The 2010 revised classification of seizures and epilepsy

Classifications of epilepsies (1989) and seizures (1981) took a central role in epilepsy care and research. Based on nearly century-old concepts, they were abandoned in 2010, and recommendations for new concepts and terminology were made in accordance with a vision of what a future classification would entail. This review outlines the major changes, the ways these changes relate to the earlier systems, the implications for the practicing health care provider, and some of the recommendations for future classification systems.

New terminology for underlying causes (genetic, structural-metabolic, and unknown) was introduced to replace the old (idiopathic, symptomatic, and cryptogenic) in 2010. The use of generalized and focal to refer to the underlying epilepsy was largely abandoned, but the terms were retained in reference to mode of seizure initiation and presentation. The terms "complex" and "simple partial" for focal seizures were abandoned in favor of more descriptive terms. Electroclinical syndromes were highlighted as specific epilepsy diagnoses and distinguished from nonsyndromic-nonspecific diagnoses. The importance of diagnosis (a clinical goal focused on the individual patient) over classification (an intellectual system for organizing information) was emphasized.

Accurate description and diagnosis of the seizures, causes, and specific type of epilepsy remain the goal in clinical epilepsy care. While terminology and concepts are being revised, the implications for patient care currently are minimal; however, the gains in the future of clear, accurate terminology and a multidomain classification system could potentially be considerable.