Epilepsy: Classification

1.1: Classification of epileptic seizures.

Previous classification

New classification

Localization-related (focal, partial) seizures

Single-focal(single-partial)
- Focal-motor
- Aura
- Automatisms
Complex-focal(complex-partial),psychomotor
Secondary-generalized

Focal seizuresDescriptive characteristics of focal seizures depending on impairment during the seizure:

Without impairment of consciousness or attention
- With observable motor or autonomic components
- With only subjective sensory/sensory or mental phenomena.
With limitation of consciousness or attention: dyscognitive.
With development to bilateral convulsive seizure (with tonic, clonic, or tonic-clonic elements.

Generalized seizures

Tonic-clonic (grand mal)
Absences
Myoclonic
Clonic
Tonic
Atonic (astatic)

Generalized seizures

Tonic-clonic (in any combination).
Absences
- Lid myoclonia with absence
- Typical
- Atypical
- With special characteristics
- Myoclonic absence
myoclonic
- Myoclonic
- Myoclonic-atonic
- Myoclonic-atonic
Clonic
Tonic
Atonic

Not classifiable

Unknown

Epileptic spasms

New classification of epileptic seizures.

Berg et al. 2010	Fisher et al. 2017
Generalized seizures Tonic-clonic (in any combination). Absences Typical Atypical With special characteristics: Myoclonic Absence Lid myoclonia with absence Myoclonic Myoclonic Myoclonic-atonic Myoclonic-atonic Clonic Tonic Atonic	Generalized seizures Motor Tonic-clonic Clonic Tonic Myoclonic Myoclonic-tonic-clonic Myoclonic-atonic Atonic Epileptic spasms Non-motor (absences) Typical Atypical Myoclonic Eyelid myoclonia
Focal seizures as a function of impairment during the seizure: Without impairment of consciousness or attention With observable motor or autonomic components With only subjective sensory/sensory or mental phenomena. With limitation of consciousness or attention (dyscognitive). With development to bilateral convulsive seizure (with tonic, clonic, or tonic-clonic components)	Focal seizures With preserved consciousness With limited consciousness Onset with motor symptoms. Automatisms Atonic Clonic Epileptic spasms Hyperkinetic Myoclonic Tonic Onset with non-motor symptoms Autonomic symspot Behavioral arrest Cognitive Emotional Sensory From focal to bilateral tonic-clonic.
	With unclear beginning Motor Tonic-clonic Epileptic spasms Non-motor Behavioral arrest
Unknown [ epileptic spasms [ other	Unclassifiable

1.2: Classification of epilepsies.

Previous classification	Berg et al.2010	ILAE 2017
Idiopathic	GeneticTo the best of current knowledge, the seizures are the direct result of one or more known or suspected genetic defects in which epileptic seizures are the leading syndrome of the disorder	Genetic
Symptomatic	Structural/metabolicThis is a completely different condition or disease that has been shown in adequate studies to be associated with a significantly increased risk of developing epilepsy	Structural
		InfectiousMetabolicImmunological
Cryptogenic	Unknown causeUnknown is meant as a neutral term for the fact that the nature of the underlying cause has not yet been elucidated	Unknown

The International League Against Epilepsy (ILAE) has updated the Classification of Epilepsies (2017] to reflect a new understanding of epilepsies and their underlying mechanisms following the major scientific advances that have occurred since the last ratified classification in 1989. This is a position paper (further editing to be awaited). Classification of epileptic seizures according to ILAE.

Focal onset	Generalized onset	Unknown onset
Preserved awareness/attention vs. restricted	Motor-tonic-clonic-nonmotor(absences)	Motor tonic-clonic-nonmotor(absences)
Onset motor versus nonmotor		Unclassified, i.e., either there is insufficient information or seizure type does not fit into either of the other two categories
Focal to bilateral tonic-clonic (formerly: secondary generalized seizure).