IEC 2025 | The ILAE framework to aide in determining the etiology of neonatal seizures
Elissa Yozawitz, MD, Children’s Hospital at Montefiore, New York City, NY, comments on the International League Against Epilepsy (ILAE) neonatal seizure framework. The framework categorizes seizures into electrographic only seizures and electroclinical seizures, with further sub-classifications into motor and non-motor seizures, and also includes sequential and unclassified seizures. Prof. Yozawitz emphasizes the importance of this framework in standardizing seizure terminology, and aiding in diagnosis and treatment. This interview took place at the 36th International Epilepsy Congress (IEC) in Lisbon, Portugal.
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Transcript
So the ILAE classification of seizures comes, first of all, it’s different than other frameworks in the past because it only looks at EEG-confirmed seizures. So any baby that has a clinically suspicious event or is critically ill, we should do an EEG. Or if you don’t have an EEG, an aEEG, something to determine if these movements are a seizure or not. Anything not a seizure, we don’t even talk about them...
So the ILAE classification of seizures comes, first of all, it’s different than other frameworks in the past because it only looks at EEG-confirmed seizures. So any baby that has a clinically suspicious event or is critically ill, we should do an EEG. Or if you don’t have an EEG, an aEEG, something to determine if these movements are a seizure or not. Anything not a seizure, we don’t even talk about them. And then the seizures break down into the electrographic only seizures and the electroclinical seizures. So within electroclinical, it’s broken down into motor seizures, which are the automatisms, clonic seizures, which is that rhythmic jerking, the epileptic spasms, myoclonic, which is that irregular jerking, and tonic, which is an extension of the arm or leg. And then the non-motor, which is autonomic, which is like if there’s an apnea or any sort of irregular autonomic type thing being like a heart problem or tachycardia, apnea, those are the common ones we see. A behavioral arrest is something that you’ll only see if the EEG is on the head and you’ll only see if the baby is awake and moving because the only sign of a seizure is the baby stops moving. Then there’s sequential seizures where there’s no predominant seizure type. There’s multiple seizure types in a row. And typically with those, tonic seizure is the component. And then we have the unclassified seizures. So the importance of this framework is everybody speaks a certain language. These are the types of seizures that have EEG correlates. So some of the older terminologies like subtle seizures or bicycling don’t typically have EEG correlates. So these are the words that we use that are seizures. So everybody can speak the same language. And then these semiologies can be associated with certain etiologies. So if you see them at the bedside, you can go back, as I said before, and it can be a clue as to what is going on and can help you treat the seizures.
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