Classifying epilepsy pragmatically: Past, present, and future

The need for a pragmatic seizure classification in clinical trials

“…2 Additional factors are essential to consider. Epilepsy classification schema must be sufficiently flexible to allow clinically useful classification in a variety of social, political, economic, and cultural contexts in addition to the clinical trial settings proposed by Steriades et al 2,4 The classification must be helpful for a variety of stakeholders. 1 Incorporating the epilepsy classification into a comprehensive team-based approach to clinical trials with the input of clinical and nonclinical stakeholders may enhance the clinical relevance of the outcomes under study.…”

“…Previously, we have noted the limitations of existing seizure classifications based on semantics, syntax, and semiotics of seizures. 2 For example, "dialeptic seizures" are unnecessarily broad. Steriade et al recommended utilizing "focal aware with or without observable signs" instead of "focal aware with or without motor signs" and not distinguishing focal unaware with or without motor signs.…”

“…3 Incorporating factors such as comorbidities, the changing demographics of epilepsy, brain age, genetic etiologies, and environmental triggers will provide further granularity. 2,4 Additionally, existing and emerging technologies should be used to increase the granularity and utility of epilepsy classification. The first ILAE seizure classification was published in 1981 following the development of video electroencephalography (EEG).…”

“…Utilizing precise language when describing seizure types is essential for localizing and managing epilepsy medically or surgically and facilitating communication to specific groups. 2,3 Steriade et al 1 recommended avoiding the term "drop attacks," noting that multiple seizure types produce falls. In contrast, the term "tonicclonic" has a specific definition and does not refer to all seizures with motor activity.…”

“…Technologies likely to impact future classifications include 7-T magnetic resonance imaging, genome sequencing, and artificial intelligence. 2 Additional factors are essential to consider. Epilepsy classification schema must be sufficiently flexible to allow clinically useful classification in a variety of social, political, economic, and cultural contexts in addition to the clinical trial settings proposed by Steriades et al 2,4 The classification must be helpful for a variety of stakeholders.…”