CLASSIFICATION OF THE IMPACT OF EPILEPSY

Classification systems are tools to facilitate understanding by creating order amongst objects, observations or ideas. At the same time, in order to be able to classify items these systems have to be defined and thus classification and the terminology used to define these items are closely related. The adaptation of a generic terminology will facilitate communication amongst all those with an interest in the area of investigation.

Global organizations are well positioned to ensure the universal use of classification systems. The WHO, for example, has a longstanding tradition of publishing the International Classification of Diseases (ICD). The ICD was first formalised in 1893 as the Bertillon Classification or International List of Causes of Death. While the title has been amended to make clearer the content and purpose and to reflect the progressive extension of the scope of the classification beyond diseases and injuries, the familiar abbreviation "ICD" has been retained. In the updated classification, conditions have been grouped in a way that was felt to be most suitable for general epidemiological purposes and the evaluation of health care.

In the seventies the need to bring order to the description of the consequences of disease became evident. The initial plan was to extend the ICD to incorporate this further classification by adding a supplementary digit to the existing ICD system. A preliminary scheme using this system was presented to WHO and after further discussions a new system was published, for trial purposes, as a supplement but not as an integral part of the ICD.

Such endeavors resulted in a manual on the classification of the consequences of disease. The International Classification of Impairments, Disabilities and Handicaps (ICIDH) was first published for trial purposes in 1980. Following the testing of the ICIDH it was felt that a totally new structure was required in order to clarify the impact of disease on the individual. In the nineties the ICIDH-2 was developed and tested. ICIDH-2 has moved away from a 'consequence of disease' classification (as in the 1980 version) to a 'components of health' classification. Although the abbreviation has been maintained the present name International Classification of Functioning, Disability and Health, reflects the intention to provide a unified and standard language and framework for the description of health and health-related states. The ICIDH-2 and a browser can be downloaded free from the ICIDH-2 website http://www.who.int/icidh

ILAE concerned with the field of epileptology desires to utilize as much as possible systems recommended by organizations such as the WHO. However, at present the ICIDH-2 is not precise enough to use for the description of the health status of people with epilepsy. It has therefore, been recommended that a commission elaborate proposals:

1. to adapt the ICIDH-2 for use to classify the consequences both of the interictal and the ictal state in persons with epilepsy in close cooperation with WHO;
2. to produce a brochure to describe the essence of the system for users in the field of epilepsy care;
3. to produce an adaptation of ICIDH-2 containing the elements that are generally applicable in the epilepsy field, the quantification of these and to provide directions for its use;
4. to develop or propose instruments of assessment, which are needed, for the correct classification of the consequences of epilepsy in so far these are not well circumscribed or perhaps unavailable.

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