What are “Provoked” seizures?

Can anyone have a seizure?

Every person’s brain is capable of having a seizure, if the provoking agent is severe enough.

Let’s take a hypothetical person: John. John has never had seizures.

John, hiking in the woods, gets an infection. Then he gets a seizure due to antibiotics.

John goes to the forest for a hike and unfortunately catches a life-threatening infection. He is given a powerful antibiotic (e.g. Imipenem). It is essential to give this antibiotic to John to save his life, but one of the side-effects of this medication is that it causes seizures. While taking the antibiotic, John has a seizure.

Lets say John gets a seizure while being given the antibiotic.

This seizure is a provoked seizure – John’s brain doesn’t seem to have an increased tendency to have seizures, yet the antibiotic caused him to have one.

Moral of the story: If the provoking agent is strong enough, anyone can have a seizure.

What other provoking agents can cause seizures?

By far, the most common reason for a provoked seizure is acute alcohol withdrawal. When alcohol is taken chronically, the alcoholic’s brain becomes used to the sedation it causes. If the alcoholic suddenly stops drinking, his/her brain becomes terribly hyperactive and sometimes can have a seizure. This usually happens between 1-3 days after the last drink.

People drinking excessive quantities of alcohol may have seizures when they stop suddenly. These are called “Withdrawal seizures”.

Abusing drugs, such as cocaine and amphetamines, may also cause seizures. Cocaine, in particular, is a dangerous drug of abuse – it can lead to bleeding inside the brain and heart attacks, amongst other things.

Cocaine can cause a seizure. Do not do drugs. Period.

Low blood sugar (e.g. due to excessive insulin use) and electrolyte problems (such as low sodium level due to excessive vomiting or diarrhoea) are common reasons for provoked seizures requiring hospitalization.

Low blood glucose can cause a seizure.

A comprehensive list of Provoking Insults that can precipitate seizures is as follows:

Provoking Insult


Alcohol intoxication & withdrawal1-3 days after the last drink
Other drug abuseParticularly Cocaine & Amphetamines (Speed)
PoisoningFor example, with pesticides
MedicationsMany medications. Characteristically, after Imipenem & antibiotics related to Levofloxacin
Low blood glucoseUsually seen in diabetics, due to excessive use of insulin
Electrolyte problems (for example low Sodium)Due to medications for blood pressure, dehydration, excessive vomiting or diarrhoea etc
Liver or kidney failure
Infections inside the head (meningitis)
High fever (Children)Some of these children may develop Epilepsy in the future. Click here: Febrile Seizures.
Lack of sleepOnly in people with Epilepsy. See below.
StressOnly in people with Epilepsy. See below.
MensesOnly in people with Epilepsy. See below.
Missing your Anti-Epileptic doseOnly in people with Epilepsy. See below.

Does a Provoked Seizure mean that I will have repeated seizures in the future?

The answer to this question depends on how severe the provoking insult was.

Let us discuss three people:

1) No increased risk of recurrence:

Luckily the antibiotic saves John’s life, but what does the incident tell us that he is at a higher risk of having more seizures in the future, as compared to the general population?

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John had a seizure, but he does not have Epilepsy.

The answer to this question is simple. No. Since it was clearly caused by an Antibiotic which John will avoid for the rest of his life, it is very unlikely he will have another seizure.

2) Increased risk of recurrence, even with a brain that does not have an increased tendency for having seizures:

Let’s consider Sachin. Sachin has diabetes; he takes insulin for his diabetes. He recently shifted to a new insulin pen and has difficulty understanding it. Every evening, he takes more insulin than required. At night, his blood sugar drops alarmingly, and he has been getting a seizure almost every night for the past few days.

Insulin pens can be confusing to use. Let’s say Sachin has a seizure because he injects too much insulin.

Does Sachin’s brain have an increased tendency for having seizures, more than any other person on the street? No.

But, even then, is Max more likely to have seizures in the future? Yes! Unless he collaborates with his doctor and finds out the exact reason (for example – by checking his blood sugar at frequent intervals for 24 hours), Max is at risk of having more seizures.

