Anleitung („instruction manual“) zur Anwendung der operationalen Klassifikation von Anfallsformen der ILAE 2017

This companion paper to the introduction of the International League Against Epilepsy (ILAE) 2017 classification of seizure types provides guidance on how to employ the classification. The classification is illustrated by tables, a glossary of relevant terms, a table mapping old to new terms, recommended abbreviations and examples. Basic and extended versions of the classification are available depending on the desired degree of detail. Key signs and symptoms of seizures (semiology) are used as a basis for categorization of seizures that are focal or generalized from onset or with unknown onset. Any focal seizure can be further optionally characterized with respect to whether awareness is retained or impaired. Impaired awareness during any segment of the seizure renders it classified as a focal impaired awareness seizure. Focal seizures can be further optionally characterized by the first motor signs and symptoms as atonic, automatisms, clonic, epileptic spasms, hyperkinetic, myoclonic or tonic activity. Nonmotor onset seizures can be manifested as autonomic, behavior arrest, cognitive, emotional, or sensory dysfunction. The earliest prominent manifestation defines the seizure type, which can then further progress to other signs and symptoms. Focal seizures can become bilateral tonic–clonic seizures. Generalized seizures include an early involvement of bilateral networks from the onset. Generalized motor seizure characteristics comprise atonic, clonic, epileptic spasms, myoclonic, myoclonic–atonic, myoclonic–tonic–clonic, tonic or tonic–clonic manifestatíons. Nonmotor (absence) seizures are typical or atypical or seizures that present prominent myoclonic activity or eyelid myoclonia. Seizures of unknown origin may have features that can still be classified as motor, nonmotor, tonic–clonic, epileptic spasms or behavior arrest. This users’ manual for the ILAE 2017 seizure classification can assist the acceptance of the new system.