Luders_1998_Classification

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

Luders_1998_Classification

Luders 1998: Classification Seizure sequence Most seizures consist of symptoms that evolve as the seizure discharge spreads to involve new cortical areas. In the semiological classification of seizures, this evolution is indicated by considering each one of the seizures described above as one component of a seizure. Any given seizure consists of one or more of these components, which are listed in order of appearance and are linked by arrows. Example: Left visual aura → left hand clonic seizure → generalized tonic-clonic seizure Left visual aura → bilateral asymmetric tonic seizure → left arm clonic seizure Abdominal aura → left hemispheric automotor seizure Olfactory aura → automotor seizure → left versive seizure → generalized tonic-clonic seizure Generalized myoclonic seizure → generalized tonic-clonic seizure
 Typical dialeptic seizure → generalized tonic-clonic seizure Typically, we limit the number of seizure components to four for practical purposes. Epilepsy classification The semiological seizure classification is a classification of the semiology of the seizures only. The epileptic syndrome, however, is defined by considering all clinical information (semiological seizure type, interictal EEG, ictal EEG, functional and anatomic neuroimaging, seizure evolution over time, neurological examination, and so on). In our institutions, we first define the epileptic syndrome, then list the semiological characteristics of the patient’s seizures, state the presumed cause of the epileptic syndrome, and record important additional medical conditions which the patient has. This approach summarizes the essential features of the epilepsy and has been described in detail elsewhere (6). Some illustrative examples follow. 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 a generalized epilpetic 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 seldome 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#Classification_System