The decades-old controversy about whether or not to include consciousness in seizure classification carries on. Blumenfeld and Jackson (2013) make a further contribution to this, and for debate, Avanzini (2013) and Wolf (2013) add commentaries on this issue.
Here, I bring up, in the same spirit of debate, a further issue raised in this paper—the downsides of creating new terminology. New terms are obviously needed when there are significant changes in meaning or concept (a “paradigm shift”) or when the old terminology is deficient in some way, and of this there is no contention. However, when any new term is introduced in the absence of any paradigm shift, one must wonder why a change is necessary. There are downsides to change: new terms are potentially confusing to the wider community, especially those not intimately involved in classification; ill-considered change encourages a view of epilepsy that ignores its historical evolution (as Georges Santayana famously said “Those who cannot remember the past are condemned to repeat it”); changing terminology can lessen the credibility and authority of any classification scheme; in our jargon-ridden society, new terms without any strong intellectual underpinning tend to fall out of usage quickly, causing even more confusion. The purpose of classification is to facilitate research, diagnosis, investigation, and treatment; and the crucial test of any change in terminology is the extent to which this facilitation has been achieved. It is not clear to me that the change of terminology from complex and simple partial seizures to “FICS” and “FACS” (or indeed to “focal” as recently proposed by Berg et al., 2010) reflects any sort of paradigm shift or is facilitatory in any way. The same criticism applies to the contentious rejection of the terms “idiopathic,” “cryptogenic,” and “symptomatic” in the new proposed classification for epilepsy (Berg et al., 2010). I don't agree with Dr. Jackson's assertion that “no one has found much use for these terms, at least not recently.” The terms are in widespread use and have stood the test of time. They are used not only in the classification of epilepsy but also in many other neurologic (e.g., the international classification of headache) and nonneurologic conditions (e.g., the classifications of lung, liver, immunologic disease). The substitution of “genetic” for “idiopathic” is furthermore misleading, as the genetic basis of the great majority of idiopathic epilepsies is not known, and these epilepsies are likely to have multifactorial causal influences encompassing environmental, developmental, provoking and genetic factors—it is a simplification to label these as just “genetic.” The substitution of “unknown” for “cryptogenic” creates no new concept whatsoever but substitutes a sonorous and venerable Greek term, and appears simply to be a change for change sake. Finally, replacing “symptomatic,” a universally understood term used throughout medicine, with “structural/metabolic” is clumsy linguistically, and ignores the many symptomatic epilepsies that have no macroscopic structural or measurable metabolic change, such as those due to immunologic, inflammatory, degenerative, toxic, developmental, genetic, or biochemical causes.
The great advantages of the traditional International League Against Epilepsy (ILAE) terminologies are that they are stable, well-established, universally used, and fully understood. New terminologies are easy to create (they may take only a car ride), but it is less easy to ameliorate their unforeseen consequences.