Could the 2017 ILAE and the four-dimensional epilepsy classifications be merged to a new “Integrated Epilepsy Classification”?
Felix Rosenow, Naoki Akamatsu, Thomas Bast, Sebastian Bauer, Christoph Baumgartner, Selim R. Benbadis, Adriana Bermeo‐Ovalle, Stefan Beyenburg, Andrew Bleasel, Alireza Bozorgi, Milan Brázdil, Mar Carreño, Norman Delanty, Michael W. Devereaux, John S. Duncan, Guadalupe Fernández‐Baca Vaca, Stefano Francione, Naiara García Losarcos, Lauren Ghanma, António Gil‐Nagel, Hajo M. Hamer, Hans Holthausen, Shirin Jamal Omidi, Philippe Kahane, Giridhar P. Kalamangalam, Andrés M. Kanner, Susanne Knake, Stjepana Kovac, Karsten Krakow, Günter Krämer, Gerhard Kurlemann, Nuria Lacuey, Patrick Landazuri, Shi Hui Lim, Luisa V. Londoño, Giorgio Lo Russo, Hans O. Lüders, Jayanti Mani, Riki Matsumoto, Jonathan Miller, Soheyl Noachtar, Rebecca O’Dwyer, André Palmini, Jun Park, Philipp S. Reif, Jan Rémi, Américo Ceiki Sakamoto, Bettina Schmitz, Susanne Schubert‐Bast, Stephan Schuele, Asim Shahid, Bernhard J. Steinhoff, Adam Strzelczyk, C. Ákos Szabó, Nitin Tandon, Kiyohito Terada, Manuel Toledo, W. van Emde Boas, Matthew C. Walker, Peter Widdess‐Walsh
Abstract
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".