New classification of epilepsies and epileptic seizures (ILAE 2017): ways of implementation in Ukraine
Classification of diseases is being created in order to ensure the unity of methodological approaches to the study of nosological units and to comparing research materials at the international level. The review presents a brief analysis of the new epilepsy classifications approved in September 2017 and the types of epileptic seizures that have been developed by the International League Against Epilepsy (ILAE). The key points for revising the classification of epilepsy are as follows: ILAE provides a revised basis for the classification of epilepsy intended to use along with the classification of seizure types; diagnostic levels: type of seizure, type of epilepsy (focal, generalized, combined generalized and focal, unknown) and epileptic syndrome; etiological diagnosis should be made at the first visit of patient and during each step on the diagnostic pathway; the diagnosis of epilepsy can be classified in more than one etiological category (structural, genetic, infectious, metabolic, immune, unknown); the term “benign” is replaced by the terms “self-limited” and “pharmacosensitive”, which are used in cases where these terms can be appropriately applied; the terms “developmental encephalopathy” and “epileptic encephalopathy” are used in cases where these terms can be appropriately applied. In the diagnosis of epilepsy, the clinician can stop at any level of diagnosis. The ILAE Commission noted that previous classifications of epileptic seizures were based on the anatomical principle, with seizures divided into temporal, frontal, parietal, occipital, diencephalic and stem ones. Modern studies have changed views on pathophysiological mechanisms and have shown that epilepsy is a network disease, and not just a symptom of the local brain pathology. Although the understanding of this origin of seizures is developing very quickly, Commission considers it insufficient to serve as the basis for the scientific classification of epileptic seizures, which at this stage was called operational. Seizures are classified by the onset (generalized, focal and unknown). All types of seizures can be motor or non-motor. Focal seizure may evolve to bilateral tonic clonic ones. Atonic, clonic, tonic, myoclonic epileptic seizures can be either focal or generalized. Unclassified type of seizure was introduced. New types of generalized seizures were introduced — absence with eyelid myoclonia, myoclonic absence, myoclonic-atonic and myoclonic-tonic-clonic seizures. New terminology, definitions and some concepts developed by ILAE are discussed. The necessity of timely introduction of new classifications 2017 into clinical practice in Ukraine is underlined. The working group of Ukrainian League Against Epilepsy proposed the main directions of this process.
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