Proposed terms for medications used in the treatment of epilepsy

The ILAE Nomenclature Task Force prepared a paper about terms to describe epilepsy medications and treatments. The paper seeks to standardize the terms we use to identify the different types and goals of epilepsy treatments. These terms will become the League’s standards following comments from the public and final approval of the edited manuscript.

Draft: Which terms should be used to describe medications used in the treatment of epilepsy? An ILAE position paper

Public comments are now closed and available for review below.


Comments

30 October 2022

I agree with this term: anti seizure medications. It's less taboo in my country (North Africa).

Toubal Nadia


30 October 2022

I don’t understand about the medication report. What does it mean?

Lealem Tilahun


30 October 2022

I think that terms as anticonvulsants should be avoided.

I think that the best term is antiepileptics medications.

I prefer the term seizure to convulsions or epileptic attack.

I think that a correct nomenclature, not only in epilepsy, can help the psychological approach of the patient to diseases.

Antonella Muroni


29 October 2022

This is to congratulate the ILAE Task Force on Nomenclature for an excellent job. I wish to concur with those colleagues who suggested the term 'antiepileptic seizure medications'.

Hamidu Ahmed


29 October 2022

I support the term 'Antiseizure medications'.

Vishnu Pratap Singh Kirar


29 October 2022

Anti-convulsive epileptic medication: ACEM

Anti-convulsive non-epi medication: ACNEM

Razvan Alecu


29 October 2022

Anti-seizure medicine (ASM)

Seizure control medication (SCM) antiepilepsy drugs tend to scare those who fear the term epilepsy owing to the stigma associated with epilepsy.

Drugs are also confused with substance of abuse, hence poor uptake and poor compliance.

My oberservation as a health care provider and person living with epilepsy

Petronilla Kemunto Mogusi 


29 October 2022

I fully agree with the suggested term changes.

A minor observation: the word antiepilepileptic (medication) also stigmatizes the category that has been demonstrated to have a direct effect on the course of epilepsy.

Thanos Covanis


28 October 2022

Epimed

Shortened from epilepsy medicine

Elizabeth


28 October 2022

The position paper is important, thank you for the initiative. I have two minor comments:

  1. The process through which a medication would be defined as 'antiepileptic' is not clear (e.g., who will define it as such?)
  2. Section 3.3 refers only to the acronym ASD and not to the aforementioned issue with the term 'drug' itself.

Sara Eyal


28 October 2022

This paper is really clear and an important step forward. I agree with the proposed term, ASM and with the need to reserve the word 'seizure' going forward to denote an epileptic seizure, and for the term epilepsy to be used consistently with the ILAE's Fisher et al definition (2014).

Thus far, we have limited or no anti-epileptogenesis treatments for epilepsy (other than perhaps Vigabatrin used prior to epilepsy developing in infants with TSC, as the findings of EPISTOP demonstrated - epilepsy development was modified). mTORi may have wider aetiology modification in TSC but has not yet been shown to modify the development of epilepsy. Thus, 'disease modifying' can be confusing, as the aetiology might have wider treatments, and this can include an anti-seizure effect, but the epilepsy disease might not be modified, Thus it might be important to define 'disease modifying' as relates to the epilepsy OR (my preference), focus on a term emphasising the concept of anti-epileptogenesis (modifying the epilepsy development specifically). Ultimately we do wish to support research where this is the key focus, and more treatments may emerge with this specific outcome demonstrated.

I consider that it is sufficient (and important) to use the term ASM while also acknowledging that stopping seizures can have other wider benefits (learning, mental health). But these are secondary rather than primary effects of these drugs.

There may be a future where we have targeted therapies for the direct aetiology of the epilepsy, and/or it's other direct comorbidities e.g. encephalopathy, intellectual impairment. We already have some of these e.g. ADHD drugs that biologically improve frontal networks (with imaging correlate). At some point, these drug developments should become equally as important as ASM development, and to support this in the future, there may be a time where we need to consider terms that denote that we are treating the aetiology directly, or that we are treating the encephalopathy symptoms.

But a great step forward, and the authors should be congratulated on the concise and clear paper produced.

Kate Riney


28 October 2022

Thank you to the authors of this paper and the individuals who have written comments. It is amazing and enlightening to read the many opinions and arguments for ASM or AED. I have personally changed to using ASM and have been part of the evangelistic movement to go in that direction. Having read this draft paper and the feedback though, I have changed my opinion a bit! I agree that words are important, however changing terminology is difficult. The sentiment that 'the ILAE is always changing terminology' is quite widespread among our non-epilepsy colleagues. Therefore I believe, the ILAE should only change terminology when it is really necessary to do so AND ideally any terminology change should be future proofed as much as is possible.

Therefore, here are my opinions which are in support of many of the previous feedback:

  1. The word 'seizure' is not equivalent to 'epileptic seizure'. It is slightly epilepsy centric to suggest the ILAE can decide that 'seizure' should only be used for an 'epileptic seizure'. An epileptic seizure is a type of seizure.
  2. The term 'anti' seems negative and old fashion. If we are making a change in the term why not also change that as well? As suggested below I agree we don’t need the 'anti'.

Therefore, if the ILAE are going to make a change, rather than AED or ASM, I would prefer 'epileptic seizure medication' ESM – because that is what they are.

I realise ESM would be an entirely new term and that it would be much easier to stay with AED or move to ASM as the community appears to be already moving in that direction. If getting rid of the 'anti' seems too big of a jump then the next best option would be 'anti-epileptic seizure medication' (ASM or AESM). Perhaps over time the ILAE could consider dropping the A!

Lynette Sadleir


28 October 2022

When we talk about epilepsy, the terminology is important for caregivers, for healthcare practitioners, patients and for their families, because 'the use of terms that do not accurately reflect the action of specific treatments can lead to misunderstanding of their effects and their inappropriate use'. A new concept on the terminology and recommendations applicable to pharmacological agents currently approved for the treatment of seizure disorders have been issued by ILAE, and this has been achieved using a modified Delphi panel. The consensus was unanimous that these medications should be collectively named as 'antiseizure medications' (ASMs).

This terminology reflects accurately their mainly symptomatic effect against seizures, and not a disease-modifying effect. This new terminology could avoid a certain stigmatization. The use of the term 'medication' versus 'drug' also avoids confusion with 'illegal recreational substance abuse'. In addition, the acronym for the term 'anticonvulsant (ASD)' is the same that is used for autism spectrum disorder, and for atrial septal defect. Appropriate terminology should also be used to describe the actions of other therapeutic modalities such as surgery, neurostimulation, and dietary treatments. ILAE has encouraged the development at the regional and national level of relevant terminology in languages other than English, taking into account the specific social and cultural context. In conclusion, the new recommendations are useful and must be integrated into our medical language in the field of epilepsy.

Mihaela Bustuchina Vlaicu


28 October 2022

I totally agree with the position paper. In the future the term 'antiepileptogenic medication' could be used, prefered over the term 'antiepileptic medication.

En el idioma español hay un problema pues no existe traducción para "seizure" y se usa la palabra convulsión en sentido amplio (sin distinguir entre crisis epilépticas convulsivas y no convulsivas) y está muy extendido el uso del término "medicación anticonvulsiva" la traducción más parecida de "seizure" es crisis epiléptica, o en españa y argentina se usa crisis comicial, por lo que algunas veces se habla de medicamentos anticomiciales.

Santiago Acebedo


28 October 2022

I agree with the clasification in relation to the concept of anti epilectic drugs for the cronic disease and anti seizures for those drugs usually used in an acute event or convulsion wich may be due to an injury to the brain craneal or extra craneal source.

Blayser Ojeda Lozada


28 October 2022

The reasoning and related considerations expressed in the paper are undoubtedly very rational and totally acceptable within a strictly scientific dimension. However, if we move into a dimension of daily clinical practice carried out in all countries of the world, in my opinion some further reflection could arise:

a. Theoretically, the term antiseizure might be referred also to psychogenic non-epileptic seizures; consequently, in our terminology, the term ASMs could be better completed with the addition of 'epileptic'; in other words, antiseizure medications (ASMs) would become antiepileptic seizure medications (AESMs); clearly, addition of epileptic does not imply a medication direct activity on the underlying disease, but exclusively on its manifestations/symptoms.

b. The term 'drug' is of course inappropriate especially if one reflects on the fact that it derives from the French word 'drogue' which means dry herb, with consequent various meanings; however, history is history, and the term drug in the current clinical practice refers to a compound, usually synthesized in a laboratory, that displays beneficial effects or leads to recovery from a disease, regardless of where or how it works. Examples of this concept: analgesic drugs, hypoglycemic drugs, antidepressant drugs and so on; furthermore, using the term 'medication' could lead in general to believe that no 'drugs' are available to treat 'epileptic seizures'; to change the current terminology it would be advantageous to discuss this aspect with FDA and other Agencies including all types of compounds used to treat all the pathologies with indications on the correct use of drug, medication, medicine.

Francesco Pisani


28 October 2022

Anticonvulsive medications

Salma Hamed Khalil


28 October 2022

In general, I agree with the terms given by the team, their reasons and their explanations

Only, between the terms medicine and medication, I think medicine is better.

Yes, medicine may push one to think about science, but also, it commonly the means 'product'.

I do not prefer the term medication because, for me, in the word medication, in addition to the fact that it is a product, one can imply the act of treating and think about taking action rather than a simple word.

Thus, in my opinion, antiseizure medicine (a product against seizure) is better than antiseizure medication.

I also thought a lot about the term antiseizure product, but it is broader, so the terms antiseizure medicine is more preferable.

