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

Hans Lüders¹, Guadalupe Fernandez-Baca Vaca², Naoki Akamatsu³, Shahram Amina⁴, Alexis Arzimanoglou⁵, Christoph Baumgartner⁶, Selim R Benbadis⁷, Andrew Bleasel⁸, Adriana Bermeo-Ovalle⁹, Alireza Bozorgi¹⁰, Mar Carreño¹¹, Michael Devereaux¹, Stefano Francione¹², Naiara García Losarcos¹³, Hajo Hamer¹⁴, Hans Holthausen¹⁵, Shirin Jamal-Omidi¹⁶, Giri Kalamangalam¹⁷, Andrés M Kanner¹⁸, Susanne Knake¹⁹, Nuria Lacuey²⁰, Samden Lhatoo²¹, Shih Hui Lim²², Luisa V Londoño²³, Jayanti Mani²⁴, Riki Matsumoto²⁵, Jonathan P Miller²⁶, Soheyl Noachtar²⁷, André Palmini²⁸, Jun Park²⁹, Felix Rosenow³⁰, Asim Shahid³¹, Stephan Schuele³², Bernhard J Steinhoff³³, Charles Ákos Szabó³⁴, Nitin Tandon³⁵, Kiyohito Terada³⁶, Walter van Emde Boas³⁷, Peter Widdess-Walsh³⁸, Philippe Kahane³⁹

Affiliations

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 Claudio Munari Epilepsy Surgery Centre - Department of Neuroscience, Milan, Italy.
¹³ University Hospitals Cleveland Medical Center - Neurology, Cleveland, Ohio, USA.
¹⁴ Epilepsy Center - Neurology, Erlangen, Germany.
¹⁵ Schoen-Klinik Vogtareuth - Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany.
¹⁶ University Hospital Cleveland Medical Center - Neurology, Epilepsy Center, Cleveland, Ohio, USA.
¹⁷ University of Florida - Department of Neurology, Gainesville, Florida, USA.
¹⁸ University of Miami, Miller School of Medicine - Department of Neurology, Miami, Florida, USA.
¹⁹ Universitatsklinikum Giessen und Marburg - Standort Marburg Ringgold standard institution - Epilepsy Center, Neurology, Marburg, Hessen, Germany.
²⁰ University Hospitals - Neurology (Epilepsy), Cleveland Heights, Ohio, USA.
²¹ UT Health Memorial Hermann Hospital, Texas Medical Center - Texas Epilepsy, Neurotechnologies and Neuroinformatics Institute, Houston, Texas, USA.
²² National Neuroscience Institute, and Duke-NUS Medical School, Singapore.
²³ Neuromédica IPS - Epilepsy, Medillin, Colombia.
²⁴ Kokilaben Dhirubhai Ambani Hospital - Department of Brain and Nervous System, Mumbai, India.
²⁵ Kobe University Graduate School of Medicine - Division of Neurology, Kobe, Japan.
²⁶ University Hospitals Case Medical Center/Case Western Reserve University - Neurosurgery, Cleveland, USA.
²⁷ Ludwig Maximilians University, Munich - Department of Neurology, Epilepsy Center, Munich, Germany.
²⁸ School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS) - Neurology Service, Porto Alegre Epilepsy Surgery Program, Porto Alegre, Brazil.
²⁹ Case Medical Center - Pediatrics, Cleveland, Ohio, USA.
³⁰ Hospital of the Goethe-University Frankfurt am Main - Epilepsy Center Frankfurt Rhine-Main, Frankfurt, Germany.
³¹ Rainbow Babies & Children's Hospital, Case Western University School of Medicine - Pediatrics, Cleveland, Ohio, USA.
³² Northwestern University Feinberg School of Medicine Ringgold standard institution - Neurology, Chicago, Illinois, USA.
³³ Kork - Epilepsy Center, Kehl-Kork, Germany.
³⁴ UTHSCSA - Neurology, San Antonio and South Texas Comprehensive Epilepsy Center, San Antonio, Texas.
³⁵ University of Texas Health Science Center - Neurosurgery, Houston, Texas, USA.
³⁶ National Hospital Organization Shizuoka Institute of Epilepsy and Neurological Disorders, Department of Epileptology, Urushiyama, Japan.
³⁷ Stichting Epilepsie Instellingen Nederland Ringgold standard institution - Neurology, Hoofddorp, Noord-Holland, The Netherlands.
³⁸ Beaumont Hospital - Department of Neurology, Dublin, Ireland.
³⁹ Grenoble-Alpes Hospital and University - Neurology Department and GIN INSERM U-1216, Grenoble, France.

