EC Neurology

Review Article Volume 17 Issue 8 - 2025

Challenges and Debates Regarding the New Classification of Epileptic Seizures of 2025

Juan Enrique Bender del Busto*

Philosopher Doctor, Second Degree Specialist in Neurology, Full Professor and Researcher, Neurology Department, International Center of Neurological Restoration (CIREN), Havana, Cuba

*Corresponding Author: Juan Enrique Bender del Busto, Philosopher Doctor, Second Degree Specialist in Neurology, Full Professor and Researcher, Neurology Department, International Center of Neurological Restoration (CIREN), Havana, Cuba.
Received: July 02, 2025; Published: July 18, 2025



The introduction of the 2025 Epileptic Seizure Classification has generated considerable debate in the neuroscientific community. Although it seeks to optimize diagnostic accuracy and communication, this article examines the main criticisms related to its complexity, the learning curve for clinicians, and its potential impact on patient management. It is argued that, while innovation is crucial, the implementation of this classification must consider its inherent challenges to ensure its effective adoption and clinical benefit. We analyze potential limitations, resistance to its adoption, its impact on clinical practice and research, and considerations for future revisions.

 Keywords: Epileptic Seizure Classification; Epilepsy; Clinical Practice and Research

  1. Bender JE. “Manejo multifactorial de la epilepsia: una necesidad perentoria”. Medimay 31 (2024): e2635.
  2. Eadie M. “Epilepsy-from the Sakikku to hughlings Jackson”. Journal of Clinical Neuroscience 2 (1995): 156-162.
  3. Jerome EJ and Timothy JP. “Epilepsy: A comprehensive textbook 2nd edition”. Philadelphia, USA. A Wolters Kluwer Business (2008).
  4. Santos-Fabelo MC. “Capítulo I Antecedentes históricos”. En: Bender del Busto JE, Santos-Fabelo MC, Hernández-Toledo L. La atención integral en el paciente con epilepsia [Internet]. Juárez: Universidad Autónoma de Ciudad Juárez, Chihuahua, México (2021): 17-30.
  5. Bender dB. “Manejo integral del paciente con epilepsia”. Deutschland, Alemania. Editorial Académica Española (2014).
  6. Gastaut H. “Clinical and elctoencephalographical classification of epileptic seizures”. Epilepsia 1 (1970): 102-113.
  7. Bender del Busto JE. “Capítulo IV Clasificación de las crisis epilépticas”. En: Bender del Busto JE, Santos-Fabelo MC, Hernández-Toledo L. La atención integral en el paciente con epilepsia [Internet]. Juárez: Universidad Autónoma de Ciudad Juárez, Chihuahua, México (2021): 55-71.
  8. Bancaud J., et al. “Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the commission on classification and terminology of the international league against epilepsy”. Epilepsia 4 (1981): 489-501.
  9. Commission on Classification and Terminology of the International League Against Epilepsy. “Proposal for revised classification of epilepsies and epileptic syndromes”. Epilepsia3 (1985): 268-278.
  10. Commission on Classification and Terminology of the International League Against Epilepsy. “Proposal for revised classification of epilepsies and epileptic syndromes”. Epilepsia4 (1989): 389-399.
  11. Lüders H., et al. “Semiological seizure classification”. Epilepsia9 (1998): 1006-1013.
  12. Fisher RS. “Epileptic Seizures and Epilepsy: Definitions Proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)”. Epilepsia 4 (2005): 470-472.
  13. Berg AT., et al. “Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009”. Epilepsia4 (2010): 676-685.
  14. Engel J. “A proposed Diagnostic Scheme for People with Epileptic Seizures and with Epilepsy: Report of the ILAE Task Force on Classification and Terminology”. Epilepsia6 (2001): 796-803.
  15. Engel J Jr. “ILAE classification of epilepsy syndromes”. Epilepsy Research 1 (2006a): S5-S10.
  16. Engel J Jr. “Report of the ILAE classification core group”. Epilepsia9 (2006b): 1558-1568.
  17. Salas-Puig J. “Nueva propuesta de clasificaciَón de las crisis epilépticas y de las epilepsias de la Liga Internacional contra la Epilepsia (ILAE) [editorial]”. Revista de Neurología 9 (2011): 513-514.
  18. Korff CM and Scheffer IE. “Epilepsy classification: a cycle of evolution and revolution”. Current Opinion in Neurology 2 (2013): 163-167.
  19. Terra Vera C and Sakamoto Américo C. “Clasificación de las crisis epilépticas para la programación terapéutica”. En E.M. Targas Yacubian, G. Contreras-Caicedo, L. Ríos-Pohl. Tratamiento farmacológico de las epilepsias. Bela Vista-Sao Paulo, Brazil: Leitura Médica Ltda. (2014): 19-34.
  20. Fisher RS., et al. “Clasificación operacional de los tipos de crisis por la Liga Internacional contra la Epilepsia: Documento-Posición de la Comisión para Clasificación y Terminología de la ILAE”. Epilepsia4 (2017): 522-530.
