ILAE Official Report: A practical clinical definition of epilepsy

Abstract

Summary Epilepsy was defined conceptually in 2005 as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. This definition is usually practically applied as having two unprovoked seizures >24 h apart. The International League Against Epilepsy (ILAE) accepted recommendations of a task force altering the practical definition for special circumstances that do not meet the two unprovoked seizures criteria. The task force proposed that epilepsy be considered to be a disease of the brain defined by any of the following conditions: (1) At least two unprovoked (or reflex) seizures occurring >24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years; (3) diagnosis of an epilepsy syndrome. Epilepsy is considered to be resolved for individuals who either had an age‐dependent epilepsy syndrome but are now past the applicable age or who have remained seizure‐free for the last 10 years and off antiseizure medicines for at least the last 5 years. “Resolved” is not necessarily identical to the conventional view of “remission or “cure.” Different practical definitions may be formed and used for various specific purposes. This revised definition of epilepsy brings the term in concordance with common use. A PowerPoint slide summarizing this article is available for download in the Supporting Information section http://onlinelibrary.wiley.com/doi/10.1111/epi.12550/suppinfo.

Altered physiological brain variation in drug‐resistant epilepsy

“…Epilepsies are a diverse group of brain diseases manifesting themselves as repetitive seizure activity (Fisher et al., 2014), with a life‐time prevalence of 7.6/1,000 persons (Fiest et al., 2017). Cohort studies have shown that 30%–40% of epilepsies are drug resistant (Brodie, Barry, Bamagous, Norrie, & Kwan, 2012; Elger & Schmidt, 2008; Laxer et al., 2014; Pitkänen et al., 2016).…”

A disease, disorder, illness or condition: How to label epilepsy?

“…If it ultimately does this, the change, however unpopular, would be justified. On the other hand, the ILAE themselves2 stated “A definition should conform to how clinicians and patients think…” (p.476). It appears the “disease” element of their revised definition does not align with what most patients or carers (and many clinicians) think.…”

“…Their recently published revised, operational definition of epilepsy 2 is therefore noteworthy. A key change is that epilepsy is no longer a “disorder,” rather it is now to be labelled a “disease.” This is intended to improve epilepsy's profile.…”

“…A key change is that epilepsy is no longer a “disorder,” rather it is now to be labelled a “disease.” This is intended to improve epilepsy's profile. “Disorder,” they said, was “poorly understood by the public and implied a functional, temporary disturbance and so minimised the seriousness of epilepsy” (p.476) 2. “Disease” was felt to hold more gravity and thus better communicate epilepsy's life implications 3…”

Critérios de decisão para a definição de exames médicos ocupacionais em atividades críticas: proposição de modelo e exemplos de aplicação no trabalho em altura

“…Foram selecionados 42 artigos sobre diabetes e utilizados sete na elaboração dessa parte do ensaio [19][20][21][22][23][24][25] . Para epilepsia, foram selecionados 35 artigos e utilizados onze [26][27][28][29][30][31][32][33][34][35][36] . Devido à limitação de tamanho permitido na publicação deste ensaio, foram utilizados os artigos mais recentes ou representativos de sociedades.…”