Table 1

List of causes of an afebrile seizure in a child presenting to the accident and emergency department

Type of seizure (% of non- febrile seizures)Cause
Isolated seizure (25%)No cause found
Epilepsy (30%)Idiopathic, complex partial, Rolandic, etc.
Symptomatic seizure (30%)CNS structural abnormalities (congenital, prenatal or perinatal, shunt obstruction)
Intracranial infection (bacterial/viral, diffuse/localised)
Ingestion (deliberate, accidental)
Trauma (head injury, non accidental injury)
Intracranial haemorrhage
Metabolic (low glucose, calcium, magnesium, high and low sodium, amino and organic acidurias, etc)
Anoxic (breath holding attacks, respiratory pathology)
Neurocutaneous syndromes
CNS degenerative diseases
Neonatal/early infant seizure (<3 months) (15%)In addition to the above causes:
    Hypoxic ischaemic encephalopathy (from birth)
    CNS infections (acute and congenital)
    Fifth day fits
    Drug withdrawal
    Pyridoxine dependency
Other diagnoses (not true seizures)Reflex anoxic “seizures” syncope, arrhythmias, seudoseizures