The ILAE classification of seizures and epilepsies: implications for the clinic

The classification of epileptic seizures and the epilepsies has recently been revised by the International League Against Epilepsy (ILAE) and a new classification scheme issued. Areas covered: The new classification scheme has been critically appraised in the light of the previous classifications and subsequent revisions. The purposes of the classification and its potential use have been extensively discussed. Expert commentary: This ILAE classification scheme, the latest of a series of proposals published in the last 30 years, has made progress as it has a multi-level structure (seizure types, epilepsy types, epilepsy syndromes) allowing for differing uses and combines the previously separate seizure types and epilepsies schemes into a single instrument. Seizures and epilepsies can also be classified based on the available diagnostic aids, which may differ substantially between counties with mature economies and resource-poor countries. An intrinsic limitation of the classification, however, is the attempt to box cases as seen in clinical practice into schematic categories, leaving no room for variants and atypical clinical presentations. Another limitation is the lack of flexibility which hampers the ability to link the instrument to the preceding classifications in order to preserve continuity and monitor disease trends in time and space.