Best regards,

Sylvestre Mutungirehe


28 October 2022

Fully support the proposed approach. It makes complete sense - we have already adopted this terminology, and it is clearer for patients and for health care professionals. It helps to manage expectations of all concerned as to what these medications can achieve

Trudy Thomas


28 October 2022

ASM reflects the exact nature of the drugs used epilepsy so it should be used.

Farida Jan


27 October 2022

Thank you for the draft.

  1. I believe both terms are needed to be in use. Anti-seizure and anti-epileptics drugs.
  2. To avoid confusion on the terminology used; Anti-epileptic direct effect/indirect effect/Anti-seizure mediations. It would be of great help to readers to have examples of medications to illustrate the new proposed terminology. Preferably, a table with all ASM included with its proposed terminology.
  3. Immunomodulatory treatments/specific treatment for pediatric syndromes like pyridoxine... etc. are needed to be specified.
  4. In last paragraph in the draft - 3rd line 'Anti-seizure medications' is written twice. 'Anti-seizure medicines' not included.

Thank you for your great effort.

Fatema Abdulla


27 October 2022

I like this paper and the fixed terms. Thank you.

Yvonne Weber


27 October 2022

In matters of words, words matter. So I did a quick mapping exercise to assess (mis)interpretations and (mis)communications with the prevailing and proposed terms, by typing the abbreviations as Google search terms.

As pointed out in the ILAE position paper, the abbreviation AED maps reliably and repeatedly to automated external defibrillators. However, ASM brings up a much more interesting and varied set of links, none related to seizures or epilepsy - professional societies, event management groups, stock symbol for silver mines, computer language code, semiconductors and after-school matters - and that is just the first page! (By the way, the position paper indicates that 'names matter..' While Google maps ILAE correctly to the League, the abbreviation PWE - persons with epilepsy - maps to puritan work ethic, plain white envelopes, a Burmese festival and a stock quote, among others.)

The point is that while physician-oriented language serves as a basis for physician-directed communications, it may not convey the same meaning in other settings. For instance, in patient-directed communications, 'it is more important to know what type of person has the disease, than what type of disease the person has' (Osler). Hence, if we choose to use the proposed term broadly, I would urge the ILAE to formulate terms that consider the (scientific) intent, (linguistic) content and (community)context. Alternatively, in keeping with the title of the paper, we could consider more than one term, with the choice depending on the intended audience and context (the coherence-contingency model).

The ILAE Nomenclature Task Force did an admirable job of outlining the clinical rationale for the proposed term/abbreviation, and may do well to use ASM for scientific publications in the English language. As anticipated by the authors, I expect this term will end up being limited to a sub-class of treatments, since it refers primarily to currently available 'symptomatic' treatments with chemical entities. As such, it excludes both non-pharmacologic therapies and novel, potentially disease-modifying interventions currently in clinical development.

A final point - as the field advances, retaining the 'anti' and 'against' prefixes will become limiting and challenging. What, then, will we stand for?

O'Neill D'Cruz


27 October 2022

Antiseizure Medication

Nimat Alkhani


27 October 2022

Anti seizure medication (ASM) is a better term than antiepileptic drug (AED). I appreciate the new wording.

Stephani


27 October 2022

I have been reflecting on this since my last comment. My concluding view is that Anti epileptic seizure medication (AESM) is the best option. This allows the thrust of this paper to be realised without confounding the meaning of seizure to by default mean ‘epileptic seizure’ which I think would create unintended wider problems.

Dr Colin Dunkley


27 October 2022

I disagree to use term 'antiseizure medication' for all medications currently used to treat epilepsy. I have several clinical cases of positive management of epilepsy on the background of only medication and more than 10-year remission was achieved. Medication for the management of epilepsy has different mechanisms of action that could have not only an antiseizure effect but also an antiepileptic effect.

Neurosurgery by definition should be antiepileptic procedure, but it doesn't have a positive effect in 30% of cases. Maybe we should consider the fact that a number of medications have 2 effects: antiseizure and antiepileptic?!

Galina Odintsova


27 October 2022

Full support for Anti-seizure medications.

For e.g. Everolimus which isn't an ASM, I'd suggest disease modifying treatment (DMT), as used in MS also - familiar concept.

Hannah Cock


27 October 2022

Agreed upon all recommendations.

Very good initiative.

Thanks

Dr Nazmul Hamid


27 October 2022

I support ASM term. We currently use the term (in Ukrainian) - протинападові препарати (ПНП) - just a precise translation from English.

Lidiya Maryenko


27 October 2022

Agree with anti-seizure medications

Dr Rashmi Adiga


27 October 2022

'ASM' is the best term.

Sopiko Digmelashvili


27 October 2022

Antiepilectic should be the correct term in those drugs we never use in an acute seizure. In that situacion is better to say antiseizures drugs.

Blayser


27 October 2022

Agree on using term 'antiseizure medication' or ASM w/c actually describes its effect seizure suppresion but NOT as the cure for the underlying pathology of epilepsy.

Elizabeth Palines


26 October 2022

Sensible and appropriate

Derrick Chan


26 October 2022

I do agree with 'anti seizure' medecine or medication.

Innovation is something that we need to accept.

Jean-baptiste Ciroyi Murhabazi


26 October 2022

ASM

Dawn Anderson


26 October 2022

Antiepileptiques, les antidecharge epileptique, les epibloquants, les anticonvulsivants

Houda boulala


26 October 2022

I prefer antiseizer medication because it treats epileptic and non epileptic events.

Asmaa Nouadria


26 October 2022

The term 'antiseizure' is still inaccurate, as several nonepileptic symptoms, especially psychogenic nonepileptic seizures use the word 'seizure'." Convulsive syncope does not use the word 'seizure' but is a seizure response to transient hypoxia.

I think 'epileptic seizure' needs to be incorporated in the terminology.

In addition, 'anti' is somewhat inaccurate. The drugs are not 'anti' seizure drugs but rather function to prevent epileptic seizures. 'Seizure prevention drugs' or 'epileptic seizure prevention drugs' would be more accurate. That is the intent of prescribing the medication - it will be more apparent to patients that way to.

Michael Sperling


26 October 2022

I like to thank the authors for their good work and clear proposition. The weight of a word is very important, especially in medecine, and it should be taken in acount what translation and abreviations or acronyms can do to the chosen words. This was quite widely reflected on, and I fully agree with the chosen terminology of anti-seizure medications.

Nicole Faignart


26 October 2022

I read the manuscript designed by the task force regarding differences of various drugs. I agree with the task force and appreciate their work.

Dr Ghulam Jelani


26 October 2022

Dear Sir/Ma'am

The antiseizure medication (ASM) without hyphen will be most appropriate terminology for the medicines used in various type of epilepsy which will remove the social stigma and treatment related lag, especially in developing countries. We need to address in future the polytherapy medications used in drug refractory epilepsy based on mechanism of action. For example we can write ASM then superscript as 3 denoting the number of antiseizure medication and subscript as Na/Cal/K channel blocker. For others therapeutic modalities apart from medications like dietary therapy, neuromodulation, and epileptic surgery, we can use term like antiseizure alternatives (ASA) with subscript as D for dietary, S for surgery, N for neuromodulation.

Dr Rahul Sinha


26 October 2022

The manuscript gives the concise details of the topic. I would recommend it to be published.

Afshan Mumtaz


26 October 2022

For the time being, the term 'Antiseizure medications' is preferred. With conclusive evidence regarding the atiepileptogenic effects of some of the drugs, subcategorization of these drugs to Antiepileptic drugs may be considered. However, presently such evidence is not available.

Kurupath Radhakrishnan


26 October 2022

Anti-seizure medication, as we have used in other medical conditions such as anti-depressants or anti-hypertensives. The seizure is the target of the medication, and the older term anti-epileptic feels outdated. The reference to 'epileptic' is to be avoided as has negative social connotations and has been used over history in a negative way for persons with epilepsy.

NICE has adopted the use of the term 'anti-seizure medication', referring to medications for use by people with epilepsy. The use of the term medication is appropriate as the word drugs are also misapplied for 'drug use'. The reference for devices or therapies used to modify or prevent seizures or epilepsy development should be used.

Janine Winterbottom


26 October 2022

Dear colleagues

Well done for an excellent, well put together paper.

My only concern is that the term anti-seizure medication may be misunderstood by persons with epilepsy and their relatives. I did a mini survey with our own patient association and many thought that the term ASM referred only to those medicines used for tonic clonic seizures. Some types of symptoms seen in other types of epilepsy, eg. in focal epilepsy and absence epilepsy are not 'seizure like' when observed such as staring, fiddling with clothes, humming, etc.

My suggestion would be to perhaps discuss this proposal also with IBE and other patient organisations. These are important users of the term as well, besides clinicians and other health care professionals, if there is to be consenus.

Thanks

Janet Mifsud


26 October 2022

I agree with the term antiseizure medication (ASM). Whether there are antiepileptic effects of ASMs is an open question and likely drug specific.

Michael Hammer


26 October 2022

As epilepsy is not a disease with a given etiology, but is defined as two or more unprovoked seizures; the fact that one says 'antiepileptic' logically means stopping these and not more. It does not imply 'disease modifying' or that it will act on the cause of seizures or on a specific etiology. Patients receiving an AEM for acute seizures but not epilepsy will not mind and are quickly reassured when given a proper explanation explanation.

Moreover, in many languages, seizures will be translated as 'crisis' or 'attack', so that the word epileptic will have to be added anyway, making it not simpler. Three words or more instead of two!

How much shall we do for being politically correct? In places or situations where epilepsy is still a stigma, doctors already use adapted words. Working on the stigma of epilepsy has still to be promoted.

