Summary Peri-ictal autonomic dysregulation is best studied using a “polygraphic” approach (EEG, 3-channel EKG, pulse Oximetry, respiration and continuous non-invasive blood pressure [BP]) and may help elucidate agonal pathophysiological mechanisms leading to Sudden Unexpected Death in Epilepsy (SUDEP). A number of autonomic phenomena have been described in generalized tonic-clonic seizures (GTCS), the commonest seizure type associated with SUDEP, including decreased heart rate variability, cardiac arrhythmias and changes in skin conductance. Post-ictal generalized EEG suppression (PGES) has been identified as a potential risk marker of SUDEP and PGES has been found to correlate with post GTCS autonomic dysregulation in some patients. Here, we describe a patient with a GTCS in whom polygraphic measurements, including continuous non-invasive blood pressure recordings, were obtained. Significant post-ictal hypotension lasting >60 seconds was found which closely correlated with PGES duration. Similar EEG changes are well described in hypotensive patients with vasovagal syncope and a similar vasodepressor phenomenon and consequent cerebral hypo-perfusion may account for the PGES observed in some patients after a GTCS. This further raises the possibility that profound, prolonged and irrecoverable hypotension may comprise one potential SUDEP mechanism.

EpSO plays a critical role in informatics tools for epilepsy patient care and multi-center clinical research.

Summary This article critiques the International League Against Epilepsy (ILAE) 2015‐2017 classifications of epilepsy, epileptic seizures, and status epilepticus. It points out the following shortcomings of the ILAE classifications: (1) they mix semiological terms with epileptogenic zone terminology; (2) simple and widely accepted terminology has been replaced by complex terminology containing less information; (3) seizure evolution cannot be described in any detail; (4) in the four‐level epilepsy classification, level two (epilepsy category) overlaps almost 100% with diagnostic level one (seizure type); and (5) the design of different classifications with distinct frameworks for newborns, adults, and patients in status epilepticus is confusing. The authors stress the importance of validating the new ILAE classifications and feel that the decision of Epilepsia to accept only manuscripts that use the ILAE classifications is premature and regrettable.

Over the last few decades the ILAE classifications for seizures and epilepsies (ILAE-EC) have been updated repeatedly to reflect the substantial progress that has been made in diagnosis and understanding of the etiology of epilepsies and seizures and to correct some of the shortcomings of the terminology used by the original taxonomy from the 1980s. However, these proposals have not been universally accepted or used in routine clinical practice. During the same period, a separate classification known as the "Four-dimensional epilepsy classification" (4D-EC) was developed which includes a seizure classification based exclusively on ictal symptomatology, which has been tested and adapted over the years. The extensive arguments for and against these two classification systems made in the past have mainly focused on the shortcomings of each system, presuming that they are incompatible. As a further more detailed discussion of the differences seemed relatively unproductive, we here review and assess the concordance between these two approaches that has evolved over time, to consider whether a classification incorporating the best aspects of the two approaches is feasible. To facilitate further discussion in this direction we outline a concrete proposal showing how such a compromise could be accomplished, the "Integrated Epilepsy Classification". This consists of five categories derived to different degrees from both of the classification systems: 1) a "Headline" summarizing localization and etiology for the less specialized users, 2) "Seizure type(s)", 3) "Epilepsy type" (focal, generalized or unknown allowing to add the epilepsy syndrome if available), 4) "Etiology", and 5) "Comorbidities & patient preferences".