  21. Beniczky S., et al. “Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy”. Epilepsia6 (2025): 1804-1823.
  22. Lüders H., et al. “Critique of the 2017 epileptic seizure and epilepsy classifications”. Epilepsia6 (2019): 1032-1039.
  23. Stefan H and Trinka E. “Generalized absence seizures: Where do we stand today?” Zeitschrift für Epileptologie 1 (2022): 56-72.
  24. Devinsky O., et al. “Idiopathic generalized epilepsy: misunderstandings, challenges, and opportunities”. Neurology3 (2024): e208076.
  25. Lewis-Smith D., et al. “Modeling seizures in the human phenotype ontology according to contemporary ILAE concepts makes big phenotypic data tractable”. Epilepsia6 (2021): 1293-1305.
  26. Takahashi Y., et al. “Different pharmacoresistance of focal epileptic spasms, generalized epileptic spasms, and generalized epileptic spasms combined with focal seizures”. Epilepsia Open1 (2022): 85-97.
  27. Gloor P. “Consciousness as a neurological concept in epileptology: a critical review”. Epilepsia2 (1986): S14-S26.
  28. Mielke H., et al. “Which seizure elements do patients memorize? A comparison of history and seizure documentation”. Epilepsia7 (2020): 1365-1375.
  29. Contreras Ramirez V., et al. “Evaluating consciousness and awareness during focal seizures: responsiveness testing versus recall testing”. Epileptic Disorders5 (2022): 899-905.
  30. Contreras Ramirez V., et al. “Testing awareness in focal seizures: clinical practice and interpretation of current guidelines”. Annals of Clinical and Translational Neurology 5 (2022): 762-765.
  31. Steriade C., et al. “Proposal for an updated seizure classification framework in clinical trials”. Epilepsia3 (2022): 565-572.
  32. Giacino JT., et al. “The JFK coma recovery scale-revised: measurement characteristics and diagnostic utility”. Archives of Physical Medicine and Rehabilitation 12 (2004): 2020-2029.
  33. Pressler RM., et al. “The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures”. Epilepsia 3 (2021): 615-628.
  34. Blume WT., et al. “Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology”. Epilepsia9 (2001): 1212-1218.
  35. Beniczky S., et al. “Seizure semiology: ILAE glossary of terms and their significance”. Epileptic Disorders3 (2022): 447-495.
  36. Trinka E., et al. “A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus”. Epilepsia10 (2015): 1515-1523.
  37. Zangwill WI and Kantor PB. “Toward a theory of continuous improvement and the learning curve”. Management Science7 (1998): 910-920.
  38. Picardo O and Ábrego AM. “La curva del aprendizaje: un enfoque neuroevolutivo y neurocientífico (2nd edition)”. UFG Editores (2021).
  39. Palmini A., et al. “From theory to practice: Critical points in the 2017 ILAE classification of epileptic seizures and epilepsies”. Epilepsia2 (2020): 350-353.
  40. Rosenow F., et al. “Could the 2017 ILAE and the four-dimensional epilepsy classifications be merged to a new "Integrated Epilepsy Classification"?” Seizure 78 (2020): 31-37.
  41. Sarmast ST., et al. “Current classification of seizures and epilepsies: scope, limitations and recommendations for future action”. Cureus 9 (2020): e10549.
  42. Commission on Classification and Terminology of the ILAE. “Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy”. Epilepsia 4 (1981): 489-501.
  43. Legnani M., et al. “Applicability and contribution of the new ILAE 2017 classification of epileptic seizures and epilepsies”. Epileptic Disorders6 (2019): 549-554.
  44. Goodman M. “The art of clarity”. The New England Journal of Medicine10 (1998): 706-708.
  45. Kartheek T., et al. “Application of 1981 and 2017 ILAE epilepsy classification of seizure types in an outpatient setting”. Annals of Indian Academy of Neurology 1 (2019): S14.
  46. Gillings MR., et al. “Technological progress and the perpetual learning curve [Spectral Lines]”. IEEE Spectrum11 (2016): 8-8.
  47. Shanafelt TD., et al. “Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014”. Mayo Clinic Proceedings12 (2015): 1600-1613.
  48. Turek G and Skjei K. “Seizure semiology, localization, and the 2017 ILAE seizure classification”. Epilepsy and Behavior 126 (2022): 108455.
  49. Loddenkemper T., et al. “A proposal for a five-dimensional patient-oriented epilepsy classification”. Epileptic Disorders 4 (2005): 308-316.
  50. Zuberi SM., et al. “ILAE classification and definition of epilepsy syndromes with onset in neonates and infants: position statement by the ILAE task force on nosology and definitions”. Epilepsia 6 (2022): 1349-1397.

Juan Enrique Bender del Busto. “Challenges and Debates Regarding the New Classification of Epileptic Seizures of 2025”. EC Neurology  17.8 (2025): 01-09 .