Fisher RS, Cross JH, D'Souza C, French JA, Haut SR,
Higurashi N, Hirsch E, Jansen FE, Lagae L, Moshé SL, Peltola J, Roulet Perez E,
Scheffer IE, Schulze-Bonhage A, Somerville E, Sperling M, Yacubian EM,
Zuberi SM. Instruction manual for the ILAE 2017 operational classification of
seizure types. Epilepsia. 2017 Mar 8. doi: 10.1111/epi.13671. [Epub ahead of print]
Abstract
This companion paper to the introduction of the
International League Against Epilepsy (ILAE) 2017 classification of seizure
types provides guidance on how to employ the classification. Illustration of
the classification is enacted by tables, a glossary of relevant terms, mapping
of old to new terms, suggested abbreviations, and examples. Basic and extended
versions of the classification are available, depending on the desired degree
of detail. Key signs and symptoms of seizures (semiology) are used as a basis
for categories of seizures that are focal or generalized from onset or with
unknown onset. Any focal seizure can further be optionally characterized by
whether awareness is retained or impaired. Impaired awareness during any
segment of the seizure renders it a focal impaired awareness seizure. Focal
seizures are further optionally characterized by motor onset signs and
symptoms: atonic, automatisms, clonic, epileptic spasms, or hyperkinetic,
myoclonic, or tonic activity. Nonmotor-onset seizures can manifest as
autonomic, behavior arrest, cognitive, emotional, or sensory dysfunction. The
earliest prominent manifestation defines the seizure type, which might then
progress to other signs and symptoms. Focal seizures can become bilateral
tonic-clonic. Generalized seizures engage bilateral networks from onset.
Generalized motor seizure characteristics comprise atonic, clonic, epileptic
spasms, myoclonic, myoclonic-atonic, myoclonic-tonic-clonic, tonic, or
tonic-clonic. Nonmotor (absence) seizures are typical or atypical, or seizures
that present prominent myoclonic activity or eyelid myoclonia. Seizures of
unknown onset may have features that can still be classified as motor,
nonmotor, tonic-clonic, epileptic spasms, or behavior arrest. This "users'
manual" for the ILAE 2017 seizure classification will assist the adoption
of the new system.
Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E,
Jansen FE, Lagae L, Moshé SL, Peltola J, Roulet Perez E, Scheffer IE, Zuberi SM.
Operational classification of seizure types by the International League
Against Epilepsy:Position Paper of the ILAE Commission for Classification and
Terminology. Epilepsia. 2017 Mar 8. doi: 10.1111/epi.13670. [Epub ahead
of print]
Abstract
The International League Against Epilepsy (ILAE) presents a
revised operational classification of seizure types. The purpose of such a
revision is to recognize that some seizure types can have either a focal or
generalized onset, to allow classification when the onset is unobserved, to
include some missing seizure types, and to adopt more transparent names.
Because current knowledge is insufficient to form a scientifically based classification,
the 2017 Classification is operational (practical) and based on the 1981
Classification, extended in 2010. Changes include the following: (1)
"partial" becomes "focal"; (2) awareness is used as a
classifier of focal seizures; (3) the terms dyscognitive, simple partial,
complex partial, psychic, and secondarily generalized are eliminated; (4) new
focal seizure types include automatisms, behavior arrest, hyperkinetic,
autonomic, cognitive, and emotional; (5) atonic, clonic, epileptic spasms,
myoclonic, and tonic seizures can be of either focal or generalized onset; (6)
focal to bilateral tonic-clonic seizure replaces secondarily generalized
seizure; (7) new generalized seizure types are absence with eyelid myoclonia,
myoclonic absence, myoclonic-atonic, myoclonic-tonic-clonic; and (8) seizures
of unknown onset may have features that can still be classified. The new
classification does not represent a fundamental change, but allows greater
flexibility and transparency in naming seizure types.
Courtesy of Doximity
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