Table 2

PROPOSED DIAGNOSTIC SCHEME FOR PEOPLE WITH EPILEPTIC SEIZURES AND WITH EPILEPSY

Epileptic seizures and epilepsy syndromes are to be described and categorized according to a system that utilizes standardized terminology, and that is sufficiently flexible to take into account the following practical and dynamic aspects of epilepsy diagnosis:

1. Some patients cannot be given a recognized syndromic diagnosis.
2. Seizure types and syndromes change as new information is obtained.
3. Complete and detailed descriptions of ictal phenomenology are not always necessary.
4. Multiple classification schemes can, and should, be designed for specific purposes (e.g. communication and teaching; therapeutic trials; epidemiological investigations; selection of surgical candidates; basic research; genetic characterizations).

This diagnostic scheme is divided into five parts, or Axes, organized to facilitate a logical clinical approach to the development of hypotheses necessary to determine the diagnostic studies and therapeutic strategies to be undertaken in individual patients:

Axis 1: Ictal phenomenology - from the Glossary of Descriptive Ictal Terminology can be used to describe ictal events with any degree of detail needed.

Axis 2: Seizure type - from the List of Epileptic Seizures. Localization within the brain and precipitating stimuli for reflex seizures should be specified when appropriate.

Axis 3: Syndrome - from the List of Epilepsy Syndromes, with the understanding that a syndromic diagnosis may not always be possible.

Axis 4: Etiology - from a Classification of Diseases Frequently Associated with Epileptic Seizures or epilepsy syndromes when possible, genetic defects, or specific pathological substrates for symptomatic focal epilepsies.

Axis 5: Impairment - this optional, but often useful, additional diagnostic parameter can be derived from an impairment classification adapted from the WHO ICIDH-2.