Editing Epilepsy (section)

=== Structural ===
Structural causes of epilepsy refer to abnormalities in the anatomy of the brain that increase the risk of seizures. These may be acquired — such as from a [[stroke]], [[traumatic brain injury]], [[brain tumor]], or [[central nervous system infection]] — or developmental and genetic in origin, as seen in conditions like [[focal cortical dysplasia]] or certain congenital brain malformations. A major example is mesial temporal sclerosis (MTS), a common cause of [[temporal lobe epilepsy]].<ref>{{Cite journal |last=Thom |first=Maria |date=2014 |title=Review: Hippocampal sclerosis in epilepsy: a neuropathology review |journal=Neuropathology and Applied Neurobiology |language=en |volume=40 |issue=5 |pages=520–543 |doi=10.1111/nan.12150 |issn=1365-2990 |pmc=4265206 |pmid=24762203}}</ref><ref name="Scheffer2017" />

Traumatic brain injury is estimated to cause between 6% and 20% of epilepsy cases, depending on severity, mechanism, and study population. Mild brain injury increases the risk about two-fold, while severe brain injury increases the risk seven-fold. In those who have experienced a high-powered gunshot wound to the head, the risk is about 50%.<ref name="Bh2011">{{cite journal |vauthors=Bhalla D, Godet B, Druet-Cabanac M, Preux PM |date=June 2011 |title=Etiologies of epilepsy: a comprehensive review |journal=Expert Review of Neurotherapeutics |volume=11 |issue=6 |pages=861–876 |doi=10.1586/ern.11.51 |pmid=21651333}}</ref> Stroke is a major cause of epilepsy, particularly in older adults.<ref>{{cite journal |vauthors=Zelano J, Holtkamp M, Agarwal N, Lattanzi S, Trinka E, Brigo F |date=June 2020 |title=How to diagnose and treat post-stroke seizures and epilepsy |journal=Epileptic Disorders |volume=22 |issue=3 |pages=252–263 |doi=10.1684/epd.2020.1159 |pmid=32597766 |doi-access=free}}</ref> Approximately 6% to 10% of individuals who experience a stroke develop epilepsy, most often within the first few years after the event. The risk is highest following severe strokes that involve cortical regions, especially in cases of intracerebral hemorrhage.<ref>{{cite journal |vauthors=Zöllner JP, Schmitt FC, Rosenow F, Kohlhase K, Seiler A, Strzelczyk A, Stefan H |date=December 2021 |title=Seizures and epilepsy in patients with ischaemic stroke |journal=Neurological Research and Practice |volume=3 |issue=1 |pages=63 |doi=10.1186/s42466-021-00161-w |pmc=8647498 |pmid=34865660 |doi-access=free}}</ref> Brain tumors are implicated in approximately 4% of epilepsy cases, with seizures occurring in nearly 30% of individuals with intracranial neoplasms.<ref name="Bh2011" /> 

In clinical practice, a structural cause is typically identified through [[neuroimaging]] (such as [[MRI]]), which reveals an abnormality that plausibly accounts for the individual's seizure semiology and [[Electroencephalography|EEG]] findings. The lesion must be epileptogenic, meaning that it is capable of generating seizures. Infections like [[encephalitis]] or [[brain abscess]] may lead to permanent structural damage, increasing the risk of epilepsy even after the infection resolves.<ref name="Scheffer2017" />

Structural damage can also result from perinatal brain injury, such as [[hypoxic-ischemic encephalopathy]], especially in low- and middle-income countries where access to prenatal and neonatal care may be limited. When seizures are linked to a clearly defined structural lesion, [[epilepsy surgery]] may be considered — particularly in individuals whose seizures do not respond to medication.<ref name="Scheffer2017" />