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international league epilepsy ilae made major contribution established standardized classifications terminology epileptic seizures syndromes provided universal vocabulary facilitated communication among clinicians also established taxonomic foundation performing quantitative clinical basic research epilepsy much however changed since adoption currently used classification epileptic seizures 1981 1 classification epilepsies epileptic syndromes 1989 2 consequently executive committee ilae took office july 1997 agreed review revision current classification system would priority executive term task force classification terminology appointed divided four working groups concerned descriptive terminology ictal events seizures syndromes diseases impairment course several meetings vigorous email discussions task force agreed would possible replace current international classifications similar revised updated classifications would universally accepted meet clinical research needs formal organizational system would expected provide rather task force proposing diagnostic scheme makes use standardized terminology concepts describe individual patients table 1 within diagnostic scheme variety approaches classification possible presented way example task force views development specific classifications continuing work progress flexible dynamic classifications revised periodically based rapidly emerging new information also resolution problems inevitably identified use point proposal include several definitive changes concepts terminology table 2 classifications presented examples could devised future although new ilae classification represented considerable effort part acknowledged experts many different countries always met certain degree resistance international epileptology community part rigid classification shapes manner future generations clinical basic neuroscientists think epilepsy epileptic phenomena thereby influencing perhaps unduly clinical practice research instance current classification epileptic seizures division partial seizures simple complex inappropriately created impression impairment consciousness certain mechanistic implications related limbic system involvement confusion times vociferous objections resulted part fact 1970 international classification epileptic seizures used term complex partial seizures synonymously temporal lobe seizures3 past two decades detailed investigations anatomic substrates ictal semiology based largely work carried epilepsy surgery centers strongly suggested fundamental mechanisms certain limbic seizures different neocortical seizures associated impairment consciousness consequently designation partial seizures simple complex process lost meaningful precision indeed 1981 classification epileptic seizures purposely based purely ictal phenomenology associated eeg findings rather anatomic substrates pathophysiologic mechanisms insufficient information available time permit authors otherwise belief task force adequate evidence exists permit creation list seizure types represent diagnostic entities opposed phenomenologic descriptions based known presumed common anatomy pathophysiology diagnostic entities would like syndromes etiologic therapeutic prognostic implications could used supplement syndromic diagnoses stand alone syndromic diagnoses cannot made 1981 classification epileptic seizures also criticized purely semiologic post hoc etiologic information eeg data often required use properly dichotomy partial versus generalized belies need avoid anatomic implications task force believes purely descriptive phenomenologic approach defining ictal semiology definite clinical value new diagnostic scheme proposed includes modification previously proposed classification ictal phenomenology 4 option used detail appropriate similarly previous dichotomous classifications based concepts partial localization related versus generalized abnormalities created false impression epileptic seizures epilepsy syndromes due either localized disturbances one hemisphere disturbances involving entire brain variety conditions focal generalized epileptogenic dysfunctions include diffuse hemispheric abnormalities multifocal abnormalities bilaterally symmetrical localized abnormalities although concepts partial generalized epileptogenicity value perhaps respect ictal events syndromes neither appropriate useful attempt contain seizures syndromes within one categorizations term partial come criticism implies part seizure part syndrome rather seizure syndrome begins part one hemisphere reason 1989 classification epilepsies epileptic syndromes replaced term partial localizationrelated latter terminology cumbersome consistently used task force proposing terms partial localizationrelated replaced older term focal remains common use must strongly emphasized however term focal mean epileptogenic region small welldelineated focus neuronal pathology focal seizures well focal syndromes almost always due diffuse times widespread areas cerebral dysfunction another change terminology evident document omission words convulsion convulsive list epileptic seizure types epilepsy syndromes task force thought nonspecific lay terms times improperly used consequently agreed consistent descriptive ictal terminology also naming epileptic seizure types syndromes avoid terms instance task force proposing term febrile convulsions replaced febrile seizures also dissatisfaction terms idiopathic cryptogenic problems former resulted misunderstanding correct definition idiopathic means disorder unto sui generis etiology unknown problems latter due imprecision definition cryptogenic usually used designate conditions idiopathic presumed symptomatic etiology determined also used conditions known whether idiopathic symptomatic task force unable find acceptable alternative term idiopathic used correctly confers useful taxonomic concept terms benign genetic discarded idiopathic epilepsies necessarily benign genetic epileptic conditions eg progressive myoclonus epilepsies idiopathic although term essential also used medicine convey meaning task force believes epileptologists learned use term idiopathic correctly value maintaining continuity consequently recommended terms idiopathic symptomatic retained term cryptogenic although still acceptable replaced precise term probably symptomatic therefore epilepsy syndromes referred either idiopathic symptomatic dichotomous classification system attempts categorize syndromes manner avoided another important criticism previous rigid syndromic classifications failure recognize fact syndromes well accepted whereas others controversial lack sufficient data formally recognizing syndrome including official international classification may give inappropriate legitimacy whereas failing recognize syndrome official classification discourage studies necessary lead acceptance official ilaesanctioned list epilepsy syndromes must differentiate universally accepted syndromes development must also sufficiently flexible permit additions deletions syndromes new information becomes available rapidly moving field genetics contributed greatly recent years understanding many diseases including epileptic disorders relationship genetic disturbances phenotypic expression remains complicated poorly understood single relatively well defined idiopathic epilepsy syndrome due one genetic abnormality