Instruction manual for the ILAE 2017 operational classification of seizure types

Abstract

Summary This companion paper to the introduction of the International League Against Epilepsy (ILAE) 2017 classification of seizure types provides guidance on how to employ the classification. Illustration of the classification is enacted by tables, a glossary of relevant terms, mapping of old to new terms, suggested abbreviations, and examples. Basic and extended versions of the classification are available, depending on the desired degree of detail. Key signs and symptoms of seizures (semiology) are used as a basis for categories of seizures that are focal or generalized from onset or with unknown onset. Any focal seizure can further be optionally characterized by whether awareness is retained or impaired. Impaired awareness during any segment of the seizure renders it a focal impaired awareness seizure. Focal seizures are further optionally characterized by motor onset signs and symptoms: atonic, automatisms, clonic, epileptic spasms, or hyperkinetic, myoclonic, or tonic activity. Nonmotor‐onset seizures can manifest as autonomic, behavior arrest, cognitive, emotional, or sensory dysfunction. The earliest prominent manifestation defines the seizure type, which might then progress to other signs and symptoms. Focal seizures can become bilateral tonic–clonic. Generalized seizures engage bilateral networks from onset. Generalized motor seizure characteristics comprise atonic, clonic, epileptic spasms, myoclonic, myoclonic–atonic, myoclonic–tonic–clonic, tonic, or tonic–clonic. Nonmotor (absence) seizures are typical or atypical, or seizures that present prominent myoclonic activity or eyelid myoclonia. Seizures of unknown onset may have features that can still be classified as motor, nonmotor, tonic–clonic, epileptic spasms, or behavior arrest. This “users’ manual” for the ILAE 2017 seizure classification will assist the adoption of the new system.

Levetiracetam-Induced Psychosis in a Patient with Epilepsy

“…It is in the group of the second generation AED, approved by the FDA en 1999 for the treatment of focal seizures or focal to bilateral seizures [4][5][6][7][8][9] initially combined with other AED but nowadays is used in monotherapy. It is a (-)-(S)-α-metil-2-oxo-1-pyrrolidine acetamide [10].…”

“…It is a (-)-(S)-α-metil-2-oxo-1-pyrrolidine acetamide [10]. Its mechanism of action is not well known, but it is thought to act by binding to synaptic vesicle protein 2A (SV2A) modulating its actions affecting, finally, neural excitability [5][6][7][8][9][10][11].…”

Overexpression of Adenosine Kinase in Patients with Epilepsy Associated With Sturge-Weber Syndrome

“…The duration of video-EEG monitoring ranged from 1-3 days, and at least three habitual seizures were recorded. The main ictal manifestations were categorized according to the new semiological seizures classification [25,26].…”

The New Classification of Seizures: An Overview for the General Physician

“…7 Recognising a number of defi ciencies in this classifi cation, the ILAE released a new seizure classifi cation in 2017. 8,9 We outline the key points of the basic and expanded seizure classifi cations. We hope this review will encourage paediatricians and general physicians to adopt the new classifi cation scheme.…”