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[A clinico-encephalographic study of epileptic children using proposal for revised classification of epilepsies and
K Yoshimura1, F Hamada, I Nomura
1Department of Pediatrics, Kochi Medical School.
Insights
This study evaluated the 1989 International League Against Epilepsy classification of epilepsies. While generally useful, the classification requires refinement for cryptogenic versus symptomatic localization-related epilepsies and generalized seizures with focal EEG activity.
Area of Science:
- Neurology
- Clinical Neurophysiology
Context:
- The 1989 International League Against Epilepsy (ILAE) classification provides a framework for categorizing epilepsies and epileptic syndromes.
- Understanding the nuances of epilepsy classification is crucial for accurate diagnosis and treatment.
Purpose:
- To assess the clinical utility and identify limitations of the 1989 ILAE classification system through a clinico-encephalographic study.
- To evaluate patient categorization within localization-related (LE) and generalized epilepsies (GE) based on the proposed classification.
Summary:
- The study analyzed 101 patients, classifying them under the 1989 ILAE proposal, with 53 in LE and 41 in GE.
- Age of onset correlated with epilepsy type; idiopathic LE and GE showed specific onset patterns.
- Medication controlled seizures in 83% of patients, with higher efficacy in idiopathic LE, cryptogenic LE, and idiopathic GE.
- Difficult-to-control seizures were noted in 17 patients, with a higher incidence of frontal foci in this subgroup.
Impact:
- Highlights the need for clearer definitions differentiating cryptogenic and symptomatic localization-related epilepsies.
- Identifies challenges in classifying patients with generalized seizures and focal epileptiform EEG activity, suggesting a need for consensus.
- Provides insights into the practical application and areas for improvement in epilepsy classification systems.
Abstract:
We reported results of a clinico-encephalographic study using proposal for classification of epilepsies and epileptic syndromes (1989 ILAE). Fifty-three patients belonged to localization-related epilepsies (LE) and syndromes; forty-one patients belonged to generalized epilepsies and syndromes (GE); one patient belonged to epilepsies and syndromes undetermined, focal or generalized; and we could not classify 4 patients. No patients with the onset after 2 years of age belonged to idiopathic LE and no patients with the onset after 10 years of age belonged to symptomatic LE and GE. The rate of patients who had a past history of febrile convulsions was 38% in idiopathic LE and 35% in idiopathic GE. The rate of patients whose epileptic seizures were well controlled by medication was 83%. It was almost 100% in idiopathic LE, cryptogenic LE and idiopathic GE, but it was 60-70% in the other three groups. In seventeen patients their seizures were difficult to control. Six cases in this group had had frontal focus at least once. Although the patients who had had frontal foci at least once were 17 cases seizures could not be controlled in 6 of them. International Classification of Epilepsies and Epileptic Syndromes is convenient to clinicians, but some problems exist. One is unclearness of a definition differentiating cryptogenic from symptomatic LE. The other is the classification of patients with generalized seizures and interictal focal cortical epileptiform EEG activities. An agreement is necessary for these problems.