3) Increased risk of recurrence, possibly due to an increased tendency of the brain to have seizures:

Let’s talk about Anita. Anita sleeps only for 5 hours on 2 consecutive nights, trying to get some work done. On the 3rd night, she has a seizure.

Anita has a seizure after staying up late at night, working on her project.

Well… I know what you’re thinking: That’s not a very severe provoking insult at all! I wonder if there is something about Anita’s brain that makes him more likely to have a seizure.

When the provoking agent is very minor such as lack of sleep, or ingestion of only a small quantity of alcohol, or just some flashing lights – We need to make sure that the patient’s brain does not have an increased tendency to have seizures.

These insults are very unlikely to cause seizures unless the brain has an increased tendency to have seizures. Therefore, they are discussed in detail in another section labelled “Seizure precipitants in Epilepsy” instead [What triggers seizures in Epilepsy?].

We have reached a very important milestone.

We have come to a point where we can easily define Epilepsy:

Epilepsy is a tendency of the brain to have repeated, unprovoked or minimally provoked seizures.
A seizure is an EVENT. It is caused by an uncontrolled ELECTICAL storm inside the brain.

What can we say about John, Max and Sudhir?

Does John the Antibiotic guy have Epilepsy? No.

Does Max the diabetic have Epilepsy? No, but he can have more seizures unless he is careful.

Does Sudhir the workaholic have Epilepsy? Possibly. He will need additional testing such as an MRI and/or an EEG to find this out.

Epilepsy is the TENDENCY to have repeated, unprovoked seizures.


Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

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NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, Swami Vivekananda Road, LIC Colony, Vile Parle

4.6 87 reviews

  • Avatar Paras Prabhu ★★★★★ 6 months ago
    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
  • Avatar Dr Shobha Sankhe ★★★★★ a month ago
    Dr Kharkar is gem of a doctor with tremendous patience, empathy, genuine concern for his patients .He guides them very methodically & scientifically … More for their neurological ill healthOur epilepsy patient is extremely happy with his treatment , Patient feels better by just visiting him too!May his selfless service to humanity flourish to reach all the needy patients!!
  • Avatar shrruti khanna ★★★★★ a month ago
    I consulted Dr Sidharth for my sister who has become very hyper and aggressive and we could not understand the issue. Keeping in mind she is someone with … More special needs Dr Sidharth was extremely understanding of the situation and did not put her through unnecessary investigation and avoided a very long stay at the hospital. He was infact more keen on her returning home to her natural environment. We highly appreciate Dr Sidharth for his effort and for looking into the matter with utmost care. It was a very difficult decision for my family to get my sister admitted but we are glad we did it under his care.Thankyou Doc.
  • Avatar Prashant Purohit ★★★★★ a month ago
    my name is prashant purohit. I m become completely bed ridden from last 9 months and was unable to walk. I couldnt find out the cause even after visiting … More many doctors and many hospital in Ahmedabad nd jodhpur.started losing hope. A good friend of mine suggested to visit a neurologist. After searching a lot, I came to know about Dr. Siddharth Kharkar and took his appointment in Nanavati Hospital. He examined and said that he suffered from \u201cPKD(PAROXYSMAL KNESIGENIC DYSKNESIA\u201c. He assured us to reverse this in 5 days time. And indeed this happened. I started recovering miraculously. today I am fully well fit I m walking as normal . Many Many thanks to Dr. Siddharth Kharkhar sir for giving me a new life.
  • Avatar Sanjay Pradhan ★★★★★ 7 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
  • Avatar N N ★★★★★ a year ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
  • Avatar Manish Ranjan ★★★★★ a year ago
    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar Pinakin Shah ★★★★★ a year ago
    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Lawrence Castellino ★★★★★ a year ago
    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
  • Avatar Hemant Kansara ★★★★★ a year ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you

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Noted as one of the best Neurologists in Mumbai

India Today Magazine - 2020, 2021, 2022, 2023

Outlook India Magazine - 2021, 2023

Ex-Assistant Professor, University of Alabama, USA

Outlook India - Best neurologist in Mumbai