Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy

Beniczky S, Trinka E, Wirrell E, Abdulla F, Al Baradie R, Alonso Vanegas M, Auvin S, Singh MB, Blumenfeld H, Bogacz Fressola A, Caraballo R, Carreno M, Cendes F, Charway A, Cook M, Craiu D, Ezeala-Adikaibe B, Frauscher B, French J, Gule MV, Higurashi N, Ikeda A, Jansen FE, Jobst B, Kahane P, Kishk N, Khoo CS, Vinayan KP, Lagae L, Lim KS, Lizcano A, McGonigal A, Perez-Gosiengfiao KT, Ryvlin P, Specchio N, Sperling MR, Stefan H, Tatum W, Tripathi M, Yacubian EM, Wiebe S, Wilmshurst J, Zhou D, Cross JH (2025)

Publication Type: Journal article

Publication year: 2025

Journal

DOI: 10.1111/epi.18338

Abstract

The International League Against Epilepsy (ILAE) has updated the operational classification of epileptic seizures, building upon the framework established in 2017. This revision, informed by the implementation experience, involved a working group appointed by the ILAE Executive Committee. Comprising 37 members from all ILAE regions, the group utilized a modified Delphi process, requiring a consensus threshold of more than two thirds for any proposal. Following public comments, the Executive Committee appointed seven additional experts to the revision task force to address and incorporate the issues raised, as appropriate. The updated classification maintains four main seizure classes: Focal, Generalized, Unknown (whether focal or generalized), and Unclassified. Taxonomic rules distinguish classifiers, which are considered to reflect biological classes and directly impact clinical management, from descriptors, which indicate other important seizure characteristics. Focal seizures and those of unknown origin are further classified by the patient's state of consciousness (impaired or preserved) during the seizure, defined operationally through clinical assessment of awareness and responsiveness. If the state of consciousness is undetermined, the seizure is classified under the parent term, that is, the main seizure class (focal seizure or seizure of unknown origin). Generalized seizures are grouped into absence seizures, generalized tonic–clonic seizures, and other generalized seizures, now including recognition of negative myoclonus as a seizure type. Seizures are described in the basic version as with or without observable manifestations, whereas an expanded version utilizes the chronological sequence of seizure semiology. This updated classification comprises four main classes and 21 seizure types. Special emphasis was placed on ensuring translatability into languages beyond English. Its aim is to establish a common language for all health care professionals involved in epilepsy care, from resource-limited areas to highly specialized centers, and to provide accessible terms for patients and caregivers.

Authors with CRIS profile

Involved external institutions

University of Malaya (UM) / Universiti Malaya Malaysia (MY) Amrita University / Amrita Vishwa Vidyapeetham India (IN) Katholieke Universiteit Leuven (KUL) / Catholic University of Leuven Belgium (BE) University of Queensland Australia (AU) University of the Philippines Manila (UPM) Philippines (PH) Universidade Estadual de Campinas (UNICAMP) / University of Campinas Brazil (BR) 37 Military Hospital Ghana (GH) Carol Davila University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie „Carol Davila” (UMF București) Romania (RO) University of Nigeria Nigeria (NG) New York University (NYU) United States (USA) (US) Groote Schuur Hospital South Africa (ZA) Jikei University School of Medicine / 東京慈恵会医科大学 Japan (JP) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) Geisel School of Medicine United States (USA) (US) Grenoble Institute of Neurosciences (GIN) / Institut des Neurosciences de Grenoble France (FR) Cairo University Egypt (EG) Aarhus University Hospital / Aarhus Universitetshospital Denmark (DK) Duke University United States (USA) (US) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Ospedale Pediatrico Bambino Gesu Italy (IT) Thomas Jefferson University Hospitals United States (USA) (US) Mayo Clinic Hospital United States (USA) (US) All India Institute of Medical Sciences India (IN) Federal University of São Paulo / Universidade Federal de São Paulo (UNIFESP) Brazil (BR) University of Calgary Canada (CA) Red Cross War Memorial Children’s Hospital South Africa (ZA) West China Medical Center of Sichuan University / 四川大学华西医学中心 China (CN) University College London (UCL) United Kingdom (GB) Christian Doppler Klinik Austria (AT) Mayo Clinic United States (USA) (US) Ministry of Health Bahrain (BH) Hôpital Universitaire Robert-Debré France (FR) Yale School of Medicine United States (USA) (US) University of the Republic / Universidad de la República (UdelaR) Uruguay (UY) Hospital Garrahan / El Hospital Garrahan Argentina (AR) Hospital Clínic de Barcelona Spain (ES) King Fahad Specialist Hospital (KFSHD) / Gulf Hospital / مستشفى الملك فهد التخصصي Saudi Arabia (SA) HMG Hospital Coyoacán Mexico (MX)

How to cite

APA:

Beniczky, S., Trinka, E., Wirrell, E., Abdulla, F., Al Baradie, R., Alonso Vanegas, M.,... Cross, J.H. (2025). Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy. Epilepsia. https://doi.org/10.1111/epi.18338

MLA:

Beniczky, Sándor, et al. "Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy." Epilepsia (2025).

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