Childhood Epilepsy_5 Practice Points

1. As per the recent International league against epilepsy (ILAE) classification, partial seizures are now called as focal seizures. The terms like simple partial seizure and complex partial seizure are no longer used. We use focal seizure with preserved awareness or focal seizure with impaired awareness.  
2. Seizures can be focal, generalized, unknown onset or unclassified onset. We call it unclassified when the seizure was not witnessed or it is not clear whether the onset was focal or not.
3. New seizure types that are now included in the ILAE classification include absence with eyelid myoclonia, myoclonic atonic, behavioural arrest, and emotional. Seizures types that are not used anymore include dyscognitive or psychic seizures type
4. Focal seizures often respond well to carbamazepine, oxcarbazepine, phenytoin and levetiracetam. Generalized seizures respond well to sodium valproate, levetiracetam.
5. Avoid valproate in adolescent girl (risk of obesity and PCOS), avoid levetiracetam in those with pre-existing behavioural disturbances, avoid phenytoin in adolescent girls (cosmetic reason), avoid phenytoin or carbamazepine for chronic prophylaxis of focal febrile seizure or febrile status epilepticus.

Visit the website of ILAE at URL: https://www.ilae.org/guidelines/definition-and-classification for further details

References

1. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE Classification of the Epilepsies: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58:512–21.
2. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational Classification of Seizure Types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58:522–530
3. Fisher RS, Cross JH, Souza CD, Higurashi N, Hirsch E, Jansen FE, et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia. 2017;58:531-42.
4. Brodie MJ, Zuberi SM, Scheffer IE, Fisher RS. The 2017 ILAE classification of seizure types and the epilepsies: what do people with epilepsy and their caregivers need to know? Epileptic Disord. 2018;20:77-87

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