title: Two-tier system of epilepsy evaluation: a useful method for developing countries.
abstract: OBJECTIVE
  To test the usefulness of a simplified and clinically oriented, the Epidemiological Classification (EC), in determination of seizure types and appropriate drug selection in epileptic patients at the primary care level.
  
  
  METHODS
  The EC was applied to all epileptic patients over 5 years then compared with the currently recommended international classifications of seizures and epilepsy (ICES/ICEES).
  
  
  RESULTS
  A total of 1176 patients were enrolled with 2:1 male preponderance and 88% had onset of disease below 30 years of age. Based on EC, 682 (58%) had partial, 333 (28.3%) had generalized and 161 (13.7%) had undetermined seizures semiology. When ICES was applied, seizure typing was same in 86.2%, 68.5% and 26.7% patients of partial, generalized and unclassified seizures respectively. About 87% patients in generalized and partial seizure semiology had no change in selected antiepileptic drug even after the ICES, but 53.6% patients in undetermined group had change in selected AED. Only, 146 patients (12.5%) found to have symptomatic cause for seizure(s) on applying the EC system. After utilizing the ICEES on 1030 patients (87.5%) of "unknown etiology" cases after the EC system, almost 86.5% patients could be classified to a definite etiological class.
  
  
  CONCLUSIONS
  The EC was found useful for determination of seizure type and appropriate AEDs selection at the primary care level. The ICES/ICEES works better at the tertiary care level. This "two-tier" system can be more effective for overall epilepsy management in developing countries with limited facilities.
authors.affiliation: Department of Neurology, Himalayan Institute of Medical Sciences, Dehradun, India.
authors.forename: D
authors.initials: D
authors.lastname: Goel
authors.forename: K K
authors.initials: KK
authors.lastname: Bansal
authors.forename: A
authors.initials: A
authors.lastname: Singhal
authors.forename: R
authors.initials: R
authors.lastname: Srivastav