A practical guide to the updated seizure classification 2025
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.
Authors
- Judith Helen Cross (ORCID: https://orcid.org/0000-0001-7345-4829)
- Luca De Palma (ORCID: https://orcid.org/0000-0002-0714-8230)
- Jo M. Wilmshurst (ORCID: https://orcid.org/0000-0001-7328-1796)
- Floor E. Jansen (ORCID: https://orcid.org/0000-0003-0745-5668)
- Michael R. Sperling (ORCID: https://orcid.org/0000-0003-0708-6006)
- Alicia Bogacz Fressola (ORCID: https://orcid.org/0000-0001-5177-7811)
- Dana Craiu (ORCID: https://orcid.org/0000-0003-4156-6812)
- Philippe Ryvlin (ORCID: https://orcid.org/0000-0001-7775-6576)
- Nirmeen A. Kishk
- Hal Blumenfeld (ORCID: https://orcid.org/0000-0003-0812-8132)
- William O. Tatum (ORCID: https://orcid.org/0000-0002-4536-3791)
- Sándor Beniczky (ORCID: https://orcid.org/0000-0002-6035-6581)
- Fernando Cendes (ORCID: https://orcid.org/0000-0001-9336-9568)
- Birgit Frauscher (ORCID: https://orcid.org/0000-0001-6064-1529)
- Angélica Lizcano (ORCID: https://orcid.org/0000-0002-0694-9423)
- Veena Kander (ORCID: https://orcid.org/0000-0003-4903-3455)
- Elza Márcia Targas Yacubian (ORCID: https://orcid.org/0000-0001-8367-0189)
- Nicola Specchio (ORCID: https://orcid.org/0000-0002-8120-0287)
- Elaine C. Wirrell (ORCID: https://orcid.org/0000-0003-3015-8282)
- Ching Soong Khoo (ORCID: https://orcid.org/0000-0002-6756-0411)
- Eugen Trinka (ORCID: https://orcid.org/0000-0002-5950-2692)
- Mamta Bhushan Singh (ORCID: https://orcid.org/0000-0002-7217-8882)
- Philippe Kahane (ORCID: https://orcid.org/0000-0003-1330-3281)
Institutions
- Mayo Clinic (US)
- Cairo University (EG)
- Thomas Jefferson University (US)
- Inserm (FR)
- University of Cape Town (ZA)
- Carol Davila University of Medicine and Pharmacy (RO)
- Duke University (US)
- Universidad de la República de Uruguay (UY)
- Universidade Estadual de Campinas (UNICAMP) (BR)
- Aarhus University (DK)
- Paracelsus Medical University (AT)
- Hospital Kuala Lumpur (MY)
- Clinical Emergency Hospital Bucharest (RO)
- Great Ormond Street Hospital (GB)
- Centre Hospitalier Universitaire de Grenoble (FR)
- University Kebangsaan Malaysia Medical Centre (MY)
- Centre Hospitalier Universitaire Vaudois (CH)
- Aarhus University Hospital (DK)
- University Medical Center Utrecht (NL)
- Yale University (US)
- University of Oxford (GB)
- Instituto Neurológico de Colombia (CO)
- Austrian Institute for Health Technology Assessment GmbH (AT)
- Christian Doppler Klinik (AT)
- Bambino Gesù Children's Hospital (IT)
- Danish Gas Technology Centre (Denmark) (DK)
- Brazilian Institute of Neuroscience and Neurotechnology (BR)
- Institute of Neuroimmunology of the Slovak Academy of Sciences (SK)
- Mayo Clinic in Florida (US)
- Grenoble Institute of Neurosciences (FR)
- Red Cross War Memorial Children's Hospital (ZA)
- University College London (GB)
- All India Institute of Medical Sciences (IN)
- Universidade Federal de São Paulo (BR)
- National University of Malaysia (MY)
- Université Grenoble Alpes (FR)
Publication Details
- Journal
- Epileptic Disorders
- Published
- 2025-10-13
- DOI
- https://doi.org/10.1002/epd2.70110
- Citations
- 5
- Primary Topic
- Epilepsy research and treatment
- Type
- article
- Field-Weighted Citation Impact
- 7.36