Felix Rosenow, Naoki Akamatsu, Thomas Bast, Sebastian Bauer, Christoph Baumgartner, Selim Benbadis, Adriana Bermeo-Ovalle, Stefan Beyenburg, Andrew Bleasel, Alireza Bozorgi, Milan Brázdil, Mar Carreño, Norman Delanty, Michael Devereaux, John Duncan, Guadalupe Fernandez-Baca Vaca, Stefano Francione, Naiara García Losarcos, Lauren Ghanma, Antonio Gil-Nagel, Hajo Hamer, Hans Holthausen, Shirin Jamal Omidi, Philippe Kahane, Giri Kalamangalam, Andrés Kanner, Susanne Knake, Stjepana Kovac, Karsten Krakow, Günter Krämer, Gerhard Kurlemann, Nuria Lacuey, Patrick Landazuri, Shi Hui Lim, Luisa V. Londoño, Giorgio LoRusso, Hans Luders, Jayanti Mani, Riki Matsumoto, Jonathan Miller, Soheyl Noachtar, Rebecca O’Dwyer, André Palmini, Jun Park, Philipp S. Reif, Jan Remi, Americo C. Sakamoto, Bettina Schmitz, Susanne Schubert-Bast, Stephan Schuele, Asim Shahid, Bernhard Steinhoff, Adam Strzelczyk, C. Akos Szabo, Nitin Tandon, Kiyohito Terada, Manuel Toledo, Walter van Emde Boas, Matthew Walker, Peter Widdess-Walsh
https://doi.org/10.1016/j.seizure.2020.02.018
Over the last few decades the ILAE classifications for seizures and epilepsies (ILAE-EC) have been updated repeatedly to reflect the substantial progress that has been made in diagnosis and understanding of the etiology of epilepsies and seizures and to correct some of the shortcomings of the terminology used by the original taxonomy from the 1980s. However, these proposals have not been universally accepted or used in routine clinical practice. During the same period, a separate classification known as the “Four-dimensional epilepsy classification” (4D-EC) was developed which includes a seizure classification based exclusively on ictal symptomatology, which has been tested and adapted over the years. The extensive arguments for and against these two classification systems made in the past have mainly focused on the shortcomings of each system, presuming that they are incompatible. As a further more detailed discussion of the differences seemed relatively unproductive, we here review and assess the concordance between these two approaches that has evolved over time, to consider whether a classification incorporating the best aspects of the two approaches is feasible. To facilitate further discussion in this direction we outline a concrete proposal showing how such a compromise could be accomplished, the “Integrated Epilepsy Classification”. This consists of five categories derived to different degrees from both of the classification systems: 1) a “Headline” summarizing localization and etiology for the less specialized users, 2) “Seizure type(s)”, 3) “Epilepsy type” (focal, generalized or unknown allowing to add the epilepsy syndrome if available), 4) “Etiology”, and 5) “Comorbidities & patient preferences”.
