Department of Pediatric Neurology, Gazi University, Faculty of Medicine, Besevler, Ankara, Turkey.
Eur Rev Med Pharmacol Sci. 2022 Apr;26(7):2343-2352. doi: 10.26355/eurrev_202204_28463.
Our aim in this study is to evaluate epilepsy classification in children with epilepsy before monitoring (based on information received from the family) and after monitoring (based on video-EEG) by comparing two separate classification systems, namely the 2017 International League Against Epilepsy (ILAE) and Semiological Seizure Classification (SSC) systems. Classifications and methods were compared in terms of simplicity, intelligibility, and applicability during daily outpatient care.
The study was performed with 230 recorded seizures of 173 patients aged between 1 and 18 years who underwent video-EEG monitoring and clinical seizure recordings. Seizure types and video-EEG data of the patients were recorded. Seizures were first classified based on information obtained from the parents of the patients in interviews, recorded as "before video-EEG monitoring classification," and a second characterization, based on video EEG-monitoring, was subsequently recorded as "after video-EEG monitoring classification". The consistency of both seizure classifications was evaluated.
For both classifications, autonomic seizures were the least congruent seizures (κ=0.27, κ=-0.005). The families generally described the seizures very well; the consistency before and after video-EEG monitoring was good. Focal seizures with impaired awareness were most common in the 2017 ILAE classification (κ=0.6), while for the SSC simple motor seizures were most common (κ=0.84). Among subtypes, clonic-tonic seizures were the most common, and the second most common subtype was dialeptic (κ=0.67). Overall, the harmony between the SSC and ILAE systems was good. The rate of good and excellent coefficients of concordance for both the SSC and 2017 ILAE was determined as 77.8% for the expanded SSC, 48% for the 2017 ILAE, 71.4% for the basic SSC, and 60% for the 2017 ILAE.
In practice, it is difficult to determine seizure patterns reliably in cases of childhood epilepsy. Parents, however, can generally describe seizures very well. Although the SSC seems to be superior, both the SSC and 2017 ILAE systems can be applied in daily use. Such classification enables the rise of new concepts and a better understanding of disease groups. The continuing development of classification systems will lead to advancements for patients.
本研究旨在通过比较两种独立的分类系统，即 2017 年国际抗癫痫联盟（ILAE）和半分性癫痫发作分类（SSC）系统，评估癫痫患儿在监测前（基于从家庭获得的信息）和监测后（基于视频-EEG）的癫痫分类。在日常门诊护理中，从简单性、可理解性和适用性方面比较分类和方法。
这项研究共纳入了 173 名年龄在 1 至 18 岁之间的患者的 230 例记录发作，这些患者接受了视频-EEG 监测和临床发作记录。记录了患者的发作类型和视频-EEG 数据。首先根据对患者家长的访谈中获得的信息对发作进行分类，记录为“视频-EEG 监测前分类”，然后根据视频-EEG 监测进行第二次特征描述，记录为“视频-EEG 监测后分类”。评估了这两种发作分类的一致性。
对于这两种分类，自主发作是最不一致的发作（κ=0.27，κ=-0.005）。家长通常能很好地描述发作，视频-EEG 监测前后的一致性良好。在 2017 年 ILAE 分类中，意识障碍下的局灶性发作最常见（κ=0.6），而 SSC 中简单运动性发作最常见（κ=0.84）。在亚型中，强直-阵挛性发作最常见，其次是二型（κ=0.67）。总体而言，SSC 和 ILAE 系统之间的协调性较好。扩展后的 SSC 、2017 年 ILAE 的良好和优秀一致性率分别为 77.8%、48%、基本 SSC 的 71.4%和 2017 年 ILAE 的 60%。
在实践中，很难可靠地确定儿童癫痫发作的模式。然而，家长通常可以很好地描述发作。虽然 SSC 似乎更优越，但 SSC 和 2017 年 ILAE 系统都可以在日常使用中应用。这种分类可以提出新的概念，并更好地理解疾病群体。分类系统的不断发展将为患者带来进步。
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