Modern technology calls for a modern approach to classification of epileptic seizures and the epilepsies.

In the last 10-15 years the ILAE Commission on Classification and Terminology has been presenting proposals to modernize the current ILAE Classification of Epileptic Seizures and Epilepsies. These proposals were discussed extensively in a series of articles published recently in Epilepsia and Epilepsy Currents. There is almost universal consensus that the availability of new diagnostic techniques as also of a modern understanding of epilepsy calls for a complete revision of the Classification of Epileptic Seizures and Epilepsies.

Are the dichotomies generalized versus focal epilepsies and idiopathic versus symptomatic epilepsies still valid in modern epileptology?

In this commentary we discuss the basic concept of an epileptogenicity level, which is variable in different brain regions and is a function of multiple factors including the basic epileptogenicity level, routine environmental or internal stimuli, and various triggering and causative factors. This concept blurs the distinction between focal versus generalized and between idiopathic versus symptomatic epilepsies. We suggest dropping the dichotomy idiopathic versus symptomatic and to instead simply list the different etiologic factors that increase the epileptogenicity level.