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New classification of epilepsy and its syndromes

      In April 2017, the International League Against Epilepsy (ILAE) published the new Classification of the Epilepsies (Scheffer et al, 2017). This classification replaces the previous version published in 1989, and reflects advances in our understanding of the epilepsies, underlying mechanisms and etiologies over the last three decades. The new classification is organized along three levels, which reflect the diagnostic pathway typically applied in a patient presenting with epileptic seizures. The first level is the definition of the seizure type, which is classified according to the 2017 operational classification of epileptic seizures (Fisher et a, 2017). The subsequent level is the type of epilepsy, which includes three different categories (focal epilepsy, generalized epilepsy, combined generalized, and focal epilepsy) in addition to the 'unknown' category. The third level consists in the definition of the epilepsy syndrome, whenever a specific syndromic diagnosis is possible. Each level is associated, whenever possible, with specification of the etiology (or etiologies), grouped into 6 categories (genetic, structural, metabolic, infectious, immune, and unknown) and any underlying co-morbidities. Updated terminology is introduced, such as developmental and epileptic encephalopathy, and replacement of the term 'benign' with the terms 'self-limited' and 'pharmacoresponsive', as appropriate. The primary goal of the new classification is to facilitate diagnosis and management, but it can also facilitate research and provide a common terminology to improve epilepsy care and knowledge throughout the world.
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