A new
and revised classification of seizures and epilepsies was released in March,
2017 by the International League against Epilepsy (ILAE). It offers clearer terms so
that patients can communicate better with their physicians and so that doctors
can better communicate with each other.
The
guidelines incorporate opinions from experts and the public and received final
approval by the ILAE executive committee before being submitting to the
peer-reviewed journal, Epilepsia
1. Complex partial seizures, grand mal and petit mal are some
of the seizure types with new updated names. Can you find your type of
seizure with its new, revised name in the updated classification below?
*
Seizures are separated based on where they begin in the brain. Focal seizures have onset in one
hemisphere of the brain, while generalized seizures engage both hemispheres at
onset.
* For
focal seizures, the next classifier
is level of awareness.
*
“Focal aware” replaces the term “simple
partial.” A seizure is “focal aware” if the person's awareness is intact,
even if they are unable to talk or respond during the seizure.
*
“Focal impaired awareness” replaces the term “complex partial.” A seizure is “focal impaired awareness” if the
person's awareness is impaired at any time.
*
Next, focal seizures are described in terms of motor symptoms.
* In
a “focal motor onset seizure,” some type of movement – whether twitching,
jerking, or stiffening – occurs during the seizure. Focal motor onset seizures
include automatisms, atonic, clonic,
epileptic spasm, hyperkinetic, myoclonic, and tonic seizures.
* In a
“focal non-motor onset seizure,” only non-motor symptoms – including changes in
emotions, sensations, or thinking – occur. Focal non-motor onset seizures
include autonomic, behavior arrest,
cognitive, emotional, and sensory seizures.
*
“Generalized tonic-clonic seizure” is still used to describe seizures with
stiffening (tonic) and jerking (clonic), replacing the old term “grand mal.”
*
“Generalized absence seizure” involves brief changes in awareness and may
involve repeated or automatic movements, such as lip smacking. This term
replaces the old term “petit mal.”
* New
seizure types, such as myoclonic-tonic-clonic
or myoclonic-atonic, are included.
*
Unknown seizures are those that physicians cannot designate as having focal or
generalized onset with about 80 percent certainty. Physicians can now describe
a seizure with an unknown onset as tonic-clonic, behavior arrest or epileptic
spasms.
1) Fisher RS, Cross JH, French JA, et al. Operational
classification of seizure types by the International League Against Epilepsy:
Position Paper. Epilepsia 2017 Epub
2017 Mar 8.
Lance
Fogan, M.D. is Clinical Professor of Neurology at
the David Geffen School of Medicine at UCLA.
“DINGS” is his first novel. It is a
mother’s dramatic story that teaches
epilepsy, now available in eBook, audiobook and soft cover editions.