A new epileptic seizure classification based exclusively on ictal semiology

• Published in: Acta neurologica Scandinavica Vol. 99; no. 3; pp. 137 - 141
• Main Authors: Lüders, H., Acharya, J., Baumgartner, C., Benbadis, S., Bleasel, A., Burgess, R., Dinner, D. S., Ebner, A., Foldvary, N., Geller, E., Hamer, H., Holthausen, H., Kotagal, P., Morris, H., Meencke, H. J., Noachtar, S., Rosenow, F., Sakamoto, A., Steinhoff, B. J., Tuxhorn, I., Wyllie, E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.1999; Blackwell
• Subjects: Biological and medical sciences; electroclinical complex; Electroencephalography - history; Epilepsy - classification; Epilepsy - history; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; History of medicine; History, 18th Century; History, 20th Century; Humans; ictal semiology; International Cooperation; Medical sciences; Nervous system (semeiology, syndromes); neuroimaging; Neurology; Neurology - history; Neurology - standards; Neurology - trends; seizure classification; Seizures - classification; Seizures - history; Syndrome; Terminology as Topic; Human; Nervous system diseases; Epilepsy; Electroencephalography; Syndrome; Cerebral disorder; Crisis; Electrodiagnosis; Symptomatology; Central nervous system disease; Classification; Diagnosis; Semiology
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/j.1600-0404.1999.tb07334.x

Historically, seizure semiology was the main feature in the differential diagnosis of epileptic syndromes. With the development of clinical EEG, the definition of electroclinical complexes became an essential tool to define epileptic syndromes, particularly focal epileptic syndromes. Modern advances in diagnostic technology, particularly in neuroimaging and molecular biology, now permit better definitions of epileptic syndromes. At the same time detailed studies showed that there does not necessarily exist a one‐to‐one relationship between epileptic seizures or electroclinical complexes and epileptic syndromes. These developments call for the reintroduction of an epileptic seizure classification based exclusively on clinical semiology, similar to the seizure classifications which were used by neurologists before the introduction of the modem diagnostic methods. This classification of epileptic seizures should always be complemented by an epileptic syndrome classification based on all the available clinical information (clinical history, neurological exam, ictal semiology, EEG, anatomical and functional neuroimaging, etc.). Such an approach is more consistent with mainstream clinical neurology and would avoid the current confusion between the classification of epileptic seizures (which in the International Seizure Classification is actually a classification of electroclinical complexes) and the classification of epileptic syndromes.