Epilepsy classification: a cycle of evolution and revolution

This review presents the new terms and concepts proposed by the International League Against Epilepsy (ILAE) Classification Commission in 2010 to describe seizures and epilepsies. This is the first major revision in 21 years and reflects the rapid evolution in our understanding of the epilepsies. The article places these changes in an historical perspective, summarizes elements of the lively debate that followed publication, presents refinements addressing those concerns and discusses issues that remain to be addressed. It describes the thinking behind the new terminology as the basis for framing further discoveries in the epilepsies. The purpose of the ILAE classification is primarily for clinical use to assist in patient care; a secondary purpose is for research. The 2010 Organization of the Epilepsies is therefore one of the most important clinical tools in the neurologist's armamentarium and impacts on virtually every epilepsy consultation. By necessity, the organization is dynamic and evolving. The new concepts reflect current understanding and were introduced as outdated terms and frameworks were no longer valid for clinical practice. These changes represent a major step forward that will improve patient management and understanding of the neurobiology of the epilepsies.