Applicability of the new ILAE classification for epilepsies (2010) in persons with epilepsy at a tertiary care center in India

Abstract

Summary Purpose To test the applicability of the new International League Against Epilepsy (ILAE) 2010 classification for epilepsies and to compare it with the ILAE 1989 classification and the ILAE 2001 diagnostic scheme in developing countries with limited resources such as India. Methods Prospective data of 500 consecutive patients with epilepsy, presenting in neurology department of All India Institute of Medical Sciences, was collected from January 2011 to June 2012 and analyzed according to the three systems proposed by ILAE in 1989, 2001, and 2010. Key Findings All 500 patients could be classified in the ILAE 1989 classification system, but only 413 in the ILAE 2001 diagnostic scheme (in axes 3 and 4) and 420 in the ILAE 2010 classification system. Leading categories were localization‐related epilepsies, symptomatic focal epilepsies, perinatal insult, and epilepsies attributed to structural and metabolic cause in ILAE 1989, 2001 axis 3, 2001 axis 4, and 2010 systems, respectively. The ILAE 1989 classification system could categorize significantly greater numbers of patients compared to the 2001 and 2010 systems, whereas the latter two remained similar. Significance A large group of patients remained unclassified in the new classification system despite our tremendous gain in knowledge through improved imaging, genomics, and molecular biology, and so on, which could be attributed to lack of availability of facilities in developing countries. Dichotomy of localization‐related and generalized epilepsy still makes for a fundamental and pragmatic working diagnosis and guides the physician about the extent of investigations and treatment especially in “epilepsies of unknown cause.”

Use of the International League Against Epilepsy (ILAE) 1989, 2010, and 2017 Classification of Epilepsy in children in a low‐resource setting: A hospital‐based cross‐sectional study

“…In a previous study conducted in India, 84% of adult patients with epilepsy could be classified using this scheme. 15 This could be because the 2010 scheme was envisaged to incorporate advances in genetic and molecular diagnosis as well as progress in neuroimaging. However, in a resource-limited setting like ours, advanced genetic testing and neuroimaging are often determined by financial constraints.…”

“…These predominantly included epilepsy syndromes with a presumed genetic basis (105 children, 14.4%); such as benign childhood epilepsy with centrotemporal spikes, childhood absence epilepsy, juvenile myoclonic epilepsy, juvenile absence epilepsy, epilepsy with febrile seizure plus, epilepsy with myoclonic atonic seizures, and autosomal dominant frontal lobe epilepsy. Other genetic causes included diagnosed single gene disorders caused by epilepsy associated genes (11), inborn errors of metabolism (7), genetic malformations of cortical development (11), and neurocutaneous disorders (15).…”

Type and etiology of pediatric epilepsy in Jordan

“…Obviously, in resource–limited countries like Jordan, some modification in classification of ILAE 2010 report is required due to limitation in availability of advanced genetic investigations. 10 - 11 …”

Comparing two classification schemes for seizures and epilepsy in rural China

“…Whilst the new scheme is generally welcomed it is important to evaluate its applicability in different clinical settings. Previous schemes have been evaluated mainly in specialized healthcare settings . The great majority of people with epilepsy, however, live in rural areas or in resource‐poor settings .…”