PMID: 30782582
DOI: 10.1684/epd.2019.1033

Review

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

Hans Lüders et al. Epileptic Disord. 2019.

. 2019 Feb 1;21(1):1-29.

doi: 10.1684/epd.2019.1033.

Authors

Affiliations

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 Claudio Munari Epilepsy Surgery Centre - Department of Neuroscience, Milan, Italy.
¹³ University Hospitals Cleveland Medical Center - Neurology, Cleveland, Ohio, USA.
¹⁴ Epilepsy Center - Neurology, Erlangen, Germany.
¹⁵ Schoen-Klinik Vogtareuth - Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany.
¹⁶ University Hospital Cleveland Medical Center - Neurology, Epilepsy Center, Cleveland, Ohio, USA.
¹⁷ University of Florida - Department of Neurology, Gainesville, Florida, USA.
¹⁸ University of Miami, Miller School of Medicine - Department of Neurology, Miami, Florida, USA.
¹⁹ Universitatsklinikum Giessen und Marburg - Standort Marburg Ringgold standard institution - Epilepsy Center, Neurology, Marburg, Hessen, Germany.
²⁰ University Hospitals - Neurology (Epilepsy), Cleveland Heights, Ohio, USA.
²¹ UT Health Memorial Hermann Hospital, Texas Medical Center - Texas Epilepsy, Neurotechnologies and Neuroinformatics Institute, Houston, Texas, USA.
²² National Neuroscience Institute, and Duke-NUS Medical School, Singapore.
²³ Neuromédica IPS - Epilepsy, Medillin, Colombia.
²⁴ Kokilaben Dhirubhai Ambani Hospital - Department of Brain and Nervous System, Mumbai, India.
²⁵ Kobe University Graduate School of Medicine - Division of Neurology, Kobe, Japan.
²⁶ University Hospitals Case Medical Center/Case Western Reserve University - Neurosurgery, Cleveland, USA.
²⁷ Ludwig Maximilians University, Munich - Department of Neurology, Epilepsy Center, Munich, Germany.
²⁸ School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS) - Neurology Service, Porto Alegre Epilepsy Surgery Program, Porto Alegre, Brazil.
²⁹ Case Medical Center - Pediatrics, Cleveland, Ohio, USA.
³⁰ Hospital of the Goethe-University Frankfurt am Main - Epilepsy Center Frankfurt Rhine-Main, Frankfurt, Germany.
³¹ Rainbow Babies & Children's Hospital, Case Western University School of Medicine - Pediatrics, Cleveland, Ohio, USA.
³² Northwestern University Feinberg School of Medicine Ringgold standard institution - Neurology, Chicago, Illinois, USA.
³³ Kork - Epilepsy Center, Kehl-Kork, Germany.
³⁴ UTHSCSA - Neurology, San Antonio and South Texas Comprehensive Epilepsy Center, San Antonio, Texas.
³⁵ University of Texas Health Science Center - Neurosurgery, Houston, Texas, USA.
³⁶ National Hospital Organization Shizuoka Institute of Epilepsy and Neurological Disorders, Department of Epileptology, Urushiyama, Japan.
³⁷ Stichting Epilepsie Instellingen Nederland Ringgold standard institution - Neurology, Hoofddorp, Noord-Holland, The Netherlands.
³⁸ Beaumont Hospital - Department of Neurology, Dublin, Ireland.
³⁹ Grenoble-Alpes Hospital and University - Neurology Department and GIN INSERM U-1216, Grenoble, France.

PMID: 30782582
DOI: 10.1684/epd.2019.1033

Abstract

This 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].

Keywords: classification; epileptogenic zone; etiology; semiology.

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

Affiliations

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

Authors

Affiliations

Abstract

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LinkOut - more resources

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Medical