Luders_1998_1.0_Overview

http://www.semanticweb.org/rjyy/ontologies/2015/5/ESSO#Luders_1998_1.0_Overview

Luders_1998_1.0_Overview

Luders 1998 Our seizure classification is based exclusively on ictal seizure semiology, either as reported by the patient or observers or as analyzed directly during video monitoring (Table 1). No EEG findings or other test results influence the classification. Ictal symptoms can be produced by epileptic interference of one of the following four “spheres”: a. Sensorial sphere.
 b. Consciousness sphere. c. Autonomic sphere. d. Motor sphere. SUMMARY OF THE ESSENTIAL CHARACTERISTICS OF THE SEMIOLOGICAL CLASSIFICATION OF EPILEPTIC SEIZURES The semiological seizure classification outlined above integrates the following features, which make it particularly useful for everyday application: 1. The terminology applied is as succinct as possible to facilitate everyday use. 2. Whenever available, “classical” terminology, well known to general neurologists and epileptologists, has been used. 3. The classification includes a few new terms, such as automotor, hypomotor, hypermotor, and dialeptic seizures. These new terms have been introduced to avoid confusion with other terms that identify similar seizures but that are defined not by pure semiological criteria but by electroclinical characteristics (see section Dialeptic seizures). 4. The semiological seizure classification includes ‘‘somatotopic modifiers’’ that permit definition of the somatotopic distribution of the ictal symptoms. 5. Each seizure type is considered a component. Different seizure evolutions are expressed by linking the different seizure types (“components”) by an arrow. Types of seizure evolution are not limited arbitrarily. This classification system should permit scientific studies of the most frequent type of seizure evolutions. 6. Ictal symptoms frequently cannot be defined with precision because of inadequate information (for example, a patient may be amnestic of the seizure and there may be no witness to the seizure or a witness may provide an incomplete and inaccurate history). The semiological difference classification permits classification of seizures with different degrees of precision. For example, if we believe that the patient had an epileptic seizure, we classify it as “epileptic seizure.” If the main manifestation was motor, we classify the seizure as a “motor seizure.” If the main manifestation was motor, we classify the seizure as a “motor seizure.” If the motor seizure affected the right arm but we do not know if it was a simple or complex motor seizure, we can classify it as “right arm motor seizure.” If we know that the movements during the seizure were “simple” (see definition above), but we have difficulty in defining the subtype, we can classify the seizure as “right arm simple motor seizure.” And finally, if by history or direct observation we can establish that the movement of the right arm was of clonic type, we can classify the seizure in its maximum degree of precision, namely as “right arm clonic seizure.” In other words, from left to right in Table 1, progressively more precise information is provided about the ictal semiology. ADVANTAGES OF SEMIOLOGICAL SEIZURE CLASSIFICATION Semiological classification of epileptic seizures has the following advantages: 1. It provides a terminology that permits clear identification of ictal semiological features independent of any other rest results. 2. It clarifies the difference between seizure classification and epileptic syndrome classification. Many epileptic syndromes may be associated with the same types of seizures (when classified semiologically); therefore, appropriate management of the patient will require that the physician define the epileptic syndrome. For example, establishing that a patient has dialeptic seizures does not tell us whether the patient has generalized epileptic syndrome such as absence epilepsy, which can be treated with ethosuximide, or a focal epileptic syndrome, in which ethosuximide is ineffective. 3. A semiological seizure classification focuses the attention of the observer on clinical semiology.
 4. A semiological seizure classification in which we do not assume a one-to-one relationship between clinical semiology and other test results promotes scientific correlation studies between the different types of seizures (classified exclusively on the basis of ictal semiology) and other test results. Such studies should eventually provide better understanding of the significance of different semiological features. 5. A semiological seizure classification, particularly if it is comprehensive, can be applied to any age group. However, certain types of seizures will not occur or will seldom occur in newborn and infants because of their incompletely developed nervous system. CONCLUSION In this short outline, we introduce a semiological seizure classification. The present version—or variants of it-has been used in daily clinical practice for >10 years in selected epilepsy centers. The advantages of a semiological seizure classification are stressed.

http://www.semanticweb.org/rjyy/ontologies/2015/5/ESSO#Luders_1998_Classification