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Comparison of ILAE 2010 and semiological seizure classification in children with epilepsy
Tugba Hirfanoglu1, Ayse Serdaroglu1, Irem Capraz2
1Department of Pediatric Neurology & Pediatric Video EEG Monitoring Unit, School of Medicine, Gazi University, Ankara, Turkey.
Insights
Semiological seizure classification (SSC) is more specific than ILAE 2010 for predicting the epileptogenic zone in children with epilepsy. SSC offers greater detail for pre-surgical evaluations, while ILAE 2010 remains a simpler option for daily practice.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Accurate seizure classification is crucial for epilepsy management and research.
- Existing classification systems, such as the International League Against Epilepsy (ILAE) 2010, have limitations in fully characterizing seizure semiology and predicting the epileptogenic zone.
- The semiological seizure classification (SSC), a component of the five-dimensional classification, offers a more detailed approach to describing seizure events.
Purpose of the Study:
- To compare the applicability and utility of the ILAE 2010 classification and SSC in children with epilepsy.
- To evaluate the ability of both classification systems to predict the epileptogenic zone.
- To investigate the correlation between seizure subtypes and the epileptogenic zone in different age groups.
Main Methods:
- A retrospective study involving 138 children with epilepsy, divided into younger (≤6 years) and older (>6 years) age groups.
- Application of both ILAE 2010 and SSC to classify seizure types, epilepsy syndromes, and etiologies.
- Statistical comparison of the two classification systems regarding their ability to predict the epileptogenic zone and correlate with seizure subtypes.
Main Results:
- ILAE 2010 classified 66.7% of seizures as focal and 15.9% as generalized.
- SSC identified simple seizures (56.5%), complex motor seizures (46.4%), and dialeptic seizures (39.9%) as most frequent.
- SSC demonstrated higher specificity in predicting the epileptogenic zone compared to ILAE 2010 (p<0.05), with stronger correlations observed in older children.
- A notable relationship between the epileptogenic zone and etiology was found with the five-dimensional classification.
Conclusions:
- Neither classification system is universally superior; the choice depends on clinical needs.
- SSC provides more detailed information for predicting the epileptogenic zone, beneficial for pre-surgical evaluations.
- ILAE 2010 offers a simpler method for routine seizure description.
- Age-related evolution of seizure types due to brain maturation must be considered in classification.
Objective:
The aim of this study was to compare both ILAE 2010 and semiological seizure classification (SSC) in terms of their applicability and utility and to predict epileptogenic zone in children with epilepsy.
Methods:
Both ILAE 2010 classification and SSC which is a part of five dimensional classification were applied for a total 138 children by dividing into younger (≤6y/o) and older (>6y/o) age groups over the last two years as retrospectively. After the assessment of the seizures types, epilepsy syndromes, and etiologies; the data were also compared to evaluate if having correlation between epileptogenic zone and seizure subtypes in both ILAE 2010 and SSC.
Results:
ILAE 2010 indicated that 66.7% of the patients had focal seizures, 15.9% had generalized seizures, and 14.4% had seizures of unknown origin. The SSC revealed that the most frequent seizure type was simple seizures (56.5%), second frequent one was complex motor seizures (46.4%) and dialeptic seizures (39.9%). To predict epileptogenic zone, SSC was found to be more specific than ILAE in terms of the more subgroups of SSC were related to the more subgroups of epileptogenic zone (p<0.05). Furthermore, there was a clear correlation between focal foci and specific seizure types in older ages, while many foci caused to same seizure types and tend to no clear focal foci with generalized onset in younger ages. On the other hand, the relationship between epileptogenic zone and etiology was more remarkable in the five dimensional classification.
Significance:
Preference of seizure classification system is unique for each patient and depends on requirements. Therefore, one dimension cannot be sufficient for evaluation the nature of the seizures in some patients. Furthermore, age related evolution of the seizure types should not be ignored due to ongoing maturation state of the brain. ILAE 2010 and SSC have weak and strong points compared to each other. Semiological seizure classification is more informative in terms of identifying the epileptogenic zone which may be important in specific occasions like pre-surgical work up, while ILAE is simple and easier method which can be applied for seizure description and their characteristics in daily practice.
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