Use of the International League Against Epilepsy (ILAE) 1989, 2010, and 2017 Classification of Epilepsy in children in a low‐resource setting: A hospital‐based cross‐sectional study

Abstract

Objectives This cross‐sectional study was designed to test the applicability of the 1989, 2010, and 2017 International League Against Epilepsy (ILAE) classification of epilepsy in children from a resource‐limited setting in India. Methods Classification of seizure types and syndromes was done through parental interviews and review of medical records in children with epilepsy aged one month to 18 years. Available investigations including EEG, MRI, and metabolic/genetic tests were used in classifying patients as per the 1989, 2010, and 2017 ILAE (level II‐epilepsy type) classification. We compared the proportion of children remaining unclassified by each scheme. Results Seven hundred and twenty‐six children (436 males, mean age 6.4 ± 4.6 years) were enrolled. Using the 1989 ILAE classification, we were able to classify 95.7%, and 82.6% children by the 2010 scheme. The 2017 ILAE classification could classify all 726 children at level I (seizure type), 664 (91.0%) children at level II (epilepsy type), and an electroclinical syndrome could be identified in 409 (56.1%) of the children. An etiology could be identified in 75%, perinatal brain injury being the most frequent. West syndrome was the most common electroclinical syndrome, identified in 22.7% patients. The 1989 ILAE classification system was superior to the 2010 system (P = .01) in epilepsy classification. There was no difference between the 1989 and 2017 schemes (P = .31) or the 2010 and 2017 schemes (P = .10). Significance The 2017 ILAE classification, being multidimensional, allowed classification of children who could not undergo extensive evaluation due to economic constraints and also provided room for overlapping etiologies.

Clinical profile and treatment outcome of epilepsy syndromes in children: A hospital‐based study in Eastern Nepal

“…Male preponderance (69.2%) was seen in this study. Male preponderance (62.0%) has been also reported by other hospital‐based studies done in children with epilepsy in this region 13,15 . However, no such gender predilection has been reported in a population‐based study done in a developed country 14 .…”

“…SLCECTS was the third most common ES diagnosed in this study (12.5% of children with ESs). This was the second most common (10.3%) ES in a hospital‐based Indian study and was the most common (25.0%) ES in a population‐based Norwegian study 13,14 . This indicates that SLCECTS is a common ES among children all over the world.…”

“…In this study, diagnosis of ES was established in 15.6% of the total children with unprovoked seizures. In a hospital‐based study conducted in India using the ILAE 2017 classification system, ES was diagnosed in 409 (56.1%) out of 726 children with epilepsy 13 . In a similar study done at a resource‐rich setup using the ILAE 1989 classification system, 21.0% children were classified to have specific ES 12 .…”

“…In a hospital‐based study conducted by Sharma et al in India using the ILAE 2017 classification system, WS was the most common electro‐clinical syndrome, identified in 22.7% children with epilepsy and 40.3% children with ESs. Among children with ESs, SLCECTS (10.3%), GEFS+ (6.8%), JME (6.1%), LGS (5.6%), GTCSA (5.1%), CAE (4.4%) Dravet syndrome (2.0%), and EMA (0.7%) were the other common ESs 13 …”

“…Of these children, 129 (18.0%) had perinatal hypoxic‐ischemic brain injury. Sequela of CNS infection (26 neonatal infections and 37 postneonatal infections) was the cause of epilepsy in 63 (9%) of 726 children with epilepsy 13 . This reflects the scenario of higher prevalence of the conditions such as perinatal brain injury secondary to HIE and infectious etiologies in this region, causing long‐term morbidity like epilepsy.…”