January 11, 2022

Proposal for an Updated Seizure Classification Framework in Clinical Trials

Abstract, originally published in Epilepsia

The International League Against Epilepsy (ILAE) seizure classification scheme has been periodically updated to improve its reliability and applicability to clinicians and researchers alike. Here, members of the Epilepsy Study Consortium propose a pragmatic seizure classification, based on the ILAE scheme, designed for use in clinical trials with a focus on outcome measures that have high reliability, broad interpretability across stakeholders, and clinical relevance in the context of the development of novel antiseizure medications. Controversies around the current ILAE classification scheme are discussed in the context of clinical trials, and pragmatic simplifications to the existing scheme are proposed, for intended use by investigators, industry sponsors, and regulatory agencies.

Key Points

We recommend modifying terminology from focal aware with or without motor signs, to focal aware with or without observable signs.

We recommend against distinguishing focal unaware with or without motor signs.

We recommend against the use of the term “drop seizures” in clinical trials, and advocate for the use of recent classification terminology.

We support integrating complementary surrogate markers (e.g., EEG) to count seizure types with poor self-report reliability.

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