Classification of paroxysmal events and the four‐dimensional epilepsy classification system

Author:

Lüders Hans1,Vaca Guadalupe Fernandez‐Baca2,Akamatsu Naoki3,Amina Shahram4,Arzimanoglou Alexis5,Baumgartner Christoph6,Benbadis Selim R.7,Bleasel Andrew8,Bermeo‐Ovalle Adriana9,Bozorgi Alireza10,Carreño Mar11,Devereaux Michael12,Francione Stefano13,Losarcos Naiara García14,Hamer Hajo15,Holthausen Hans16,Jamal‐Omidi Shirin17,Kalamangalam Giri18,Kanner Andrés M.19,Knake Susanne20,Lacuey Nuria21,Lhatoo Samden22,Lim Shih Hui23,Londoño Luisa V.24,Mani Jayanti25,Matsumoto Riki26,Miller Jonathan P.27,Noachtar Soheyl28,Palmini André29,Park Jun30,Rosenow Felix31,Shahid Asim32,Schuele Stephan33,Steinhoff Bernhard J.34,Ákos Szabó Charles35,Tandon Nitin36,Terada Kiyohito37,van Emde Boas Walter38,Widdess‐Walsh Peter39,Kahane Philippe40

Affiliation:

1. Case medical Center ‐ Neurology Cleveland Ohio USA

2. University Hospitals Ringgold standard institution ‐ Neurology Cleveland Ohio USA

3. International University of Health and Welfare School of Medicine, Department of Neurology Narita Japan

4. Kaiser Permanente Northern California, Neuroscience Department Redwood City California USA

5. Department of Clinical Epileptology, Sleep Disorders and Functional Pediatric Neurology University Hospitals of Lyon; Member of the European Reference Network on Rare and Complex epilepsies, ERN EpiCARE Lyon France

6. Sigmund Freud Privat Universitat Wien Paris Ringgold standard institution, Department for Epileptology and Clinical Neurophysiology, and General Hospital Hietzing with Neurological Center Rosenhuegel, Department of Neurology Vienna Austria

7. University of South Florida, Department of Neurology Tampa Florida USA

8. Westmead Hospital‐Neurology Wentworthville New South Wales Australia

9. Rush University Medical Center ‐ Department of Neurological Sciences Section of Epilepsy Chicago Illinois USA

10. St. Elizabeth Mercy hospital, ‐ Neurology Youngstown Ohio USA

11. Hospital Clínic ‐ Epilepsy Unit, Department of Neurology; Member of the European Reference Network on Rare and Complex epilepsies ERN EpiCARE Barcelona Spain

12. Case medical Center – Neurology Cleveland Ohio USA

13. Claudio Munari Epilepsy Surgery Centre ‐ Department of Neuroscience Milan Italy

14. University Hospitals Cleveland Medical Center – Neurology Cleveland Ohio USA

15. Epilepsy Center – Neurology Erlangen Germany

16. Schoen‐Klinik Vogtareuth ‐ Neuropediatric Clinic and Clinic for Neurorehabilitation Epilepsy Center for Children and Adolescents Vogtareuth Germany

17. University Hospital Cleveland Medical Center ‐ Neurology, Epilepsy Center Cleveland Ohio USA

18. University of Florida ‐ Department of Neurology Gainesville Florida USA

19. University of Miami, Miller School of Medicine ‐ Department of Neurology Miami Florida USA

20. Universitatsklinikum Giessen und Marburg ‐ Standort Marburg Ringgold standard institution ‐ Epilepsy Center, Neurology Marburg Hessen Germany

21. University Hospitals ‐ Neurology (Epilepsy) Cleveland Heights Ohio USA

22. UT Health Memorial Hermann Hospital, Texas Medical Center ‐ Texas Epilepsy Neurotechnologies and Neuroinformatics Institute Houston Texas USA

23. National Neuroscience Institute Ringgold standard institution – Neurology, Singapore General Hospital Academia, and Duke‐NUS Medical School Ringgold standard institution ‐ Academic Development Department Office of Academic and Clinical Development Singapore

24. Neuromédica IPS – Epilepsy Medillin Colombia

25. Kokilaben Dhirubhai Ambani Hospital ‐ Department of Brain and Nervous System Mumbai India

26. Kobe University Graduate School of Medicine ‐ Division of Neurology Kobe Japan

27. University Hospitals Case Medical Center/Case Western Reserve University – Neurosurgery Cleveland USA

28. Ludwig Maximilians University, Munich ‐ Department of Neurology, Epilepsy Center Munich Germany

29. School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS) ‐ Neurology Service Porto Alegre Epilepsy Surgery Program Porto Alegre Brazil

30. Case Medical Center – Pediatrics Cleveland Ohio USA

31. Hospital of the Goethe‐University Frankfurt am Main ‐ Epilepsy Center Frankfurt Rhine‐Main Frankfurt Germany

32. Rainbow Babies & Children's Hospital Case Western University School of Medicine – Pediatrics Cleveland Ohio USA

33. Northwestern University Feinberg School of Medicine Ringgold standard institution – Neurology Chicago Illinois USA

34. Kork ‐ Epilepsy Center Kehl‐Kork Germany

35. UTHSCSA ‐ Neurology San Antonio and South Texas Comprehensive Epilepsy Center San Antonio Texas

36. University of Texas Health Science Center – Neurosurgery Houston Texas USA

37. National Hospital Organization Shizuoka Institute of Epilepsy and Neurological Disorders, Department of Epileptology Urushiyama Japan

38. Stichting Epilepsie Instellingen Nederland Ringgold standard institution – Neurology Hoofddorp Noord‐Holland The Netherlands

39. Beaumont Hospital ‐ Department of Neurology Dublin Ireland

40. Grenoble‐Alpes Hospital and University ‐ Neurology Department and GIN INSERM U‐1216 Grenoble France

Abstract

ABSTRACTThis educational review describes the classification of paroxysmal events and a four‐dimensional epilepsy classification system. Paroxysmal events are classified as epileptic and non‐epileptic paroxysmal events. Non‐epileptic events are, in turn, classified as psychogenic and organic paroxysmal events. The following four dimensions are used to classify epileptic paroxysmal events: ictal semiology, the epileptogenic zone, etiology, and comorbidities. Efforts are made to keep these four dimensions as independent as possible.The review also includes 12 educational vignettes and three more detailed case reports classified using the 2017 classification of the ILAE and the four‐dimensional epilepsy classification. In addition, a case is described which is classified using the four‐dimensional epilepsy classification with different degrees of precision by an emergency department physician, a neurologist, and an epileptologist. [Published with video sequences on www.epilepticdisorders.com]

Publisher

Wiley

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