A practical guide to the updated seizure classification 2025.
Publication/Presentation Date
12-1-2025
Abstract
This paper provides a practical guide to applying the updated seizure classification in clinical settings. The updated classification, published by the International League Against Epilepsy in 2025, builds on the operational classification introduced in 2017. It aims to enhance clarity, clinical relevance, and consistency in seizure terminology across various healthcare settings. The classification system distinguishes between four main seizure classes: focal, generalized, unknown whether focal or generalized, and unclassified. The basic version allows for application even in resource-limited or primary care environments, while the expanded version offers detailed semiological descriptors and supports advanced diagnostic and surgical decision-making. Consciousness, defined through awareness (recall) and responsiveness, is now considered a classifier. The paper also highlights the importance of distinguishing observable from non-observable features and integrates semiology into the expanded classification with attention to temporal sequence and somatotopic detail. Generalized seizures are categorized into seizure types having a direct impact on syndrome diagnosis and treatment decisions. Epileptic spasms are given special attention because of their unique presentation and the urgency of early intervention, particularly in infants. To support clinical implementation, this paper includes a comprehensive table of semiological descriptors, definitions of generalized seizure types, and a series of real-world case vignettes illustrating the application of the updated seizure classification. Supplementary figures and videos further support the educational aims of the paper. This practical guide is intended for healthcare professionals managing patients with epilepsy, providing a clear, structured approach to seizure classification that is adaptable to varying levels of clinical expertise and diagnostic resources.
Volume
27
Issue
6
First Page
1087
Last Page
1104
ISSN
1950-6945
Published In/Presented At
Beniczky, S., Trinka, E., Wirrell, E., Singh, M. B., Blumenfeld, H., Bogacz Fressola, A., Cendes, F., Craiu, D., Frauscher, B., Jansen, F. E., Kahane, P., Kander, V., Kishk, N., Khoo, C. S., Lizcano, A., De Palma, L., Ryvlin, P., Specchio, N., Sperling, M. R., Tatum, W., … Cross, J. H. (2025). A practical guide to the updated seizure classification 2025. Epileptic disorders : international epilepsy journal with videotape, 27(6), 1087–1104. https://doi.org/10.1002/epd2.70110
Disciplines
Medicine and Health Sciences
PubMedID
41081650
Department(s)
Department of Surgery
Document Type
Article