Seizure Updated ILAE Classification
Seizure Updated ILAE Classification
Seizure Updated ILAE Classification
The International League against Epilepsy (ILAE) Commission on Classification and Terminology, 20052009 has provided an updated approach to classification of seizures. Based on: clinical features of seizures associated electroencephalographic findings.
Focal seizures arise from a neuronal network either discretely localized within one cerebral hemisphere or more broadly distributed but still within the hemisphere. With the new classification system, the subcategories of "simple focal seizures" and "complex focal seizures" have been eliminated. Instead, depending on the presence of cognitive impairment, they can be described as focal seizures with or without dyscognitive features.
Focal seizures can also evolve into generalized seizures. In the past this was referred to as focal seizures with secondary generalization, but the new system relies on specific descriptions of the type of generalized seizures that evolve from the focal seizure. The routine interictal (i.e., between seizures) electroencephalogram (EEG) in patients with focal seizures is often normal or may show brief discharges termed epileptiform spikes, or sharp waves. Since focal seizures can arise from the medial temporal lobe or inferior frontal lobe (i.e., regions distant from the scalp), the EEG recorded during the seizure may be nonlocalizing.
Focal seizures may also manifest as changes in somatic sensation (e.g., paresthesias), vision (flashing lights or formed hallucinations), equilibrium (sensation of falling or vertigo), or autonomic function (flushing, sweating, piloerection). Focal seizures arising from the temporal or frontal cortex may also cause alterations in hearing, olfaction, or higher cortical function (psychic symptoms). sensation of unusual intense odors (e.g., burning rubber or kerosene) or sounds (crude or highly complex sounds) an epigastric sensation that rises from the stomach or chest to the head. Some patients describe odd, internal feelings such as fear, a sense of impending change, detachment, depersonalization, dj vu, or illusions that objects are growing smaller (micropsia) or larger (macropsia).
Automatisms--involuntary, automatic behaviors that have a wide range of manifestations. (chewing, lip smacking, swallowing, or "picking" movements of the hands, or more elaborate behaviors such as a display of emotion or running.) Confused following the seizure Transition to full recovery of consciousness may range from seconds up to an hour Anterograde amnesia or, in cases involving the dominant hemisphere, a postictalaphasia.
Generalized Seizures
Typical Absence Seizures (symmetric, 3-Hz spikeand-wave discharge) Atypical Absence Seizures (slow spike-and-wave pattern with a frequency of 2.5/s) Generalized, Tonic-Clonic Seizures Atonic Seizures Myoclonic Seizures