Final point: how would you qualify a medication used to stop continuous spike waves during sleep and cognitive/behavioral regression and no/unrecognized seizures? LKS is an example.

Thanks for your feedback.

Roulet Perez Eliane


26 October 2022

'Anti-epileptic medication' vs anti seizure medication perhaps are not synonymous and cannot replace each other as all the seizures are not epilepsy. There are certain drugs which is useful in suppressing acute seizure episode. For example midazolam and lorazepam are not used as a long term antiepileptic drugs; therefore, 'antiepileptic medications and measures' might be an alternative, which would include both pharmacological and non pharmacological treatment, like dietary therapy, yoga, relaxation exercises, and so on.

Dr GP Burman India


25 October 2022

Yo estoy a favor de que se continue usando el termino de FAE farmaco antiepileptico, y cuando esten mas avanzadas las investigaciones sobre la epileptogenesis debatir otra acepcion, me parece que de cambiarlo ahora puede generar algun tipo de confusion.

Dra. Marite Garcia Llano


25 October 2022

Thank you very much for sending the decisions of the task force on the terminology to be used when naming drugs whose action is as an anticonvulsant. I agree to use the term 'antiseizure' as it refers to the direct action of the drug, thus avoiding confusion and undue expectations regarding the direct effects of the drug.

Best Regards

Ligia Trinidad Zambrano Zambrano


25 October 2022

On behalf of the Functional (Dissociative) Seizures Task Force

The Functional (Dissociative) Seizures Task Force would like to draw attention to the difficulties of this new terminology of antiseizure medication.

We know how complicated any change of terminology is and that unanimity on a term is impossible. We want to take a constructive approach. We consider this change problematic on several levels and would like to share our opinion here.

  1. We have concerns about the proposal of the Nomenclature Task Force that the term 'seizure' should exclusively be applied to epileptic seizures.

    The proposal brought up for the term seizure "claimed” exclusively for epilepsy is unfortunate.

    1.1 The term 'seizures' exists outside of epileptic seizures: There are some manifestations whose terminology cannot be determined by the ILAE and which use the term 'seizure', like reflex anoxic seizures, hypocalcemia seizures or hypoglycemic seizures. We note that the term 'seizures' is also used for functional/ dissociative seizures in international nosology (DSM-5 and ICD-11).

    1.2 The concept of exclusivity is problematic:
    The word seizure, which is readily defined in every English-language dictionary as non-exclusive to epilepsy, is not unique to medical jargon, but part of everyday vocabulary. An analogy that illustrates the irrationality of the idea that seizure is only associated with epilepsy is found in the term 'headache'. Clinicians use descriptors for various headaches to differentiate the type of headache, such as migraine headache vs tension headache (attributing functional etiology), without giving this a second thought.
    Cardiologists and pulmonologists are not expected to claim 'attack' to be exclusively used for heart attacks or asthma attacks; and if our field can tolerate the etiological ambiguity of 'stroke' (even allowing the usage of 'heat stroke') it will cope with non-epileptic 'seizures'.

    1.3 Implications of the exclusive use of 'seizures' in the context of epilepsy for functional /dissociative seizures
    As the Functional (Dissociative) Seizures Task Force, we have been working for several years on a new terminology for PNES, which is absolutely necessary. It is within the mandate of medical organizations to advise on technical language used within their fields of expertise, as the ILAE has done regarding the terminology for medication aimed at reducing epileptic seizures. However, the ancillary provision of avoiding the word 'seizure' for non-epileptic seizures seems utterly inappropriate. This discussion has been addressed over a decade ago in the literature and by the ILAE (see Neurology 2010). From that discussion, 'As noted by the International League Against Epilepsy consensus, the word seizure derives from the Greek, meaning to take hold. A seizure, by definition, is a sudden onset of symptoms. The seizure may be descriptively modified by the preceding term "epileptic," but that it is attributed to epileptiform activity is not inherently invested in the word "seizure".'

    Obviously, the pros and cons of the suffix 'seizures' have been widely discussed in the literature, among international experts, members of the Task Force, the Psychiatric Commission and with patients. Unanimity is not possible, but a consensus is emerging. We wish to keep the suffix 'seizure' in relation to functional (dissociative) seizures. We will detail our arguments for this in a position paper in the near future.

    Relieving functional (dissociative) seizures of their nomenclatorial validity unfortunately continues a long and harmful tradition of delegitimizing this illness and denying patients the authenticity of their symptoms (see also 'pseudoseizures').

    Of course, we are aware that the term 'antiseizure medications' (if it was to be endorsed by the ILAE) would be a potential source of confusion for our patients and this is regrettable. It will take time to explain that 'antiseizure medications' are only helpful for some forms of seizures.
    However, we think that the benefits of maintaining the seizure suffix for functional/dissociative seizures outweigh this risk.
    WE WOULD THEREFORE ASK THE NOMENCLATURE TASK FORCE TO PLEASE REMOVE THE RECOMMENDATION THAT 'SEIZURE' SHOULD ONLY BE USED FOR EPILEPTIC SEIZURES.
  2. The nomenclature Task Force recommends a switch from the term 'antiepileptic' to 'antiseizure' medication because current drugs have no proven disease modifying properties.

    2.1 Implications for the psychiatric dimension of epilepsy
    The argument that treatments should be named by their 'primarily symptomatic effect against seizures to reduce the possibility undue expectations, or an incorrect understanding of the real action of these medications' is highly questionable. The article mentions that 'the term  "antiseizure" to describe these agents does not exclude the possibility of a favorable influence on the course of the disease and associated comorbidities, as long as these beneficial effects can be explained solely by suppression of seizure activity'. Valproate, lamotrigine, pregabalin have clear psychotropic effects, used outside epilepsy. The nonseizure manifestations of epilepsy (its psychological, psychiatric, cognitive and social dimensions) are embraced in the current ILAE definition of epilepsy. The term 'antiseizure medication' therefore seems very simplistic and overly narrow. In clinical practice, the choice of antiepileptic drug most often takes into account the psychiatric profile of the patient, sometimes to avoid negative psychotropic effects of certain molecules or, on the contrary, to achieve positive psychotropic effects. These choices are made because epilepsy does not only involve seizures. Psychotropic effects may cause medication to be continued even if there is effect on seizures.

    2.2 Risk of confusion in the management of single/provoked epileptic seizure
    Moreover, we would like to point out the potential of the label 'antiseizure medicine' to cause confusion in the context of epileptic seizures, which would not be treated with medication - such as an isolated first seizure without risk factors or recurrence, febrile seizures or other provoked seizures. In such circumstances one would explain the difference between a single/provoked epileptic seizure (typically not requiring medication) and epilepsy as a chronic disorder predisposing the individual to further (unprovoked) seizures (requiring medication). In this sort of discussion the term 'antiepileptic drug' makes more sense than the term 'antiseizure medication'.
    While there may be little histological or physiological evidence that 'antiepileptic drugs' have disease modifying properties, they may in fact have such effects by virtue of stopping seizures if the wider definition of epilepsy (not only including seizures but also associated psychological, psychiatric, cognitive and social dimensions) is taken into account.

References:

Benbadis SR. Psychogenic nonepileptic "seizures" or "attacks"? It's not just semantics: attacks. Neurology. 2010;75(1):84-6

LaFrance WC, Jr. Psychogenic nonepileptic "seizures" or "attacks"?: It's not just semantics: Seizures. Neurology. 2010;75(1):87-8.

Karam C, Sethi NK, Sethi P, Torgovnick J, Arsura E, Cowan RB, et al. Correspondence. Psychogenic nonepileptic "seizures " or "attacks"? It's not just semantics: Attacks v. Seizures. Neurology. 2010;75(23):2135-7.

Coraline Hingray


25 October 2022

It has been a good discussion. From early in the comments, the term 'epilepsy medicine/medication' might be more in line with how patients refer to their medicines (blood pressure medicine, heart medicine, allergy medicine...) Rarely do they use the term 'anti' as a prefix. It is the medicine(s) they take for their epilepsy. If epilepsy might be too stigmatizing then 'seizure medicine'. Drop the 'anti'.

Edward Bertram


25 October 2022

First of all, I would like to thank the group of authors for their work on this important issue.

Regarding the terminologies: 

  • 'Antiseizure' medication - I agree this terminology
  • 'Seizure' versus 'epileptic seizure' - If the term "seizure" will be used only to describe 'epileptic seizures', then the term 'epileptic' is redundant when referring to a seizure. But since the term 'seizure' is often used to describe not only epileptic but also non-epileptic events, in such cases it will be necessary to add the term 'epileptic' to avoid the diagnostic errors.
  • ‘Medication’ versus ‘medicine’ or ‘drug’ - I prefer 'Medication'.

Sofia Kasradze


25 October 2022

Antiseizure

Munayr Aldarah


24 October 2022

I agree it's time to use a term in the English language that does not induce misinterpretation, as ASMs, without hyphen, and in English drug or medications are equivalent. But in other languages? In Italian, 'drug' cannot be used to refer to medications, and the translation of 'seizure' can induce confusion without the 'epileptic' prefix. But I'm sure it will be easy to accept the acronym ASM, as happened for AED.

Tiziana Rosso


23 October 2022

Dear colleagues,

To answer this challenging question, whether antiseizure or antiepileptic medication is appropriate, we must first have a thorough understanding of epileptogenesis. There is growing evidence that existing antiseizure can cure seizures by increasing the threshold for seizures but has little or no influence on the underlying dynamic process of epileptogenesis development. The advanced development in neuroradiology, neuroimmunology, neuropsychology, and neuropathology that supports the notion that epilepsy is a progressive disorder bolsters this argument. In fact, it was discovered that patients with epilepsy on anticonvulsant medicine had progressive cortical thinning, cognitive decline, and aberrant brain pathology abnormalities.

