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An expert task force in the USA has created a new definition for epilepsy that refines the scope of patients diagnosed with this condition. The study published in Epilepsia, the journal of the International League Against Epilepsy (ILAE), provides a greater level of detail to diagnose epilepsy by including individuals with two unprovoked seizures, and those with one unprovoked seizure and other factors that increase risk of seizure recurrence.

A 2005 report by the ILAE task force defined an epileptic seizure as “a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain” and epilepsy as “a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures, and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure.”

However, Dr Robert Fisher from Stanford University School of Medicine, lead author of the new task force believes that the 2005 definition does not allow a patient to outgrow epilepsy, nor does it take into account some clinicians’ views that epilepsy is present after a first unprovoked seizure when there is a high risk for another. “The task force recommendation resolves these issues with the new, more practical, definition of epilepsy that is aimed at clinicians”, says Dr Fisher.

The task force suggests that epilepsy is a disease of the brain defined as at least two unprovoked (or reflex) seizures occurring more than 24 hours apart, or one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60 per cent) after two unprovoked seizures, occurring over the next ten years, or diagnosis of an epilepsy syndrome.

“The burden of determining recurrence risk does not fall on the clinician. If information is not available on recurrence risk after a first seizure, then the definition defaults to the old definition,” says Dr Fisher. According to the article, epilepsy is “resolved” in individuals who are past the applicable age of an age-dependent epilepsy syndrome, or those that have been free of seizures for the last ten years and off anti-epileptic drugs (AEDs) for five years or more.

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