[A critical analysis of the new classification of epilepsies and epileptic seizures of the International League Against Epilepsy (ILAE)]

Abstract

The classification of epilepsies and epileptic syndromes currently in use dates back to the eighties. Around thirty years later, it is now time to look for new approaches that are better adapted to the numerous advances that have taken place over the years in the different areas of research on epilepsy (genetics, neuroimaging, neurophysiology, etc.). In response to repeated calls by different authors to modify the classical approaches to epilepsy, in the year 2010 the Commission on Classification and Terminology of the International League Against Epilepsy (ILAE), led by Berg, published a terminological and conceptual revision of epileptic seizures and epilepsies with recommendations regarding the direction to be followed in their classification. This article, however, has received a great deal of criticism because it proposes a radical change with the elimination of classical concepts, without maintaining the useful elements and modifying only the parts that reflect obsolete concepts in the light of current scientific evidence. Unnecessary confusion has been generated by, for example, eliminating the division between focal and generalised epilepsies, but keeping the concept of focal and generalised epileptic seizures or by proposing a classification that mixes different approaches, electroclinical criteria, aetiology, and so on. Thus, the ILAE has before it the important task of striking a balance between the different opinions that have arisen and offering a new, more moderate proposal. At this point it would do well to recall the words of Seneca, who warned of the dangers of not proceeding in that way when he said: 'everything that exceeds the bounds of moderation has an unstable foundation'.