[LS5-2A-2] The new Classification of the Epilepsies
The first major overhaul of the Classification of the Epilepsies in 28 years was delineated in March 2017 by the International League Against Epilepsy, and is akin to the DSM-5 for psychiatric diseases as the major tool for clinical use in the epilepsies. The new classification builds on the recent re-definition of epilepsy. Two key documents are presented: a new classification of seizure types and a new framework for the diagnosis of epilepsy. New terminology has also been introduced with the fundamental principle being the use of more transparent language, employing words that mean what they say. This will assist patients, families and clinicians in understanding an epilepsy diagnosis.
The overarching framework integrates the diagnosis of seizure types, epilepsy types and epilepsy syndromes with consideration of aetiology and comorbidities. From the patient’s first presentation, it highlights that clinicians need to consider the aetiology, and recognizes an increasingly broad range of aetiologies with therapeutic consequences. These range from structural abnormalities, to genetic, immune, infectious and metabolic causes, and emphasizes that there remains an unknown group, for future research focus. The framework begins with seizure types and then allows the clinician to move to the epilepsy type diagnosis, including a new group of ‘generalized and focal epilepsy’ as well as generalized, focal and unknown. An epilepsy type is not the same as an epilepsy syndrome, with these two groupings providing complementary information. The new seizure type classification has a brief and an expanded version, allowing more complete description of the individual’s attacks.
The overarching framework integrates the diagnosis of seizure types, epilepsy types and epilepsy syndromes with consideration of aetiology and comorbidities. From the patient’s first presentation, it highlights that clinicians need to consider the aetiology, and recognizes an increasingly broad range of aetiologies with therapeutic consequences. These range from structural abnormalities, to genetic, immune, infectious and metabolic causes, and emphasizes that there remains an unknown group, for future research focus. The framework begins with seizure types and then allows the clinician to move to the epilepsy type diagnosis, including a new group of ‘generalized and focal epilepsy’ as well as generalized, focal and unknown. An epilepsy type is not the same as an epilepsy syndrome, with these two groupings providing complementary information. The new seizure type classification has a brief and an expanded version, allowing more complete description of the individual’s attacks.