New York, USA
|Ley Sander, Consultant
|David Thurman, Consultant
There were two major projects undertaken by the Commission over the past four years and a third that was not completed.
- The major activity was an effort to develop guidelines for the classification and definitions of acute symptomatic seizures. Acute symptomatic seizures have an incidence equal to or greater than the incidence of epilepsy in most countries. The age specific distribution is similar to that of epilepsy (high in the first year of life and high in the elderly). They differ from epilepsy in several important aspects. Because of the antecedents, mortality is exceeding high. The risk for subsequent epilepsy—that is, further seizures — is modest (0 to 30 percent depending on the insult). Long-term treatment with antiseizure medications is seldom necessary. The treatment rather is related to addressing the underlying condition.
There has been a problem with classification of such seizures and the assignment to this category has been somewhat arbitrary. To this end, we attempt to provided guidelines to distinguish this class of seizures from unprovoked seizures. After preliminary work in 2004 by Commission members, a two-day meeting was held in Umea, Sweden to establish guidelines. This meeting was followed by phone conferences to complete the paper with compilation and a final report, which I hope will be published in Epilepsia.
Unfortunately for our Commission, a paper defining epilepsy and approved by the ILAE was published in April 2005 (Fisher et al. Epilepsia. 2005 Apr; 46:470-2) and recommended the abolishment of the term (and presumably the concepts of) acute symptomatic seizures, rather considering most of these cases to be epilepsy. This in essence seems to have made the efforts of this Commission irrelevant to epilepsy. This explains my hesitation to submit this report. Since these seem an important subgroup of the seizure disorders and from an epidemiologic standpoint will continue to be a separate category, the group feels we should still submit this and hope for approval.
- A workshop on mortality was held by the previous Commission. After several false starts, the results of this workshop were published as a report from the Commission as a supplement to Epilepsia in December 2005.
- Sudden death in epilepsy remains a major problem for people with epilepsy, particularly those with long- standing disease and frequent seizures. An effort was made to combine the three major case control studies of SUDEP in order to establish predictive models. There was preliminary agreement by the investigators of these three studies to combine data to allow development of predictive models. Unfortunately, only two of the data sets were provided. We feel this is still an appropriate undertaking and should be pursued by the ILAE under some auspices.
W. Allen Hauser, Chair
New York, USA