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Epilepsia,
22489-501,
1981.
Raven
Press,
New
York
Proposal for Revised Clinical andElectroencephalographic Classification ofEpileptic Seizures
From
the
Commission
on
Classification
and
Terminology
of
theInternational League Against Epilepsy"In
1969,
the International League AgainstEpilepsy published
a
scheme for classifica-tion of epileptic seizures. Professor
H.
Gastaut, then Secretary-General of ILAEand
a
member of the Commission an Clas-sification, related the history of the workwhich represents a milestone in efforts atclassifying epileptic seizures and has led toworld-wide adoption (Gastaut,
1970).
Since the publication of the
1969
classifi-cation, objective and sophisticated methodsfor studying epileptic seizures have becamecommonplace. These methods include
video
display
of
epileptic seizures on mag-netic tape, the simultaneous recording
of
the electroencephalogram using hard-wiredrecording techniques and radiotelemetrywith split screen display and instant replaycapability.Since
1975,
two- further Commissions
on
Classification and TerminoIogy of the In-ternational League Against Epilepsy haveconvened in order
to
continue to update,amend, and improve the dassification inthe light
of
the cap y afforded by thenewer techniques to study seizures. Severalworkshops were convened. In December
1975
a
workshop
on
complex partia1 sei-zures took place at Bethesda, Maryland,under
a
Commission chaired by Jerome
K.
MerIis of Baltimore and comprising Dr.Merlis, Dr. D. David Daly of Dallas, Dr.Dieter Janz
of
Berlin, Dr. J. Kiffin Penry
of
Bethesda, Dr. Carlo Albert0 Tassinari ofMarseille. In addition, Dr. Rudolph Dreyer
of
Bethel, Dr. Antonio
V.
Escueta
of
Los
Angeles, Dr.
K.
F.
Masuhr of Berlin, Dr.Richard
H.
Mattson of New Haven, Dr.Roger
J.
Porter of Bethesda, Dr. DieterSchmidt of Berlin, and Dr. Gregory
0.
Walsh
of
Los
Angeles attended as partici-pants and discussants in this workshop.In
1977,
a
workshop
on
generalized sei-zures was held in Berlin. The above Com-mission members were present with the ad-dition
of
Dr. Toyoji Wada
of
Shizuoka andinvited participants who presented vid-eotape data, including Dr. A. Cirignotta ofBologna, Dr. Peter Kellaway
of
Houston,Dr. Cesare Lombroso of Boston, Dr.
K.
.
Masuhr
of
Berlin, and Dr. D. Stefan
of
Bonn. The results of these workshops com-prise the majar portions
of
the version
of
the International Classification of EpilepticSeizures herewith proposed.In
1979,
the present Commission wasconstituted, consisting
of
Dr. Jean Bancaud
of
Paris, Dr. Olaf Henriksen of Oslo, Dr.Francisco Rubio-Donnadieu of MexicoCity, Dr. Masakatsu Seino
of
Sbizuoka, Dr.Fritz
E.
Dreifuss
of
CharlottesvilIe (Chair-man), and Dr.
J.
Kiffin Penry, President of
~ ~~ ~~ ~~ ~~ ~
*
Jean Bancaud (Paris),
Olaf
Henriksen
(Oslo),
Francisco Rubio-Donnadieu (Mexico City), Masakatsu SeinoAddress correspondence and reprint requests
ta
Dr. Dreifuss at Department
of
Neurolagy, University
of
(Shizuoka), Fritz
E.
Dreifuss, Chairman (Charlottesville),
J.
Kiffin Penry, ex-officio (Winston-Salem).Virginia Medical Center, Charlottesville. Virginia
22908.
489
 
