article · Epilepsia
The International League Against Epilepsy (ILAE) has revised its operational classification of epileptic seizures, building on the 2017 framework. This update involved a working group of 37 members from all ILAE regions, using a modified Delphi process to achieve consensus. The classification retains four main seizure classes: Focal, Generalized, Unknown (whether focal or generalized), and Unclassified. It differentiates between classifiers, which reflect biological classes and influence clinical management, and descriptors, which indicate other seizure characteristics. Focal seizures and those of unknown origin are further categorised by the patient's state of consciousness. Generalized seizures now include negative myoclonus. The updated classification, comprising four main classes and 21 seizure types, aims to establish a common language for healthcare professionals, patients, and caregivers globally, including in resource-limited areas.
An updated and globally consistent classification of epileptic seizures is crucial for accurate diagnosis, effective treatment, and clear communication among healthcare professionals. It also helps patients and caregivers better understand and manage epilepsy, ensuring consistent care standards across diverse settings, from specialised centres to resource-limited areas.
This updated classification is a clinical tool designed to standardise communication and understanding of epileptic seizures among healthcare professionals, patients, and caregivers globally. It is an applied framework for clinical practice, aiming to improve diagnostic accuracy and treatment consistency. It is not a commercial product but a foundational guideline for medical practice, with direct implications for training and clinical decision-making.
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The International League Against Epilepsy (ILAE) has updated the operational classification of epileptic seizures, building upon the framework established in 2017. This revision, informed by the implementation experience, involved a working group appointed by the ILAE Executive Committee. Comprising 37 members from all ILAE regions, the group utilized a modified Delphi process, requiring a consensus threshold of more than two thirds for any proposal. Following public comments, the Executive Committee appointed seven additional experts to the revision task force to address and incorporate the issues raised, as appropriate. The updated classification maintains four main seizure classes: Focal, Generalized, Unknown (whether focal or generalized), and Unclassified. Taxonomic rules distinguish classifiers, which are considered to reflect biological classes and directly impact clinical management, from descriptors, which indicate other important seizure characteristics. Focal seizures and those of unknown origin are further classified by the patient's state of consciousness (impaired or preserved) during the seizure, defined operationally through clinical assessment of awareness and responsiveness. If the state of consciousness is undetermined, the seizure is classified under the parent term, that is, the main seizure class (focal seizure or seizure of unknown origin). Generalized seizures are grouped into absence seizures, generalized tonic-clonic seizures, and other generalized seizures, now including recognition of negative myoclonus as a seizure type. Seizures are described in the basic version as with or without observable manifestations, whereas an expanded version utilizes the chronological sequence of seizure semiology. This updated classification comprises four main classes and 21 seizure types. Special emphasis was placed on ensuring translatability into languages beyond English. Its aim is to establish a common language for all health care professionals involved in epilepsy care, from resource-limited areas to highly specialized centers, and to provide accessible terms for patients and caregivers.
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DOI: 10.1111/epi.18338
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