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New definition of epilepsy - Who has epilepsy now that didn’t have it before?

      Until recently, epilepsy was defined by the International League Against Epilepsy (ILAE) as the occurrence of 2 or more unprovoked epileptic seizures. The occurrence of 2 unprovoked seizures was a way to determine the presence of epilepsy, a state defined as the enduring predisposition of the brain to generate seizures. The occurrence of two seizures was used as a “surrogate marker” for the presence of this brain state. In 2014, a new practical definition was accepted by the ILAE, which expanded the definition of epilepsy to include 1) at least two unprovoked (or reflex) seizures occurring >24 h apart 2) One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years or 3) Diagnosis of an epilepsy syndrome. The new definition does not indicate how we know that any individual has a “greater likelihood than not” (>60%) of having another seizure. This is left up to the clinician to determine. Reflex epilepsies (eg photosensitive epilepsy, eating epilepsy) are also included under the definition for the first time. The new definition now also includes discussion of resolution of epilepsy. Epilepsy is now considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years.
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