My personal opinion:

  1. Antiseizure medication (ASM): I believe it is prudent to use the term antiseizure medication when the drug has only pure antiseizure effects and does not affect the epileptogenesis process.
  2. Antiseizure medication-plus (ASM-P): If the drug is proved to have antiseizure and anti-epileptogenesis properties, even if they are minimal.
  3. Antiepileptogenic (AEG) is a drug that is proven to stop or modify the progression of the disease.

Antiepileptogenesis, the prevention of epilepsy or its progression, and the reversal of the epileptogenic process or treatment are relatively new areas of interest in fundamental research. The development of antiepileptogenic interventions would be significantly aided by the identification of reliable biomarkers of epileptogenesis that could be used to develop cost-effective, high-throughput screening models for potential antiepileptogenic compounds, as well as to enrich patient populations and serve as surrogate endpoints in clinical trials. Without these indicators, clinical validation of antiepileptogenic therapies would be prohibitively expensive. Epileptogenic mechanisms, antiepileptogenic therapies, and biomarkers are likely to be particular to the several causes of epilepsy, which include, among others, genetic factors, cell loss and synaptic plasticity, abnormalities of cortical development, and autoimmune illnesses. High priority is being given to studies that seek to determine how epilepsy begins and to identify biomarkers for specific models of human epilepsy, including mesial temporal lobe epilepsy with hippocampal sclerosis, traumatic brain injury, and a number of pediatric diseases, including tuberous sclerosis and West syndrome.

The aim of AEG is to:

  • Prevention of seizure progression in part or entirely.
  • Complete abortion and the development of epilepsy.
  • Partial prevention can delay the development of epilepsy or reduce its severity.

Alawi Aqel Al-Attas


23 October 2022

I do agree on term anti seizure medications, due to their apparent effect on seizure suppression and not on epileptogenicity.

Asieh Mehramiri


23 October 2022

AEDs medications do not cover all aspect of epilepsy. They only terminate or reduce seizure frequency. I suggest 'Seizure controlling drugs (SCD)'. As the main desired action of the drugs is controlling seizure frequency, but they do not cover all aspects of symptoms associated with the epilepsy.

Mahmoudreza Hadjighassem


22 October 2022

My concern mainly is the description of the acronym 'ASM' in other lenguages. Seizure in Spanish translates as 'Crisis Epiléptica'; there is no an unique word for seizure. So if the new nomination is 'anti seizure medications', it must be named 'medicación anti crisis Epiléptica'? With preoccupation, I've heard in many Spanish-speaking conferences the use of 'medicación anti crisis' as textual translation of ASM.

The problem is that we can have in Spanish many types of other 'crisis', for example 'crisis de pánico', 'crisis psicológicas' and others.

Knowing that English is the main language for scientific papers, terminology that will be used also with patients must be clear without any possibility of confusion.

If I tell the patient in Spanish… I will prescribe you a 'medicamento anti crisis'... Am I telling the patient, I will give you medication for treating your epilepsy (crisis epiléptica) or your panic attack (crisis de pánico)?

In the mean time, while the translation to other languages of ASM is not absolutely established, my personal option will be to keep using the term in Spanish 'fármaco antiepiléptico'.

Loreto Ríos Pohl


21 October 2022

Antiseizure Medications is apt.

Obasohan Evbenaye Stanley


21 October 2022

I support the use of the term 'anti-seizure medication'.

Judy Tapper


21 October 2022

Epilepsy Ireland welcomes this consultation from our colleagues in the International League Against Epilepsy, regarding the standardising of terms for medications in the treatment of epilepsy.

Epilepsy Ireland are the national patient organisation representing people with epilepsy in Ireland and we were established in 1966. Like the ILAE, our vision is to achieve a society where no person’s life is limited by epilepsy. We work towards this vision by:

  • Empowering people with epilepsy through support and education
  • Centring people with epilepsy and their families in the work of Epilepsy Ireland
  • Working collaboratively to improve the care of people with epilepsy and knowledge of the condition
  • Transforming perceptions of epilepsy and public policy relevant to the condition

From the outset, we agree with the points made in the paper that the terminology used for medications in the treatment of epilepsy should be standardised as 'Anti-seizure medications' (ASMs), moving away from the more-commonly used term of 'Anti-epileptic drugs' (AEDs).

Our additional points on this consultation are reflective of conversations we have had with our members & services users – and are also reflective of perceived public perception when it comes it epilepsy. We have outlined these points briefly below:

1. ‘Anti-Epileptic’ can have negative connotations.

In Ireland, there is a considerable portion of the epilepsy community who would describe themselves as 'epileptic'. While this terminology is not something that is used by Epilepsy Ireland, we are conscious that it is commonly used amongst our community. Within the community itself, there are differing opinions as to the connotations of the term epileptic. Some use this term as they view it as taking ownership of their condition and use it as a way of being up-front about the condition – but others view this term with disdain, feeling that it defines a person by the condition. While there are two sides to this argument, is clear that when the word 'epileptic' is mentioned, most people’s minds will immediately think of a person.

Therefore, when the words ‘Anti-Epileptic’ are introduced, there are negative connotations in that it could be perceived that the drug is Anti the person themselves. Anti-Seizure Medications much more accurately describes what the medication is trying to do – prevent seizure activity. We feel the term Anti-Seizure medication is more inclusive and removes potential negative connotations.

2. ‘Drugs’ can have a negative connotation.

It is fair to say that when the term drugs is used, the vast majority of the general public will immediately think of illegal substances. In addition, with the presentation of certain seizures, there can often be the misconception from the public that a person with epilepsy is on drugs. Therefore, as an organisation which aims to increase public awareness of epilepsy, there is somewhat mixed messages when we talk about this misconception to then go on to talk about how the condition is treated most through 'Anti-Epileptic Drugs'. We also feel the word medications is more reflective that epilepsy is a long-term health condition that can potentially be treated.

This is another reason why we feel Anti-Seizure Medications is more suitable term to describe the treatment of epilepsy through medication.

These are our two key additional points in relation to this consultation. We would like to thank our colleagues in the ILAE for opportunity to contribute to this consultation and we look forward to hearing more on the outcome of same. Should further discussion be required on the points made above, please do not hesitate to contact us.

Paddy McGeoghegan


21 October 2022

Dear colleagues, thank you for allowing us to share our opinions.

As an Spanish-native speaker, I think there should be some considerations in our language. The term 'seizure' translated as 'crisis' in Spanish not only means 'epileptic' but also another significance, which in fact, I think could be stigmatizing. Thus, I think in Spanish, the term 'crisis epiléptica' should be used, which would be 'epileptic seizure' in English.

Daniel Vázquez Justes


21 October 2022

‘Antiseizure’ as preferred term for medications having a symptomatic effect - I think ‘Antiseizure’ is preferable.

‘Seizure’ versus ‘epileptic seizure’ - ‘Seizure’ and ‘Medication’ versus ‘medicine’ or ‘drug’ - I think ‘drug’ is preferable.

When should the term ‘antiepileptic’ be used? - I agree that it is more logical and correct to reserve the term 'antiepileptic' for drugs that proved a direct effect on the course of epilepsy, the likelihood development of epilepsy or the likelihood of developing more severe epilepsy. And the term 'anticonvulsant' should be used for the symptomatic use of the drug.

  • The same terminology, in my opinion, is logical to use for other methods of treatment.
  • The need to understand each other in the medical community, to speak the same language is very important. The development of terms in accordance with the English version in other countries, but taking into account national characteristics and preferences, is just as important!!! Many thanks to colleagues for raising difficult topics and providing the opportunity to participate in the discussion.

Aleksandra


20 October 2022

Epilepsy and seizures affect citizens from all the world, a population that is largely and predominantly non-English speaking. So, the considerations about 'seizure' and 'epileptic attack' should be both accepted, as a function of the population/culture (without 'obligatory' or 'preferable' designation...).

The terminology to be applied to pharmacological treatments that exert a symptomatic effect against seizures should be defined as MAS - Medications Against Seizure. This because such medications are 'against' seizures, and not anti. And this is is not a question of semantics...

António Martins da Silva


20 October 2022

We understand and support many of the reasons for the proposal to change the term Anti-Epileptic Drug to Anti-Seizure Medication. However, we have major concerns about the statement in Recommendation 3.2 and this appears to be a premise upon which the proposal and rationale for the change of term is founded.

Patients present with seizures or an equivalent colloquial term (rather than with epilepsy) and very many of which are not epileptic, especially so in children and young people. It may be that the Task Force has determined that term the 'seizure' should preferably now be reserved to indicate 'epileptic seizures', but with all respect, that is not the real world. In reality, many presentations of seizures represent what are then established to be non-epileptic seizures. The first task of the clinician in making a diagnosis of epilepsy is to distinguish between epileptic and non-epileptic seizures.

Across the world, 80% of people with epilepsy live in low & middle income countries (LMIC) and, not only is there a 'treatment gap', there is also a 'diagnostic gap' magnitudes greater than in high-income countries (HIC). Misdiagnosis rates of 30% are reported in HIC and are likely considerably higher in LMIC. It is crucial to improve the accuracy of epilepsy diagnosis globally.

Using the term Anti-Seizure Medication may add a substantial risk to people presenting with both epileptic and non-epileptic seizures then being inappropriately treated for their 'seizures'. In our view this woud be a retrograde step in the quality of the diagnosis and care of people with epilepsy particularly in LMICs. Changes in nomenclature should not inadvertently contribute to an even wider 'diagnostic gap'.

