A new epileptic seizure classification based exclusively on ictal semiology

Historically, seizure semiology was the main feature in the differential di agnosis of epileptic syndromes. With the development of clinical EEG, the d efinition of electroclinical complexes became an essential tool to define e pileptic syndromes, particularly focal epileptic syndromes. Modern advances in diagnostic technology, particularly in neuroimaging and molecular biolo gy, now permit better definitions of epileptic syndromes. At the same time detailed studies showed that there does not necessarily exist a one-to-one relationship between epileptic seizures or electroclinical complexes and ep ileptic syndromes. These developments call for the reintroduction of an epi leptic seizure classification based exclusively on clinical semiology, simi lar to the seizure classifications which were used by neurologists before t he introduction of the modern diagnostic methods. This classification of ep ileptic seizures should always be complemented by an epileptic syndrome cla ssification based on all. the available clinical information (clinical hist ory, neurological exam, ictal semiology, EEG, anatomical and functional neu roimaging, etc.). Such an approach is more consistent with mainstream clini cal neurology and would avoid the current confusion between the classificat ion of epileptic seizures (which in the International Seizure Classificatio n is actually a classification of electroclinical complexes) and the classi fication of epileptic syndromes.