Commentary – Should consciousness be included in the classification of focal (partial) seizures?

Authors

  • Hal Blumenfeld,

    1. Department ofNeurology,, Yale University School of Medicine, New Haven, Connecticut, U.S.A
    2. Department ofNeurobiology, and, Yale University School of Medicine, New Haven, Connecticut, U.S.A
    3. Department ofNeurosurgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
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  • Graeme D. Jackson

    1. Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
    2. Brain Research Institute, Florey Neuroscience Institutes, Heidelberg West, Victoria, Australia
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Summary

The ILAE 2010 report does not classify focal seizures and instead uses “descriptors” to distinguish focal seizures with versus without impaired consciousness. Below, we recall a recent informal conversation that took place while traveling a back road in Australia (true story), discussing problems with the old terms as well as new biological and practical evidence separating events formerly known as complex partial versus simple partial seizures. Impaired level of consciousness is a core distinguishing feature of focal seizures, which arises from established physiological mechanisms and can be readily determined based on behavior in most cases. After some debate, we arrive at succinct terms compatible with the old as well as the new ILAE classification report: Focal Impaired Consciousness Seizures (FICS), and Focal Aware Conscious Seizures (FACS). We hope that this discussion will bring impaired consciousness off the back roads of epilepsy classification, and provide useful names for these two very common seizure types.

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