. Prof. Dr. Ömür Günaldı emphasizes that surgical treatment can offer highly successful results when the right patients are selected and that accurately identifying the cause directly influences treatment outcomes.