The concept of the epilepsy syndrome: how useful is it in clinical practice?

An epilepsy syndrome is a disorder characterized by a cluster of symptoms and signs customarily occurring in combination. A syndromic approach to the epilepsies would be of practical value for diagnostic, prognostic, and therapeutic purposes. However, despite considerable efforts by leaders in the field of epileptology and the improved knowledge of the clinical, genetic, imaging, and biologic aspects of epilepsy, there are no measurable objective criteria for recognizing seizure types and epilepsy syndromes as separate diagnostic entities with well-defined prognostic and therapeutic aspects. The lack of pragmatic, evidence-based instruments to devise a syndromic classification useful for clinical practice can be explained by the evolving concept of epilepsy syndrome, its dynamic characteristics, the poor prognostic predictivity, and the extremely complex genetic and pathophysiologic mechanisms underlying the epileptic phenomena. In addition, the results of the published reports on epilepsy syndromes are mostly biased by flaws in the study population, design, and statistical analysis. The Classification Core Group of the International League Against Epilepsy (ILAE), which is working on a new classification of the epilepsies, stated that the process of syndrome identification requires that an evidence-based approach be applied to the published literature and future studies.