Wednesday, May 24, 2017


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.