We appreciate the challenges in finding an improvement to the term Anti-Epileptic Drug but perhaps 'Anti-Epileptic-Seizure Medication' or similar might be considered.

On behalf of the Executive Committee of the British Paediatric Neurology Association & the British Paediatric Epilespy Group


20 October 2022

This is well written and well thought out. I do not recommend any changes.

Paul C. Van Ness


20 October 2022

Congratulations on a great position paper. I support the term 'antiseizure medication' for symptomatic treatment of seizures.

For medications that have a disease-modifying effect, perhaps terms like 'disease modifying epilepsy medications' or 'anti-epileptogenic medications' could be considered.

I wonder what term will be used to replace PNES. Or will this be a separate paper on terminology of seizures? I agree that the term has negative connotations and calling them 'seizures' can be misleading when patients see different doctors. Perhaps a term that includes 'functional paroxysmal events'.

Thank you

Melody Asukile


20 October 2022

My term for epilepsy medications is easy to understand.

Abbreviation: M4E

Term: Medication(s) for Epilepsy

You see, a simple approach to this is what's needed, so that it can be accessible and understandable to all. We (patients and medics) know what the medications are and do, and you can also group them together; so keeping a simple understandable description is needed.

Sam Downie


20 October 2022

Antiseizure Medication.

The arguments put forward are very sound. I must confess that I have used antiseizure medications for over a year plus now. Seizure is the starting point and as such, epilepsy and attendant convulsion where it occurs are secondary.

Again, AEDs could easily be confused in an emergency situation with automated external defibrillator.

I most appreciate the opportunity to comment.

Olusola Adetunji Talabi No


20 October 2022

I do agreed that medication is prescribed to treat symptoms (seizure), but if seizure had recure, you did reach the epilepsy defention based on the classification of ILAE. So, if we consider epilepsy is a condition causing seizure, that means we are treating the cause, not the term. I would prefer Antiseizure medication.

Dr. AlQassmi Amal


20 October 2022

Seizure stabilsers

Dr Bobby Hmar


20 October 2022

I think the term 'antiseizure medication' (ASM) is the way to go, as it is well described and explained in the position paper. However in German the term 'Anti-Anfalls Medikament' seems to be potentially a bit more misleading in comparison to the English term, due to the german word 'Anfall', for which seizure is generally used more broadly (even though most of the time an epileptic seizure is meant by patients and non-neurologists when they use this specific term). On the other hand, any other word combination for ASM in German also feels either inaccurate, misleading or overcomplicated.

Johannes Koren


20 October 2022

I appreciate the article and its methodology.

I think that it will be great to make a multi-centric cross sectional study to determine the terminology of epilepsy and everything releated to it in the most spoken languages because in some languages, such as Arabic for example, the terminllogy is vague.

Mohamed Mahdaoui 


20 October 2022

Dear authors,

It's a very beautiful work.

I agree with the use of the term anti-seizure medication because it is more appropriate to the effect of the drug on epilepsy, at least until now.

For the use of the terms seizure and epileptic seizure, I hope that ILAE can make a clear and firm definition of whether these two terms are interchangeable or not. If a seizure refers to an epileptic seizure, then there is no longer a term for a non-epileptic seizure, but non-epileptic event.

Thank you for this wonderful opportunity.

Machlusil Husna


20 October 2022

Thank you for putting together such a great document.

The term ASMs is simple, informative and explicit. It is time to replace the deeply rooted term of AED.

Farzad Sina, MD


20 October 2022

I fully support the recommendations in the paper. As a caregiver to a daughter with refractory epilepsy, the title of AED did lead me to believe that the medication was having an impact on the disease and not solely the symptoms. Furthermore, my daughter finds the word 'drug' very uncomfortable, for the reasons stated in the paper. (We speak British English). Antiseizure medication is clear and a more accurate description of what she is taking. Thank you for your work on this.

Naomi Shooter


20 October 2022

Antiepileptic Drugs (AEDs)

Prof Meir Bialer


20 October 2022

I also endorse the term 'Antiseizure'. I can also suggest 'Antilep'.

Geoffrey Otieno


20 October 2022

I support the logical approach to address the issue of the specific nomenclature of the medicines used to control seizure/epileptic seizures.

My vote is for 'Anti seizure medicine'

Thanks a lot to the task force, ILAE and IBE.

Selina Husna Banu


20 October 2022

I agree with the term proposed 'Antiseizure medication'... but I think it will not be accepted by all the patients.

Regards,

Kanar karim


20 October 2022

All types of epileptic drugs including diet also

Darshana Kumari wankhede


20 October 2022

I think that the term anti-seizure would be the most appropriate.

Rosa Ysabel Alvarado Merino


19 October 2022

I concur with the recommendation of calling them antiseizure medications.

Luis Bello-Espinosa


18 October 2022

The term anti-seizure medication (ASM) is clear and direct and should be accepted. I also think the term seizure suppressants (SS) suggested by Dr Jaseja for treatments that are not medications (stimulation) would be useful.

Kenneth W Sommerville MD, FAES


18 October 2022

I agree with the proposed use of terminology.

Hina Dave, MD


18 October 2022

I think, the first question it must be: is the term epilepsy still necessary? Thanks.

Luis


18 October 2022

I agree with Anti-seizure medicine/medication.

Natasha Denvir


17 October 2022

I completely agree with the proposed changes; however, I am sure that this is not change the misunderstanding of antiseizures medicines.

Iwona Kurkowska-Jastrzebska


16 October 2022

I agree with the drugs that we use for management of epilepsy.

Aliosky


15 October 2022

'Which terms should be used to describe medications used in the treatment of epilepsy?'

I wanted to share some thoughts on how to describe medications used in the treatment of epilepsy. I have had epilepsy for 45 years and am fortunate that after 5 neurosurgeries, including RNS and LITT, I am seizure free. I also have worked in clinical neurology and research. So as a patient and as a practitioner and author, I believe that it would be more productive to consider the type of treatment and the type of event. As is well known, seizures can result from events that do not originate from the brain.

'Anti-epilepsy' medications (AEMs) are not clearly useful unless the seizure resulted from a neurological event. Therefore, I do not think that AEM is an accurate definition of all medications that treat epilepsy. In addition, subclinical seizures are often not considered when documenting the effectiveness of an antiepileptic drug It is not possible to IDENTIFY the source of seizures without specialized diagnostic testing.

'Anti-convulsant medication' is not a useful term because there are several types of seizures, from subclinical to complex partial with auras, that do not show with convulsions.

I suggest that the term 'Anti-seizure medication' be used for the reasons discussed above.

Annick Winokur


15 October 2022

Thank you for putting together such a great document.

  • I am agreeable with the proposed nomenclature - Antiseizure Medications.
  • Point 3.4: However, using the term 'antiepileptic drugs, AEDs' for future potentially disease altering medications should be discouraged as well, as this could cause confusion with older literature naming ASMs as AEDs. Those agents could be named, as for example, Disease Modifying Antiseizure medications (DMAMS) or disease modifying antiepileptic medications (DMAEM or DMAMs).
  • I also suggest more elaboration in point 3.5.
  • I would suggest including pharmacists with epilepsy pharmacotherapy expertise in current and future working groups. I would love to participate given my expertise in ASMs.

Sherif Hanafy Mahmoud, BSc (Pharm), MSc, PhD, FNCS
Clinical Associate Professor and Director of Certificate to Canadian Pharmacy Practice (CCPP) Program

University of Alberta
College of Health Sciences
Faculty of Pharmacy and Pharmaceutical Sciences

Sherif Mahmoud


14 October 2022

I agree with the term proposed 'Antiseizure medication'.

Yimber Matos


14 October 2022

I have gone through the article given in the link. I prefer term antiseizure medications over others.

Bishnu Acharya


14 October 2022

I agree with what is being suggested with the name change to Antiseizure medications. The previous terminology led to confusion when the child's development did not improve despite seizure control.

Shahnaz Ibrahim


13 October 2022

I am in full agreeance with the proposed changes to the nomenclature as outlined in the position paper.

Michelle Dixon


13 October 2022

Prefer the term anti-seizure medication

Dr Poorani Anandakrishnan


13 October 2022

Anti seizure medication

Aye Mya Min Aye


13 October 2022

Excellent paper, well written and very necessary. Thanks.

Curtis Claassen


13 October 2022

I agree with 'antiepileptic medication'.

Maria Luiza Giraldes Manreza


13 October 2022

Anti-epileptic drugs AEDs they also help to control seizures; most patient with epilepsy become seizures free.

Dr Neha PT


12 October 2022

The paper is excellent, but I do believe that the 'Application to non-pharmacological treatments' needs more expansion. Perhaps those who are neurosurgeons that have conducted surgery in epileptic patients could expand here on whether they consider surgery anti-epileptic/anti-seizure and why. Similarly, those who have conducted neurostimulation could give their opinions as well. The use of cannabinoids as an anti-seizure treatment option should be noted in this section as well.

Regarding dietary treatments, this should be expanded on what the treatments offered are and what is being researched. Two of the main treatments are the Ketogenic diet and omega-3 supplementation.

My PhD project was investigating the beneficial and therapeutic potential of omega-3 supplementation as a non-pharmacological treatment option for drug-resistant epileptic patients living in Sudan. I am happy to contribute my thoughts to this particular section.

Several clinical trials have shown that omega-3 fatty acids as an adjunct to AEDs can reduce the frequency of seizures in drug-responsive and resistant epileptic patients. Its mechanisms of action have been hypothesized and include an increase in membrane fluidity and consequently the activities of membrane proteins, induced by the incorporation of these highly unsaturated fatty acids in the neuronal membrane.

