BAGIAN/SMF SARAF
FAKULTAS KEDOKTERAN
UNIVERSITAS SYIAH KUALA
RUMAH SAKIT UMUM DR. ZAINOEL ABIDIN
The New Definition and Classification
of Seizures and Epilepsy
Oleh:
Nadia Fiany
1607101030098
Pembimbing:
dr. Nova Dian Lestari, Sp.S
Introduction
Classifications for seizures and epilepsy were previously
constructed in 1981(ILAE, 1981), 1985 (ILAE, 1985) and 1989
(ILAE, 1989).
Having seizure and epilepsy classifications are exceedingly
important For the clinicians and care teams, patients and families,
and researchers.
International League Against Epilepsy (ILAE) commissioned a
new operational classification of seizure types and epilepsies .
These changes improve the intuitiveness, transparency and
versatility of the classifications, and allow for
inclusion/classification of previously unclassifiable seizure and
epilepsy types.
History of seizure and epilepsy classifications
The first modern classification proposed in 1964, and
international use of this classification popularized in
1970
Distinction between seizure types and epilepsy types
was not frequently made. large percentage of patients
with seizures are unclassifiable as to a specific epilepsy
type according to the 1989 criteria. 3
The seizure classification was first updated in 1981, seizure
classification promulgated the terms “simple partial”,
“complex partial”, “generalized”, and “unclassifiable”
The classification of the epilepsies were partially updated in
1985/1989 (ILAE, 1985, 1989) and then again in 2010
2010 revision being an intermediate stage aiming towards a
final accepted epilepsy classification
4
ILAE to assemble a new task force, which developed and published a new
definition of epilepsy in 2014 then final classification of seizures and the
epilepsies in 2017.
The new classification of seizures continues to rely on semiology, EEG
and occasionally supplementary information from imaging.
Classification of the epilepsy type and epilepsy syndrome does utilize
more of these recent advances, being aided significantlyby genetics, lab
findings and neuroimaging findings, though still with a major focus
5
throughout the diagnostic process on etiology.
Definition of seizure and epilepsy
Epileptic seizure is “a transient occurrence of signs and/or
symptoms due to abnormal excessive or synchronous neuronal
activity in the brain”
-ILAE ,2005
epilepsy is diagnosed when an individual has:
1.At least two unprovoked or reflex seizures>24 h apart,
2.One unprovoked or reflex seizure and a probability of having another seizure similar to the general
recurrence risk after two unprovoked seizures (≥60%) over the next 10 years
3.An epilepsy syndrome
6
Epilepsy is considered “resolved” under the
following circumstances:
1) in a patient with an age-dependent
epilepsy syndrome who is older than the
age in which this syndrome is active,
2) a patient who has been seizure free for
≥10 years and has been off all antiseizure 7
medications for ≥5 years.
A recent study found the long-term
recurrence of seizures in patients
diagnosed with the new definition was
83.6% at 10 years, thus supporting
treatment and a diagnosis of epilepsy
after only one seizure.
8
Examples of evidence that increases the
probability of having additional seizures
include:
1) Epilepti form activity on EEG or
2) a potential epileptogenic abnormality
on brain imaging. 9
Classification of seizure types
Basic Version Expanded Version
• More useful for doctors in general • Epileptologists/neurophysiologists
practice, pediatricians, non- and researchers
neurologists and general
neurologists, nurses and health
care workers
10
11
• A generalized onset seizure is when both
hemispheres (potentially asymmetrically) are activated
at onset of the seizure, according to behavior and EEG.
•“Unknown” onset refers to when the onset is unknown
but other manifestations are known. This is clarified
further below.
•“Unclassified” remains as a category, although usage
may decrease given the addition of additional seizure
types and the “unknown onset” category.
•Few events are clearly seizures, yet unclassifiable
focal seizures optionally are classified as “aware” or
12
“impaired awareness” seizures.
13
Epilepsy Etiology
Structural Genetic Infectious
Metabolic Immune unknown
14
15
TERIMA KASIH
16
