title: Instruction manual for the ILAE 2017 operational classification of seizure types.
abstract: This companion paper to the introduction of the International League Against Epilepsy (ILAE) 2017 classification of seizure types provides guidance on how to employ the classification. Illustration of the classification is enacted by tables, a glossary of relevant terms, mapping of old to new terms, suggested abbreviations, and examples. Basic and extended versions of the classification are available, depending on the desired degree of detail. Key signs and symptoms of seizures (semiology) are used as a basis for categories of seizures that are focal or generalized from onset or with unknown onset. Any focal seizure can further be optionally characterized by whether awareness is retained or impaired. Impaired awareness during any segment of the seizure renders it a focal impaired awareness seizure. Focal seizures are further optionally characterized by motor onset signs and symptoms: atonic, automatisms, clonic, epileptic spasms, or hyperkinetic, myoclonic, or tonic activity. Nonmotor-onset seizures can manifest as autonomic, behavior arrest, cognitive, emotional, or sensory dysfunction. The earliest prominent manifestation defines the seizure type, which might then progress to other signs and symptoms. Focal seizures can become bilateral tonic-clonic. Generalized seizures engage bilateral networks from onset. Generalized motor seizure characteristics comprise atonic, clonic, epileptic spasms, myoclonic, myoclonic-atonic, myoclonic-tonic-clonic, tonic, or tonic-clonic. Nonmotor (absence) seizures are typical or atypical, or seizures that present prominent myoclonic activity or eyelid myoclonia. Seizures of unknown onset may have features that can still be classified as motor, nonmotor, tonic-clonic, epileptic spasms, or behavior arrest. This "users' manual" for the ILAE 2017 seizure classification will assist the adoption of the new system.
authors.affiliation: Stanford Department of Neurology & Neurological Sciences, Stanford, California, U.S.A.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Fisher
authors.affiliation: UCL-Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: J Helen
authors.initials: JH
authors.lastname: Cross
authors.affiliation: Bombay Epilepsy Society, Mumbai, India.
authors.forename: Carol
authors.initials: C
authors.lastname: D'Souza
authors.affiliation: Department of Neurology, NYU Langone School of Medicine, New York, New York, U.S.A.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: French
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, New York, U.S.A.
authors.forename: Sheryl R
authors.initials: SR
authors.lastname: Haut
authors.affiliation: Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Norimichi
authors.initials: N
authors.lastname: Higurashi
authors.affiliation: Unite Francis Rohmer, Strasbourg, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Hirsch
authors.affiliation: Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands.
authors.forename: Floor E
authors.initials: FE
authors.lastname: Jansen
authors.affiliation: Pediatric Neurology, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Lagae
authors.affiliation: Saul R. Korey Department of Neurology, Department of Pediatrics and Dominick P. Purpura Department Neuroscience, Montefiore Medical Center, Bronx, New York, U.S.A.
authors.forename: Solomon L
authors.initials: SL
authors.lastname: Moshé
authors.affiliation: Department of Neurology, Tampere University Hospital, Tampere, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Peltola
authors.affiliation: Pediatric Neurorehabilitation Unit, CHUV, Lausanne, Switzerland.
authors.forename: Eliane
authors.initials: E
authors.lastname: Roulet Perez
authors.affiliation: Florey Institute and University of Melbourne, Austin Health and Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Scheffer
authors.affiliation: Epilepsy Center, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
authors.affiliation: Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ernest
authors.initials: E
authors.lastname: Somerville
authors.affiliation: Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Michael
authors.initials: M
authors.lastname: Sperling
authors.affiliation: Department of Neurology and Neurosurgery, Epilepsy Research and Treatment Unit, São Paulo, Brazil.
authors.forename: Elza Márcia
authors.initials: EM
authors.lastname: Yacubian
authors.affiliation: The Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, United Kingdom.|College of Medicine, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Sameer M
authors.initials: SM
authors.lastname: Zuberi
mesh_terms: D001364:Awareness; D004569:Electroencephalography; D006801:Humans; D007390:International Agencies / Q000592:standards; D012640:Seizures / Q000145:classification* / Q000503:physiopathology; D009626:Terminology as Topic
keywords: Classification; Epilepsy (taxonomy); Focal; Generalized; Seizures