Seizure types

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Future classifications

In 1997, the ILAE began work on revising the classification of seizures, epilepsies and epileptic syndromes. This revision remains in gestation and has not superseded the 1981 classification.

Proposed changes to terminology include:

• Replace partial with the older term focal to describe seizures that originate in one part of the brain (though not necessarily a small or well defined area). The word partial was regarded as ambiguous.
• Drop the terms simple partial and complex partial - grouping based on the effect to consciousness is no longer regarded as useful.
• Replace cryptogenic with probably symptomatic.

The hierarchy presented has the structure:

Self limiting seizure types

Generalized seizures

Tonic-clonic seizures (includes variations beginning with a clonic or myoclonic phase)

Clonic seizures (with and without tonic features)

Typical absence seizures

Atypical absence seizures

Myoclonic absence seizures

Tonic seizures

Spasms

Myoclonic seizures

Massive bilateral myoclonus

Eyelid myoclonia (with and without absences)

Myoclonic atonic seizures

Negative myoclonus

Atonic seizures

Reflex seizures in generalized epilepsy syndromes

Seizures of the posterior neocortex

Neocortical temporal lobe seizures

Focal seizures

Focal sensory seizures

Focal motor seizures

Gelastic seizures

Hemiclonic seizures

Secondarily generalized seizures

Reflex seizures in focal epilepsy syndromes

Continuous seizure types

Generalized status epilepticus

Generalized tonic-clonic status epilepticus

Clonic status epilepticus

Absence status epilepticus

Tonic status epilepticus

Myoclonic status epilepticus

Focal status epilepticus

Epilepsia partialis continua of Kojevnikov

Aura continua

Limbic status epilepticus (psychomotor status)

Hemiconvulsive status with hemiparesis

Earlier classifications

The 1981 classification was a revision of the one devised by Henri Gastaut for the ILAE and published in 1970. A significant difference was the distinction between simple and complex partial seizures. In the 1970 classification, the distinction was whether the symptoms involved elementary sensory or motor functions (simple) or whether "higher functions" were involved (complex). This was changed to consider whether consciousness was fully retained or not. As a result, studies that group patients according to these classifications are not directly comparable from one generation to another. The 1970 classification was important for standardising the modern terms for many seizure types. Prior to this, terms such as petit mal, grand mal, Jacksonian, psychomotor and temporal-lobe seizures were used.

The earliest classification of seizures can be attributed to Babylonian scholars who inscribed their medical knowledge into stone tablets know as the Sakikku (meaning All Diseases). This dates from the reign of the Babylonian king Adad-apla-iddina of the Second Dynasty of Isin - reckoned to be between 1067 and 1046 BC. Many types of seizures are described, each attributed to a certain demon or departed spirit and given a prognosis.