Therefore, according to the hypothesized mechanisms of action, I would consider it anti-seizure treatment option, rather than anti-epileptic. As far as I understand, this type of therapy is not targeting the epilepsy itself.

I am happy to add references and/or expand further if required for the section.

Nada R. Abuknesha


12 October 2022

I absolutely agree with the content of this position paper, also with the statements stated in Table 1. In alignment with this paper, as a next step, I believe that more appropriate terms should also be agreed to define treatments and strategies aiming at targeting the underlying pathology, such as 'anti-epileptic', 'anti-epileptogenic', or 'disease-modifying' effect or therapies. Finally, considering other languages to precisely define terminology and avoid misunderstandings is very valuable.

Laetitia Chauvière


12 October 2022

It is my privilege, honor and pleasure to be invited for comments on medications used in treatment of epilepsy.

The aim of revisiting terminology related to treatment of epilepsy is a welcome and well thought strategy.

It is widely believed that epilepsy is not cured but controlled or suppressed.

The term antiseizure medication is more appropriate than prevailing terms like antiepileptics or anticonvulsants, since the term 'epilepsy' is still shrouded with misconceptions and considered as a social stigma.

My thoughts:

In the article, it has been repeatedly stated that current medications suppress symptoms (seizures).

In my opinion, 'antiseizure medication (ASM)' term may be replaced by seizure suppressants (SS) or seizure suppressant medication (SSM) especially in view of the fact that medication is intended and targeted to suppress seizures or seizure activity and not to act against seizures as in all epilepsy cases the underlying or associated cause is not exactly known. Seizure suppressants (SS) term eliminates the need to discriminate between medicine and medication and will also include other treatment modalities. The suffix term 'medicine' or 'medication' may be misconstrued by general public that the treatment is being targeted to 'cure' their epilepsy ailment. In contrast, seizure suppressants are likely to impart a more thoughtful and accurate meaning that the treatment is aimed at suppressing the disorder.

It is only an opinion that I recommend for deliberation.

Dr Harinder Jaseja


12 October 2022

I fully agree with the proposition 'antiseizure medication', for all the reasons that you have described.

I personally don't have a problem with the term 'epileptic seizure' because it is very clear that these kind of seizures are symptoms of one or other form of epilepsy, and I have seen problems with translation of 'seizures', per se.

Kind regards,
Ilse

Ilse Smolders


12 October 2022

Present position paper from ILAE Nomenclature Task Force using modified Delphi Process provides accurate recommendations on the terminology to be applied to pharmacological treatments that exert a supportive effect against seizurres. These recommendations reduce the possibility of undue expectations and misunderstanding.

Bashir Ahmad Sanaie


12 October 2022

The term ASDs is simple, informative and explicit. It is time to replace the deeply rooted term of AED, as this term is still used even in 2022 by the NHS, FDA, Epilepsy Foundation, etc.

The other difficult problem is to convince drug companies to use the term ASMs, as their marketing use AED. In some companies, Epi is part of the brand name, such as Epitam, Epilim. In our speaking countries, it took us replacing the term (saraa) for epilepsy, and still drugs are marketed as called AEDs, so we need to agree on an alterative name such antifits medicine

مضاتات النوبات )

Tahir Obeid FRCP (UK) FAAN


11 October 2022

Antiseizure Medication

Dr Anju Aggarwal


11 October 2022

Totally agree on ASM as a perfect term instead of AED.

Hanka Laue-Gizzi


11 October 2022

Antiepileptic Drugs

Mohamed Hanafy Aly Ghonemy


11 October 2022

Antiseizure medications

Louise


11 October 2022

GABA Mediation Medications

Houda Rahay Khemamhem


11 October 2022

I fully agree with the new terminology proposed.

Congratulations for the work.

Magda Lahorgue Nunes


11 October 2022

I think these medications should be described as Anti-seizure medicine because this name seems to be not complicated, and it brings out the actual effect of the medicine.

For me it would even be easy to send someone to the drug store to buy it for me because the name can easily be understood. Thanks.

Denis


11 October 2022

This comment was written by Dr. Harden and Dr. Peter Forgacs.

We have reviewed this position paper and agree with the conclusions and recommendations. We find the justifications for changing to the newer terminology strong and compelling. In accordance with this shift to more accurate terminology, we have been consistently using the term 'antiseizure medication' (ASM) in our epilepsy clinical development programs since inception in 2019. While many epilepsy professionals have already adopted this newer terminology, we hope that the broader global epilepsy community will continue to adopt this change. Therefore, we suggest that the ILAE consider implementing a wide international dissemination of this nomenclature change to spur uniformity in the English language literature, with accurate and consistent translations from languages other than English, in order to enable efficient and complete searches of scientific data and clinical trial repositories. Further, we suggest obtaining input from the epilepsy basic science community, for whom the term 'anticonvulsants' may be accurate for some epilepsy animal models. This segment of our community should weigh in as to whether they would also adopt the revised nomenclature.

Cynthia Harden, MD


11 October 2022

Epimanagement

Naftali Ndungu


11 October 2022

I agree with the use of 'anti-seizure' medication rather than antiepileptic. I would use either term seizure or epileptic seizure, but the latter one emphazises the epileptic nature of the event and may help differentiate between psychogenic non-epileptic seizures. Although, I have to say that my prefered term for PNES is spells rather than seizures. I finally agree with the use of medication rather than drug.

Jorge Burneo


11 October 2022

Antiseizure

Stefka Mantarova


11 October 2022

I agree with the position of the authors.

Stefania Bruno


11 October 2022

More study on hypo seizures is needed.

Pauline Wild


11 October 2022

I think the term antiseizure medications (ASMs) is probably the most adecuate.

It's true that the term drug in Latin countries like mine (Spain) may seem similar to 'droga'. Even though I think that most of the practicioners know the correct definition for drug, I understand the fear of missunderstanding.

Guillermo Hernandez


11 October 2022

I am not native English, but I would suggest to change the title of the position paper to 'Which terms should be used to describe medications used in the treatment of seizures? An ILAE position paper' because unfortunatelly nowadays we treat seizures but we do not treat/prevent/change epilepsy.

Mercè Falip


11 October 2022

  1. I totally agree with the keypoints and conclusion of the paper.
  2. While doing my engineering research, I was also got confused many times with terminology using 'Anti-Epileptic Drugs'
  3. So its better to be specific as 'Anti-Seizure Medicines'

My opinion is genuinely based on my engineering knowledge, but the reading paper was an excellent experience for me.

Dr. Varsha K. Harpale


11 October 2022

I think anti seizure is the right word to use.

I think your position paper is great.

Thanks for the work.

Ariane Bernier


10 October 2022

This is a fascinating ILAE position paper. In application to non-pharmacological treatments, it is not clear if it is possible to use both terms antiseizure and antiepileptic for surgery or neuromodulation. It is unclear when it is appropriate to use antiepileptic and antiepileptogenic terms.

Daniel San Juan Orta


10 October 2022

Antiepileptic drugs

Dr Nazmul Hamid


10 October 2022

Comment 1: Antiseizure medication term is used based on clinical trials that show that these medications exert an antiseizure effect instudies. What about a subpopulation of patients in whom the same agents might cause exacerbation of seizures (for example Valproic acid given in patients with Mitochondrial disease. Carbamazepine given in patients with SCN1A mutation)? I think it would be hard to explain to patients and families how an (anti) seizure medication might be (pro) seizures. So based on those cases, my comment is to avoid using the prefix (anti) and use another term that might be more neutral like modulation or other.

Comment 2: Where would medication with an unclear mechanism of action yet widely used, like for example steroids in patients with infantile spams, be positioned? We know that it is highly effective in stopping spasms, and yet we cannot position it as antiseizure medication. At the same time, we are not 100 percent sure that its effect is due to immune modulation.

Thank you

Maher Arabi


10 October 2022

I agree with the proposals in the position paper. The use of medicine vs medication still seems similar to me.

Naluca Mwendaweli-Beckford


10 October 2022

Antiseizure medication is correct. In other languages, like Spanish, Medicamento Anti-Crisis (MAC) o Fármaco Anti-Crisis (FAC) podría utilizarse por igual.

Arnold Rene Thompson Cerna


10 October 2022

Sounds logical although I am asking myself why the ILAE community spends so much time and effort for a vocabulary the rest of the neurological world does not care about… Nice job though!

Bernhard Steinhoff


6 October 2022

Antiseizure medicine is a more inclusive term than antiepileptic medicine, and therefore is more acceptable.

Masaraf Hussain


5 October 2022

I agree with the draft's rationale for using the term 'antiseizure medication' and associated abbreviation 'ASM'. At least in Michigan I have noticed that most of the epileptologists and clinical neurophysiologists I know have already started adopting this term.

I also agree that our discipline should think hard on what to call current and future disease-modifying drug therapies for epilepsy.

A reasonable counterargument is that the epilepsy field is seen as relentlessly inventing new terminologies (for instance, the number of epilepsy and seizure semiology classifications since the 1980s) that are perceived as nonincremental changes in understanding; and that therefore mere wording changes are a distraction and a means by which non-epileptologists may become confused.

Tyson Burghardt


3 October 2022

I support the use of the term antiseizure medication based on the arguments well delineated in the document.

Alica Goldman


3 October 2022

Epilepsy Action welcomes the proposed changes to the terms to describe epilepsy medications and treatments.

Epilepsy Action have already begun using antiseizure medications (ASMs) to replace antiepileptic drugs (AEDs), as we agree that it is a more appropriate term and reflects that the medications are preventing seizures, rather than treating epilepsy itself.

We believe that reserving the term ‘seizure’ to indicate ‘epileptic seizures’ would greatly simplify the current language.

