PROPOSAL FOR REVISED SEIZURE CLASSIFICATION

Epilepsia, Vol. 22, August 1981

I.     PARTIAL (FOCAL, LOCAL) SEIZURES

Partial seizures can be classified into one of the following three
fundamental groups:

-  Simple partial seizures

-  Complex partial seizures
     1.   With impairment of consciousness at onset
     2.   Simple partial onset followed by impairment of consciousness

-  Partial seizures evolving to generalized tonic-clonic convulsions (GTC)
     1.   Simple evolving to GTC
     2.   Complex evolving to GTC (including those with simple partial onset)


Clinical seizure type

A.   Simple partial seizures (consciousness not impaired)

     1.   With motor signs

          a.   focal motor without march
          b.   focal motor with march (Jacksonian)
          c.   versive
          d.   postural
          e.   phonatory (vocalization or arrest of speech)

     2.   With somatosensory or special-sensory symptoms (simple
          hallucinations, e.g.,tingling, light flashes, buzzing)

          a.   somatosensory
          b.   visual
          c.   auditory
          d.   olfactory
          e.   gustatory

     3.   With autonomic symptoms or signs (including epigastric sensation,

          pallor, sweating, flushing, piloerection, and pupillary dilatation)

     4.   With psychic symptoms (disturbance of higher cerebral function).

          These symptoms rarely occur without impairment of consciousness

          and are much more commonly experienced as complex partial seizures.

          a.   dysphasic
          b.   dysmnesic (e.g., d‚j… vu)
          c.   cognitive (e.g., dreamy states, distortions of time sense)
          d.   affective (fear, anger, etc.)
          e.   illusions (e.g., macropsia)
          f.   structured hallucinations (e.g., music, scenes)

B.   Complex partial seizures (with impairment of consciousness;
     may sometimes begin with simple symptomatology)

     1.   Simple partial onset followed by impairment of consciousness

          a.   with simple partial features (A.1.-A.4.) followed by impaired
               consciousness

          b.   with automatisms

     2.   With impairment of consciousness at onset

          a.   with impairment of consciousness only
          b.   with automatisms

C.   Partial seizures evolving to secondarily generalized seizures
     (This may be generalized tonic-clonic, tonic, or clonic.)

     1.   Simple partial seizures (A) evolving to generalized seizures
     2.   Complex partial seizures (B) evolving to generalized seizures
     3.   Simple partial seizures evolving to complex partial seizures
          evolving to generalized seizures


         II.  GENERALIZED SEIZURES (CONVULSIVE OR NONCONVULSIVE)

Generalized seizures are those in which the first clinical changes indicate
initial involvement of both hemispheres.  Consciousness may be impaired and
this impairment may be the initial manifestation.  Motor manifestations are
bilateral.  The ictal electroencephalographic patterns initially are bilateral
and presumably reflect neuronal discharge which is widespread in both
hemispheres.

A.   1.   Absence seizures

          a.   impairment of consciousness only
          b.   with mild clonic components
          c.   with atonic components
          d.   with tonic components
          e.   with automatisms
          f.   with autonomic components

          (b through f may be used alone or in combination)

     2.   Atypical absence  May have:

          a.   changes in tone that are more pronounced than in A.1
          b.   onset and/or cessation that is not abrupt

B.   Myoclonic seizures  Myoclonic jerks (simple or multiple)
C.   Clonic seizures
D.   Tonic seizures
E.   Tonic-clonic seizures
F.   Atonic seizures (astatic) 

     Combinations of the above may occur, e.g., B and F, B and D.


                  III.  UNCLASSIFIED EPILEPTIC SEIZURES

Includes all seizures that cannot be classified because of inadequate or
incomplete data and some that defy classification in hitherto described
categories.  This includes some neonatal seizures, e.g., rhythmic eye
movements, chewing, and swimming movements.