different members family sharing common genetic abnormality different epilepsy syndromes considered premature attempt classify epilepsy syndromes great extent basis specific genetic etiologies doubt however near future genetic classifications certain epilepsy syndromes become possible classifications considerable clinical value necessary classifications include syndromes families addition syndromes individuals indeed task force included three conditions current recommended list epilepsy syndromes cf table 4 generalized epilepsy febrile seizures plus familial focal epilepsy variable foci idiopathic generalized epilepsies variable phenotypes first two considered syndromes development diagnosis would possible without evidence multiple affected family members third new concept remains discussion task force asking general assembly approve diagnostic scheme rather fixed classification next meets buenos aires may 2001 diagnostic scheme intended provide basis standardized description individual patients consists five levels axes table 1 axes organized facilitate logical clinical approach development hypotheses necessary determine diagnostic studies performed therapeutic strategies undertaken diagnostic scheme described made flexible dynamic modules within task force make periodic changes updates needed approval executive committee task force proposing diagnostic scheme include development flexible rather rigid classifications eliminating need general assembly meets every 2 years agree every revision acceptance diagnostic scheme therefore exclude creation various classification systems seizures syndromes continued use aspects current classification task force concerned construction classification systems next executive term anticipated seizures syndromes organized fixed dichotomous classifications rather categorized various ways various purposes axis 1 consists description ictal semiology using standardized glossary descriptive terminology description ictal event without reference etiology anatomy mechanisms brief extremely detailed required clinical research purposes although detailed descriptions onset evolution localized ictal phenomena often necessary useful instance patients candidates surgical treatment research designed elucidate anatomic substrates pathophysiologic mechanisms underlying specific clinical behaviors communication among clinicians among researchers greatly enhanced establishment standardized terminology describing ictal semiology axis 2 epileptic seizure type types experienced patient derived list accepted seizure types represent diagnostic entities etiologic therapeutic andor prognostic implications localization within brain specified appropriate case reflex seizures specific stimulus also specified task force constructed list accepted epileptic seizure types including forms status epilepticus precipitating factors reflex seizures table 3 seizure types divided selflimited seizures continuous seizures divided generalized seizures focal seizures anticipated approaches organization categorization classification seizure types devised specific purposes axis 3 syndromic diagnosis derived list accepted epilepsy syndromes table 4 although understood syndromic diagnosis may always possible recommended list distinguishes epilepsy syndromes conditions epileptic seizures require diagnosis epilepsy also identifies syndromes still development important stress list shown table 4 contains syndromes still discussion new concept idiopathic generalized epilepsies variable phenotypes reflex epilepsies task force continue revise list based results deliberations input membership new information epileptic seizures anticipated different approaches organization categorization classification epilepsy syndromes created specific purposes one example approach classification epilepsy syndromes shown table 5 whereas classification system may easy epileptologists understand simplified version likely constructed teaching purposes used primary care physicians whereas detailed completely different classification systems might necessary epidemiologic studies clinical drug trials presurgical evaluation basic research genetic characterizations axis 4 specify etiology known etiology could consist specific disease derived classification diseases frequently associated epileptic seizures syndromes table 6 genetic defect specific pathologic substrate instance symptomatic focal epilepsies classification diseases frequently associated epileptic seizures shown table 6 preliminary require considerable effort course next executive term made comprehensive possible axis 5 optional designation degree impairment caused epileptic condition classification impairment derived world health organization icidh2 international classification functioning disability 5 currently preparation modification may necessary application seizure disorders recent draft glossary descriptive terminology ictal semiology axis 1 detailed descriptions epileptic seizure types axis 2 epileptic syndromes axis 3 current draft classification icidh2 axis 5 viewed ilae classification website httpwwwepilepsyorgctf although proposal put ilae general assembly may merely requests approval overall diagnostic scheme permission continue revise update details within axis ongoing flexible manner input membership details well overall scheme welcome task force would particularly like invite comments important remaining problems including terms describing ictal impairment consciousness acceptance idiopathic generalized epilepsies variable phenotypes single syndrome inclusion category epileptic encephalopathies proposed categorization reflex seizures syndromes see classification task force questionnaire comments task force directed chair email email protected mail fax 13102068461 acknowledgment work task force classification website supported part generous grant glaxosmithkline axis concept originally suggested dr jeffrey nicholl members task force classification terminology include jerome engel jr los angeles california usa chair warren blume london ontario canada chair working group glossary descriptive terminology peter williamson lebanon new hampshire usa chair working group seizures natalio fejerman buenos aires argentina chair working group syndromes diseases harry meinardi hague netherlands chair working group impairment jean aicardi paris france frederick andermann montreal quebec canada alexis arzimanoglou paris france giuliano avanzini milan italy samuel berkovic melbourne australia carol camfield halifax nova scotia canada bernardo dalla bernardina verona italy charlotte dravet marseille france francois dubeau montreal quebec canada olivier dulac paris france orvar eegolofsson uppsala sweden robert fraser seattle washington usa renzo guerrini london uk allen hauser new york new york usa matilde leonardi geneva switzerland hans lders cleveland ohio usa eli mizrahi houston texas usa claudio munari deceased milan italy jeffrey noebels houston texas usa cp panayiotopoulos london uk perrine plouin paris france marieke reuvekampthuss groningen netherlands masakazu seino shizuoka japan arthur sonnen deceased breda netherlands carlo alberto tassinari bologna italy rupprecht thorbecke bielefeld germany david treiman new brunswick new jersey usa walter van emde boas heemstede netherlands federico vigevano rome italy heinzgregor wieser zrich switzerland peter wolf bielefeld germany benjamin zifkin montreal quebec canada