Epilepsy And Its Classfication
1st Year MBBS, Islamabad Medical and Dental College
Seizures and epilepsy classiﬁcations were previously developed in 1981 (ILAE, 1981), 1985 (ILAE, 1985), and 1989 (ILAE, 1989).1Seizure and epilepsy classiﬁcations are crucial for clinicians and care teams, patients and families, and researchers.2From the perspective of the patient, it provides a recognizable diagnosis/etiology and improves comprehension. For clinicians and the patient's care team, these classiﬁcations enhance communication and discussion. These classiﬁcations allow researchers to investigate drugs or surgical treatments, responses, and typical clinical courses for various types of seizures and epilepsy.
Epilepsy is a neurological disorder characterized by unprovoked, recurrent seizures.3 Aseizure is an abnormal surge of electrical activity in your brain. Epilepsy is diagnosed when you have two or more seizures with no other identiﬁable cause, According to the World Health Organization (WHO), epilepsy affects 50 million people worldwide and nearly 3.5 million people in the United States, according to the Centers for Disease Control and Prevention (CDC).Epilepsy can affect anyone, but it most commonly occurs in young children and older adults. According to research published in 2021, men are more likely than women to develop epilepsy, possibly due to greater exposure to risk factors such as alcohol use and head trauma.Source:https://myacare.com/blog/pediatric-epilepsy -how-is-epilepsy-different-in-children
There is an old terminology for the classiﬁcation of epilepsy and a modern terminology by ILAE for Epilepsy. In 2017 the International League against Epilepsy revised the classiﬁcation of seizure types as well as epilepsy types which allows us to use a common language to discuss and research epilepsy.4It also allows us to provide information to patients about the trajectory of their disease, prognosis, and possible comorbidities. It is important to note this classiﬁcation system is to be used when diagnosis of epilepsy has already been made. There are 3 main types based on seizure onset: Focal Onset, Generalized Onset, and Unknown Onset.
Aseizure is considered focal when it begins in cortical area or hemisphere. A seizure is generalized when both hemispheres are rapidly involved at the onset. A third category of unknown set is used when the onset is absent or unclear, but the seizure must be described using all known features. Onset is perhaps the most important characteristic to correctly identify, as it affects treatment with antiepileptic drugs and for early identiﬁcation of potential candidates for epilepsy surgery.5
Generalized convulsions are associated with disturbances of consciousness due to damage to both hemispheres, so it is not necessary to indicate this in the classiﬁcation. As with focal seizures, there may be motor or non-motor seizures. It is important to remember that a generalized seizure does not necessarily mean that the manifestations are symmetrical or that all parts of the brain are equally involved.6
Unknown indicates that the cause of epilepsy has not yet been identiﬁed. This may be because processing has not been completed or processing has not been disclosed. Also, depending on the source, a comprehensive study may not be possible.7
- Varnado S, Price D. Basics of modern epilepsy classiﬁcation and terminology, Current Problems in Pediatric and Adolescent Health Care, Volume 50, I s s u e , 11 , 2 0 2 0 , 1 0 0 8 9 1 , I S S N 1 5 3 8 -5442,https://doi.org/10.1016/j.cppeds.2020.100891
- Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, Lagae L, Moshé SL, Peltola J, Roulet Perez E, Scheffer IE. Operational classiﬁcation of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classiﬁcation and Terminology. Epilepsia. 2017 Apr; 58(4):522-30.
- World Health Organization, Global Campaign against Epilepsy, Programme for Neurological Diseases, Neuroscience (World Health Organization), International Bureau for Epilepsy, World Health Organization. Department of Mental Health, Substance Abuse, International Bureau of Epilepsy, International League against Epilepsy. Atlas: epilepsy care in the world. World Health Organization; 2005.
- Shelley Varnado, Dana Price,Basics of modern epilepsy classiﬁcation and terminology,Current Problems in Pediatric and Adolescent Health Care, Volume 50, Issue,11,2020,100891,ISSN 1538 5442,https://doi.org/10.1016/j.cppeds.2020.100891.
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