Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy.
Alicia Bogacz Fressola, Aileen McGonigal, Stéphane Auvin, J Helen Cross, Lieven Lagae, Dong Zhou, Eugen Trinka, Sándor Beniczky, Fatema Abdulla, Raidah Al Baradie, Mario Alonso Vanegas, Nicola Specchio, Mar Carreno, Augustina Charway, Birinus Ezeala-Adikaibe, M V Gule, Barbara Jobst, Nirmeen Kishk, Kheng-Seang Lim, Angelica Lizcano, Katerina Tanya Perez-Gosiengfiao, William Tatum, Philippe Ryvlin, Norimichi Higurashi, Akio Ikeda, Floor E Jansen, Fernando Cendes, Mark Cook, Hal Blumenfeld, Birgit Frauscher, Roberto Caraballo, Dana Craiu, Philippe Kahane, Mamta Bhushan Singh, Hermann Stefan, Samuel Wiebe, Jo Wilmshurst, Michael R Sperling, Elza Márcia Yacubian, Jacqueline French, Elaine Wirrell, Ching Soong Khoo, Kollencheri Puthenveettil Vinayan, Manjari Tripathi
Journal: Epilepsia
2025;66(6):1804-1823
PMID: 40264351
Abstract
The International League Against Epilepsy (ILAE) has updated the operational classification of epileptic seizures, building upon the framework established in 2017. This revision, informed by the implementation experience, involved a working group appointed by the ILAE Executive Committee. Comprising 37 members from all ILAE regions, the group utilized a modified Delphi process, requiring a consensus threshold of more than two thirds for any proposal. Following public comments, the Executive Committee appointed seven additional experts to the revision task force to address and incorporate the issues raised, as appropriate. The updated classification maintains four main seizure classes: Focal, Generalized, Unknown (whether focal or generalized), and Unclassified. Taxonomic rules distinguish classifiers, which are considered to reflect biological classes and directly impact clinical management, from descriptors, which indicate other important seizure characteristics. Focal seizures and those of unknown origin are further classified by the patient's state of consciousness (impaired or preserved) during the seizure, defined operationally through clinical assessment of awareness and responsiveness. If the state of consciousness is undetermined, the seizure is classified under the parent term, that is, the main seizure class (focal seizure or seizure of unknown origin). Generalized seizures are grouped into absence seizures, generalized tonic-clonic seizures, and other generalized seizures, now including recognition of negative myoclonus as a seizure type. Seizures are described in the basic version as with or without observable manifestations, whereas an expanded version utilizes the chronological sequence of seizure semiology. This updated classification comprises four main classes and 21 seizure types. Special emphasis was placed on ensuring translatability into languages beyond English. Its aim is to establish a common language for all health care professionals involved in epilepsy care, from resource-limited areas to highly specialized centers, and to provide accessible terms for patients and caregivers.
© 2025 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
Address:
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.; Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark.; Department of Neurology, Center for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.; Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.; Medical Informatics, and Technology, Institute of Public Health, Medical Decision Making, and Health Technology Assessment, University for Health Sciences, Hall in Tyrol, Austria.; Division of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.; Department of Clinical Neurosciences, Salmaniya Medical Complex, Government Hospitals, Manama, Kingdom of Bahrain.; King Fahd Specialist Hospital Dammam, Al Hofuf, Saudi Arabia.; International Epilepsy Center HMG Coyoacán, Mexico City, Mexico.; Pediatric Neurology Department, CRMR Epilepsies Rares, APHP, Robert Debré University Hospital, Paris, France.; INSERM NeuroDiderot, Université Paris Cité, Paris, France.; Institut Universitaire de France, Paris, France.; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.; Department of Neurology, Neuroscience, and Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.; Neurological Institute, Universidad de la República, Montevideo, Uruguay.; Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina.; Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona, Barcelona, Spain.; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona, Barcelona, Spain.; Department of Neurology, School of Medical Sciences, University of Campinas, São Paulo, Brazil.; Brazilian Institute of Neuroscience and Neurotechnology, São Paulo, Brazil.; 37 Military Hospital, Accra, Ghana.; Faculties of Engineering and Information Technology, and Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.; Pediatric Neurology Discipline, Neuroscience Department, "Carol Davila" University of Medicine, Bucharest, Romania.; Center of Expertise of Rare Pediatric Neurological Disorders Al Obregia Clinical Hospital, Bucharest, Romania.; Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.; Neurology Unit, Memfys Hospital, Enugu, Nigeria.; Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA.; Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA.; Department of Neurology, New York University, New York, New York, USA.; Division of Neurology, Department of Medicine, Neuroscience Institute and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.; Centre for Global Epilepsy, University of Oxford, Oxford, UK.; Musashi-Kosugi Pediatrics & Epilepsy Clinic and Department of Pediatrics, Jikei University School of Medicine, Minato-ku, Japan.; Department of Epilepsy, Movement Disorders, and Physiology, Kyoto University Graduate School of Medicine Shogoin, Kyoto, Japan.; Department of Child Neurology, Brain Center, University Medical Center, Utrecht, the Netherlands.; Department of Neurology, Dartmouth-Hitchcock Health, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.; Neurology Department, CHU Grenoble Alpes, Université Grenoble Alpes, INSERM, U1216, Grenoble Institut Neurosciences, Grenoble, France.; Department of Neurology, School of Medicine, Kasralainy Hospital, Cairo University, Cairo, Egypt.; Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.; Neurology Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.; Centre for Global Epilepsy, Wolfson College, University of Oxford, Oxford, UK.; Department of Pediatric Neurology and Amrita Advanced Center for Epilepsy, Amrita Institute of Medical Sciences, Cochin, India.; Pediatric Neurology, University of Leuven, Leuven, Belgium.; Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.; Department of Clinical Neurophysiology and Epilepsy Clinic, Neurocentro and Coneuro, Pereira, Colombia.; Laboratory of Neuroimmunology, Medcare, Pereira, Colombia.; Centre for Neurosciences, Mater Hospital Brisbane, University of Queensland, Brisbane, Queensland, Australia.; Department of Neurosciences, University of the Philippines-Philippine General Hospital, Manila, Philippines.; Department of Neurosciences, Makati Medical Center, Makati, Philippines.; Institute for Neurological Sciences, St. Lukes Medical Center Global City, Taguig, Philippines.; Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland.; Neurology, Epilepsy, and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy and University Hospitals KU Leuven, Leuven, Belgium.; Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.; Department of Neurology-Biomagnetism, University Hospital, Erlangen, Germany.; Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.; Department of Neurology, AIIMS, Delhi, India.; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Department of Pediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.; Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.; NIHR BRC Great Ormond Street Institute of Child Health, Great Ormond Street Hospital & Young Epilepsy, University College London, London, UK.
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