Climate-related exposures and seizures in children: A systematic review

Climate-related exposures, including air pollution, temperature extremes, humidity, and atmospheric conditions, are increasingly recognized as potential seizure triggers. As climate change intensifies, understanding the environmental contributors to pediatric seizure risk has important implications for anticipatory guidance and public health preparedness. Previous reviews have focused primarily on adults or basic science, with limited synthesis of pediatric evidence. Therefore, we conducted a systematic review to evaluate associations between climate-related exposures and seizures in children, including those with and without epilepsy.

Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we conducted a systematic review registered in PROSPERO (Prospective Register of Systematic Reviews; CRD420251133772). We searched PubMed, Embase, Web of Science Core Collection, PsycInfo, Global Health, and Environment Index from date of database inception to August 29, 2025 and performed backward and forward citation tracking on June 9, 2026. Eligible studies examined associations between climate-related exposures and seizure-related outcomes in children ≤18 years old. Two reviewers independently screened studies and extracted data. Findings were synthesized narratively, and risk of bias was assessed using ROBINS-I V2 (Risk of Bias in Non-Randomized Studies of Interventions, Version 2).

Thirty-three studies met inclusion criteria; 20 examined temperature, 16 air pollution, and 10 other exposures. Only one study was conducted in a lower-middle-income country, and no studies were conducted in low-income countries. Nitrogen dioxide (NO₂) showed the most consistent associations with seizures, particularly among children with established epilepsy, although effect sizes were generally modest. A representative study reported 2%-4% increases in hospitalizations per 10 μg/m³ increase in NO₂. Associations between ambient temperature and seizure were less consistent, although findings for febrile seizures were more consistent. Heterogeneity in findings likely reflected differences in exposure assessment, outcome definitions, and confounder adjustment.

Climate-related exposures, particularly NO₂ and temperature extremes, may increase seizure risk in children. These findings support consideration of environmental exposures in clinical counseling. The near absence of studies from low- and lower-middle-income countries limits generalizability and highlights an important priority for future research.