Daniel Jennings


2 October 2022

I think we are not yet there where there is a need to give up ‘antiepileptic’ in favour of ‘antiseizure’. How does it matter? I haven’t had a patient/practitioner get confused by the use of term antiepileptic and developing wrong notions about it because of the terminology. And even if someone did, it is unlikely to be settled with the introduction of a new terminology. It is going to make waters murkier. It will only create more uncertainty in peoples’ minds about the medications.

It is a very narrow view to consider seizures as just the symptom of epilepsy and to call medications as symptomatic treatment. It is well known that medications have an effect on epileptiform discharges and the discharges can not be considered the symptom of epilepsy. While seizures may not be driving epilepsy, they certainly are not independent of epilepsy. It seems unnecessary to demerit the medications that we and patients rely on, for no fathomable benefits.

Seizures are the cornerstone of a diagnosis of epilepsy and there are not many gains in rejecting an existing popular terminology for no practical reasons. Let the new treatments become available and name them in a novel fashion like ‘disease modifying treatment for epilepsy’ rather than causing confusion by discarding the ongoing popular terminology.

If the exercise of changing terminology had to be undertaken, first of all it should have been established by a wider survey among the community of patients, doctors and caregivers that the current terminology is misleading and that for which a change in terminology will clear that misconception. Just epileptologists talking among themselves and recommending changes would be force feeding the agenda.

Piyush Ostwal


2 October 2022

I think that the use of the word - Anti is confusing. Epilepsy is a life long condition for most people even if they are secure free that is what the medical practitioners tell us. I would favour a clear and concise methods of describing drugs and the uses. I believe that the communication should be clear.

Commonly Prescribed Epileptic Medications
     Brand name
Generic name
Indication
     Ativan
Lorazepam
Status epileticus
     Buccolam
Midazolam
Status epileticus
     Epanutin
Phenytoin
Focal & tonic-clonic
     Epilim
Sodium valproate
All forms of epilepsy & bipolar disorder
     Frisium
Clobazam
Adjunct in epilepsy
     Fycompa
Perampanel
Focal seizures
     Keppra
Levetiracetam
Focal & tonic-clonic
     Lamictal
Lamotrigine
Focal & tonic-clonic & bipolar disorder
     Lyrica
Pregabalin
Focal seizures & neuropathic pain
     Neurontin
Gabapentin
Focal seizures & neuropathic pain
     Phenobarbital
Phenobarbital
All forms of epilepsy
     Tegretol
Carbazazepine
Focal & tonic-clonic & trigeminal neuralgia
     Topamax
Topiramate
     Trileptal
Oxcarbazepine
Focal & tonic-clonic & migraine prophylaxis
Focal & tonic-clonic
     Vimpat
Lacosamide
Focal seizures

Lorraine Lally


28 September 2022

The term 'Antiseizure medication' covers all aspects well.

Dr Tanjina Sharifa


27 September 2022

In some languages, e.g. Italian, the use of the equivalent 'ASMs' sounds a little bit vague. On the other hand, 'anti-epileptic' is different from 'anti-epileptogenic'. Accordingly, I agree that, on the other hand, it was acknowledged that in other languages the term ‘epileptic’ should be retained when referring to epileptic seizures, to avoid misinterpretation, especially among non-specialists.

Pasquale Striano


26 September 2022

I agree with the statements in the position paper.

Tony Marson


23 September 2022

I prefer it is called Anti-seizure medication instead of AED, as most patients take time to agree with the term epilepsy. So, when you prescribe the anti-epiletic drugs, they will be in denial and will say God forbid they don't have epilepsy. This usually affects drug compliance here in Nigeria.

Olajumoke Aanu Akande


20 September 2022

Antiseizure medication is a better term as it avoids the social stigma associated with the word epilepsy. This is particularly true in Neonatology where parents are worried regarding the nature of seizures in their babies. They frequently ask their physicians whether the baby with seizures is having an epilepsy or not, as the word epilepsy has a different meaning and connotation in their minds. Fortunately, in newborn babies, we use ASM briefly for a few days/weeks only.

Antiepileptics, on the other hand, imply long term therapy, which is generally not required in newborns.

Ashok Kumar


19 September 2022

The Dravet Syndrome Foundation supports the position to standardize the use of 'ASM' when describing therapeutics that treat seizures.

Veronica Hood


18 September 2022

'Antiseizure' is in fact the most accurate term to use, given the symptomatic focus of the medications used in treatment of epilepsy patients.

Lara Morrow


15 September 2022

I am supportive of using the term ASMs.

I think a separate position should be reached regarding the meaning of the term ‘seizure’ when used without qualification. In this area I think if we mean ‘epileptic seizure’ then that is what we should say. I think if the term seizure is used without qualification then we shouldn’t will it to mean more than that. The term ‘seizure’ where there is continuing uncertainty as to its basis, or in other usages like reflex aystolic seizure, febrile seizure, non-epileptic seizure etc., require it to not implicitly mean more than it should. It is easier for us to control our own use of language and use epileptic seizure where possible rather than will everyone using the term seizure to imply something more specific. This is particularly important as we step into digital capture of this type of term.

Colin Dunkley


15 September 2022

I agree with the position paper, as well. It is written clearly on the topic by using 'transparent language; words that mean what they say'.

Reza Shervin Badv


15 September 2022

I agree with opinions of authors that the term 'anti-seizure Medication' is more appropriate than previously used term anti-epileptic drugs.

Dr Sandeep Patil


15 September 2022

SYMPTOMATIC CARE

Elisa Osanni


11 September 2022

I agree with the proposal to call antiseizures drugs instead of antiepileptic drugs, due to the reasons well explained in the paper (I've been using the term for the last almost two years).

Instead of 'drugs' (even if I'm comfortable with the word), I will propose 'pills'. However, I see no need to change the name because we, as clinicians and scientists, should not be worried with what 'people' may think about the words we use and because 'pill' will not be appreciated by most of our colleagues.

It is difficult to foresee a positive action of an anti-seizure, but certainly reduction of seizures aspects in each particular case. Hence, for a while, I see no advantage to start calling a particular name for a particular oral (drugs, pills?). When, and if, other non-oral medications appear with the capacity to change the course and comorbilities of the disease, then we will think about getting a new or different name. In what other, different of oral medications (cetogenic diet, neuromodulation, etc) are of concern, I suggest using 'oral merdication' and 'non-oral medication' and, in this case, to mention the specific treatment.

José Pimentel


11 September 2022

Thank you for this excellent, necessary, and very objective article updating the terminology in epilepsy. I fully agree that the term ASM is much more appropriate, leaving the term drugs for illicit substances. However, I have an observation. No medication is exclusively intended for a single type of seizure. Even ethosuximide can also be effective in myoclonic seizures. So a broader term like antiseizures medication seems to make more sense. On the other hand, I liked it when Dr. Engel called attention to the term antiepileptogenic.

Elza Márcia Yacubian


9 September 2022

Brief & quick comments/suggestions:

  1. Word 'disease' to be avoided completely & replaced with 'disorder' everywhere
  2. Word 'drugs' to be replaced with 'medications' uniformly & therefore the term 'Anti-epileptic medications' (AEMs) is preferred...
    Justification:
    a. Every individual in today's digital world is well educated & has an access to media & hence there is improved awareness to accept the term 'epilepsy' among the majority. The day is not too far when every PWE will accept this term!
    b. The term 'epilepsy' alone can describe all the symptoms of this disorder - motor, sensory, emotional etc. & hence it is appropriate to continue to use the term - 'Anti-epileptic medications' (AEMs).
    c. The term Anti-'seizure' primarily refers to 'motor component', in my opinion.
    d. Also, the terminology for medications used as disease-modifying agents or those used based on patho-physiology are difficult to identify & may not sufficiently reflect on the objectives of the Task Force. In fact they may add to the complexity of too many terms used.
    e. Lastly - medications in general can be classified/sub-classified based on
    • chemical classification
    • mechanism of action
    • site of action
    • clinical classification

Wish to propose & participate to contribute by using such principles relevant to identifying AEMs along with appropriate terminology as we move ahead with improved understanding of Pathophysiology of Epilepsy.

More later. Thank you & sincere regards to Task Force Team,

Dr Chanda Kulkarni


9 September 2022

Agree with ASM. Regarding using the word seizure and not using it for non-epileptic seizures, we may need to reach a consensus on the current term dissociative 'seizure' perhaps 'episode'?

Sarah Kerley


8 September 2022

I greatly appreciate the thought and work that has gone into the draft. Thank you for your work! I will comment on the word 'anti' in conjunction with ASM. 'Anti' reflects that the medicine's purpose is to fully controls seizures. Many people, my daughter in particular, does not have full retraction from seizures while on these medications. They suppress them at best in her case. To label them as 'anti' may give an incomplete description of their capability or mislead the public and medical professionals, though 'anti' is the desired effect, it might not be obtained. The term Seizure Suppressant Medications (SSM), or even Seizure Suppressants (SS) may be a more appropriate term, especially in my daughters case. Thank you for your review and possible consideration of my comments as a non-medical professional.

David Boggs


7 September 2022

I found the clarification of the terms to be helpful to lay people. However, continuing to refer to epilepsy as a disease creates continued stigma for the epilepsy community. To the lay person this implies contagious and will not help the community to prevent discrimination and eradicate fear.

C. Quinn


6 September 2022

Having read the paper, I agree with the proposed use of ASMs, whilst it does not qualify the specifics as discussed and may need some refinement over time, it is a much preferred and patient/clinician identifiable term.