490
COMMISSION ON CLASSIFICATION AND TERMINOLOGY
the ILAE (ex-officio). The charge to theCommission was to:
(1)
complete the devel-opment of a revision of the InternationalClassification of Epileptic Seizures basedupon a study of videotapes of simultane-ously recorded electrical and clinical mani-festations of epileptic seizures;
(2)
obtainthe majority approval of the Classificationof Epileptic Seizures from the active chap-ters of the League and other pertinent inter-national societies;
(3)
promote the use ofthis classification throughout the world;
(4)
develop a current dictionary of epilepsyand promote its use throughout the world;
(5)
develop a classification
of
the epilepsies,acquire approval of
a
classification, andpromote its use throughout the world.A further video workshop, this time ad-dressing variations of absence seizures,was held in Bethesda. In addition to mem-bers of the Commission, Dr. Roger J. Por-ter of Bethesda and Dr. Carlo Albert0 Tas-sinari of Bologna attended the workshop.Subsequent meetings of the Commissionwere held in conjunction with the EpilepsyInternational Meetings in Florence in
1979
and in Copenhagen in
1980.
Between thesetwo meetings, each chapter of the ILAE re-ceived a draft copy of the proposed revisedclassification. Many chapters discussed theproposal
in
extenso
and provided feedbackto the Commission, and this was incorpo-rated in
a
further revision which resultedfrom discussions held by the Commissionand representatives from many of thechapters at Copenhagen. A subsequent re-vision was circulated to all the chapters ofthe ILAE once more, as well as to the In-ternational Federation of Societies of Elec-troencephalography and Clinical Neuro-physiology and the World Federation ofNeurosurgical Societies.The present proposal does not represent
a
unanimity of views. There are those whowould prefer the substitution of “focal” for“partial” in the description
of
seizures. Thecompromise to retain “partial” stems fromthe compromise arrived at on this verypoint in the formulation of the
1969
clas-sification. A more persuasive argumentexisted for abolishing the words “simple”and “complex” in favor of “partial seizureswith retention of consciousness” and“partial seizures with disturbance of con-sciousness”. Some considered that epilepticsyndromes or fragments of syndromes such
as
hemicorporeal seizures of childhood, in-fantile spasms, and myoclonic astatic sei-zures should be preserved.What resulted is
a
compromise whichrepresents
a
synthesis of the efforts ofmany persons examining hundreds of sei-zures over many years. This compilation ofknowledge has been brought in line with thestate-of-the-art technology without extrap-olating to what cannot be observed, butcognizant of the evanescence of any livingsemantic endeavor which must remainsubject to continual revision.
INTRODUCTION
Attempts at classification of seizureshave to
a
large extent paralleled knowledgeabout these disorders,
so
much
so
that it isnot clear whether the classification is thefather or the child of our concepts. It iscertain that recent advances in knowledgeabout inheritance, prognosis, and therapyof seizures have been predicated on abilityto distinguish accurately between their dif-ferent forms and to objectively identify andmeasure their effects.The concept of classification according tothe defect of function, prognosis, and theoptimum mode of therapy is relatively re-cent. Earlier classifications were particu-larly aimed at describing presenting symp-toms and elucidating which seizures wereprimarily on an organic basis and whichwere primarily on a hysterical basis. Thus,the classification of Gowers was into grandmal, petit mal, and hysteroid. Jacksonrealized that
a
single classification couldnot meet all needs and suggested ananatomicophysiological classification andone based on taxonomy and purely utilitar-
Epilepsia,
Vol.
22,
August
1981
 
PROPOSAL FOR REVISED SEIZURE CLASSIFICATION
491
ian; he compared the first to a botanicaland the second to
a
gardener’s arrangementof plants. Of the latter, he said: “Plainlyenough, such an arrangement goes by whatis most superficial or striking. The advan-tages of it are obvious. It facilitates theidentification and the application of knowl-edge to utilitarian purposes, but it must notbe trusted
as
a
natural classification. How-ever much of it may be further elaborated,it makes not even an approach to a scien-tific classification” (Jackson,
193
1).
The concept of classification into gen-eralized and partial seizures, while datingback to Jackson, did not become commonusage until developed by the Commissionon Classification of the International LeagueAgainst Epilepsy in
1969.
The developmentof new and more specific drugs reinforcedthe necessity for the development of moreaccurate diagnosis and quantification.Moreover, increased knowledge about sideeffects of medications have raised questionsregarding which seizures should be treatedfor which length of time, necessitating thedevelopment of prognostic criteria, againbased on the accuracy of classification.Apart from the heuristic value of such aclassification, it is
of
great importance thatfor purposes of communication, unanimityof terminology be attained. This is espe-cially important in clinical research.The main feature of the
1969
classifica-tion is a distinction between seizures thatare generalized from the beginning andthose that are partial
or
focal at onset andbecome generalized secondarily.The last
5
years have seen the develop-ment and diversification of objective meth-ods for documenting seizures, includingprolonged EEG recording and the use ofvideotape, which allows for capture andavailability for review of seizures. Usingthese techniques, investigators all over theworld have
a
common medium for ex-change of information and this was used inthe further elaboration of the proposedclassification in a series of workshop ses-sions in
1975, 1977,
and
1979.
The first ad-dressed the classification of partial sei-zures, the second, generalized seizures andthe last, the categories of atypical absenceseizures and the various seizures seen ininfancy and childhood.The convention of describing
(1)
clinicalseizure type,
(2)
electroencephalographicseizure type,
(3)
electroencephalographicinterictal expression,
(4)
anatomic sub-strate,
(5)
etiology, and
(6)
age has beenchanged from the
1969
International Clas-sification.Only clinical seizure type and ictal andinterictal electroencephalographic expres-sions have been retained. The anatomicsubstrate, etiology, and age factors havebeen deleted
as
they were largely based onhistorical or speculative information ratherthan information based on direct observa-tion. In
a
description
of
seizures, ratherthan epilepsy, the latter should be the onlyconsideration.With further elaboration of monitoringtechnology, changes in other physiologicalparameters will, in future, be includedunder ictal expression.The other major distinction from the pre-vious version is the separation of partialseizures into simple and complex depend-ing on whether or not consciousness is dis-turbed. In the case of the complex partialseizure, the sequence is crucial, that is,even if the onset is a simple partial one, theoccurrence of disturbance
of
consciousnessevolves into a complex partial seizure.Thus, unlike the
1969
version, the currentproposal allows for longitudinal descriptionof evolving seizure manifestations, therebyimproving descriptive accuracy.The Commission recommends that sim-ple seizures be classified as those with re-tention of consciousness and complex sei-zures be those in which consciousness isimpaired. Many persons feel that the term“complex” refers to higher cortical inte-grative function disturbances and wouldprefer that we abandon the terms “simple”
Epilepsia, Vol.
22,
August
1981
of 00

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