Kathryn Coleman


5 September 2022

ASM

DR.P.A.M.KUNJU


5 September 2022

I would state in the introduction (and perhaps also in the abstract) that the scope of the Task Force was to define terminology for the English language only, otherwise the reader may think 'this does not work in my language'.

Fiorenzo Albani


4 September 2022

The draft is good, but I wonder whether MTOR inhibitors would fall in the category of antiseizure medication, antiepileptic medication, or both.

Pedro André Kowacs


4 September 2022

Epimed... short form of epilepsy medication. Nobody chooses to suffer but everything happens unknowingly. So the terms used should give hope to those affected.

Elizabeth


2 September 2022

I strongly agree with the preferred terminology, and it is what we typically use in our clinic here in Calgary.

Nancy Thornton


2 September 2022

I agree with the statements and the content of the position paper. I also appreciate it was suggested that terminology should be adapted to other languages as best applicable. A similar effort should be done to define at best antiepileptogenesis, antiepileptic and disease-modifying since the difference among these terms is not unequivocally defined.

Annamaria Vezzani


1 September 2022

The position paper is excellent. Entirely agree with the use of the term 'Antiseizure Medication/s.' In fact, the Neuroscience Health Care Professional Group, has been using this term for several years.

Lenor Cabral-Lim


1 September 2022

Anti-Epileptic Medications or 'ASMs' might be better for assessing those, like myself, that have to answer the EMTs or First Responders questioning: 'Are you epileptic? Have you been drinking or using illicit drugs? - standard question we have to ask.' When the EMTs that say out loud that they haven't seen me since the last time I had an epileptic seizure at _____ location to their co-workers. 'Or maybe did you forget to take your epilepsy medication today?' ASMs I'm fine with; its the continuous ignorance that I hate!

Paige


31 August 2022

I wholeheartedly agree with the ASM term, but disagree with parts of the following discussion.

It seems that the panel is proposing the term 'antiepileptic' for medications that prevent the development of epilepsy when the term 'antiepileptogenic' is more accurate.

I don't believe the term 'antiepileptic' should ever be supported. Rather, a general term for medications used to treat epilepsy should be called 'antiepilepsy medications'. I thought this was what had been agreed years ago.

I also question why this paper needs to open the issue of whether the term 'seizure' should always mean 'epileptic seizure'. This is an important issue that needs a different forum. Personally, I would prefer continuing the use of the term 'non-epileptic seizure', but would support the use of the term 'seizure' to mean epileptic seizure when not qualified.

Jerome Engel, Jr.


31 August 2022

I think the drugs for seizures may be divided into prophylactic and abortive. The prophylactic ones may be Phenytoin, Levetiracetam, etc. that aim to prevent seizures. While the abortive treatment includes midazolam, propofol, etc.

Thus a uniform term like antiseizure medications may not be correct in its entirety. We should make two terms - prophylactic seizure drugs and abortive seizure drugs.

Jitin Bajaj


30 August 2022

Dear colleagues,

I believe that it is necessary to reach clear definitions on the treatment of epilepsies. I believe that the work carried out by this group is considerable and requires the recognition and courage to investigate a field that not only involves medicine, but also linguistics. I believe that one of the weak points of the proposal is that it is not clear to which public the motivation to clarify the definitions is directed, and therefore the concepts that go into each word may have a diferent appraisal. If the target audience is the medical profession, and more specifically neurologists/epileptologists, I would strongly agree with several of the statements made. However, if the audience is broader, including the community at large, then there are aspects that I would not agree with.

Since English is not mynative language, I took the discretion to look up the definitions of "treatment" and "seizure" in 3 English- dictionaries, which I present below:

Cambridge Dictionary:
Treatment: the use of drugs, exercises, etc. to cure a person of an illness or injury
Seizure: 1. the action of taking something by force or with legal authority 2. a very sudden attack of an illness in which someone becomes unconscious or develops violent movements 3. the act of taking hold or possession of something 4. A seizure is also a medical condition that can cause you to lose control of your muscles and, often, cause you to become unconscious

Merriam Webster Dictionary:
Treatment: the action or way of treating a patient or a condition medically or surgically : management and care to prevent, cure, ameliorate, or slow progression of a medical condition
Definition of seizure 1a: the act, action, or process of seizing: the state of being seized, b: the taking possession of person or property by legal process
2a: a sudden attack (as of disease)especially: the physical manifestations (such as convulsions, sensory disturbances, or loss of consciousness) resulting from abnormal electrical discharges in the brain (as in epilepsy) b: an abnormal electrical discharge in the brain

Oxford Learner´s Dictionaries:
Treatment: something that is done to cure an illness or injury, or to make someone look and feel good
Seizure: seizure (of something) the use of legal authority to take something from somebody; an amount of something that is taken in this way seizure of something the act of using force to take control of a country, town, etc. a sudden attack of an illness, especially one that affects the brain

If the article is going to the general public, and non-specialist clinicians such as general practitioners, paediatricians, internists, nurses, or family and community physicians, then they should have been invited to be panelists for the Delphi group. From what I see, all the panelists in the Delphi group work in a center dedicated to neurology/epileptology, with the exception of one person. Can it be said then that there really was a representation of people with epilepsy mentioning that the IBE was there with only one person?

If other people are not included, there is a risk of working and then divulging terms that, although we understand them in the world of epileptology, do not necessarily represent the reality of those other actors. For example, for several years the Pediatric Epilepsy Training – PET strategy has made a semantic and therefore conceptual differentiation between what is 'seizure' versus 'epileptic seizure'. If the public of PET are GPs, paediatricians, nurses, among others, then the assertion of the Delphi group's text is a bit daring: 'The Task Force considered that the term "antiseizure" is sufficiently explanatory in the English language, and that including the term "epileptic" when describing the effect of these medications is redundant'. It is perhaps 'redundant' for epileptologists and some neurologists, but not necessarily for everyone else. Note that in the definition of seizure in the three dictionaries, the medical explanation is the last one, being that of the case of epilepsy even the last one. In the three cases of seizure definition, the legal explanation appears first. From the examples of the PET strategy and the dictionary definitions, the purpose of changing and 'progressivly imposing' a kind of terminology is not so clear to me, as stated that 'The Task Force also determined that in the English language the term "seizure" should preferably be reserved to indicate "epileptic seizures", and preferably avoided when describing non-epileptic events'. This intention may be valid in the area of epiletology/neurology, but it is not necessarily so for other professionals in the health area, and I fear much less so for the general public. 'Seizure' has many other meanings in the general public, and even in other professions, not only in English, but also in other languages, that are not restricted to 'clinical manifestations due to hypersynchronic neuronal discharges'. In texts and presentations addressed to a specialized audience or with a particular interest in epilepsy, I would agree with the term ASM. In an open and wide public, the clarification of 'epileptic ASM' is not superfluous.

The article starts with the proposal that 'The present position paper from the ILAE Nomenclature Task Force provides recommendations on the terminology to be applied to pharmacological treatments that exert a symptomatic effect against seizures'. Taking this statement into account, I would modify the first Key Point by adding the word pharmacological. The terminology used to describe pharmacological treatments should accurately reflect the nature of their primary action. In the same way that it stated from the idea of providing 'recommendations on the terminology to be applied to pharmacological treatments that exert a symptomatic effect against seizures', then it would not make much sense to direct the discussion into non-pharmacological treatments. The intention of the task force is not clear to me there, because, again, the readership is too broad. Some may consider the term antiseizure surgery instead of epilepsy surgery, antiseizure neurostimulation instead of VNS, or antiseizure dietary treatments appropriate, but for others the term 'antiepileptic' will be more valid. Seriously, are we operating on symptoms or on diseases?

Jaime Carrizosa


30 August 2022

I prefer the term 'antiseizure medications'. However, since there are also non-epileptic seizures for which specific medications may be developed in the future, we propose to add one or more letters to the term 'antiseizure medications', which will mean that these are medications specifically against epileptic seizures, and remove the prefix 'anti-' to remove the stigmatizing connotation (undertones). For example we propose: 'episeizure medications' or 'eseizure medications'.

In my article 'Pathogenesis of epilepsy and mental diseases, the role of the blood-brain barrier in the context of neurochemical theories' (https://www.psychiatryjournal.in/archives/2022/vol4/issue1), I had proposed to name the phenomenon when the prescription of antiepileptic drugs is accompanied by an improvement in the electroencephalographic picture, but with a deterioration in the clinic and an increase in seizures, and a change in drugs leads to the opposite result - an improvement in the clinical picture and a deterioration in the electroencephalographic picture - 'drug clinical-EEG dissociation', in short, 'drug CED''. But cause the term 'drugs', which in the English medical literature can be used interchangeably with 'medicines' or 'medications' - but in community settings (and in its literal translation into other languages) - can be extended to denote compounds associated with non-therapeutic, illegal recreational abuse and dependence, it will be better to name this fenomenon 'medication clinical-EEG dissociation', in short, 'medication CED'.

Alexander Kharibegashvili


30 August 2022

'Epilepsy medication'

Phillip Standing


30 August 2022

I agree with using the term 'antiseizure medications'.

Gogi Kumar


30 August 2022

Very nice paper!

Paragraph 3.4, specifically: 'Therefore, the term "antiseizure" and "antiepileptic" should not be regarded as being mutually exclusive.'

I just wonder if here it means that antiseizure should be a subset of antiepileptic, i.e. that all antiepileptic medications are 'antiseizure' (but not the other way around); meaning that you could call a set of medications antiseizure which contain both antiepileptic and antiseizure medications?

Samuel Håkansson


30 August 2022

I support this name change to 'antiseizure medications.'

Wesley Kerr


30 August 2022

I definitely appreciate the term 'anti-seizure medication' vs. 'anti-convulsant medication'. Not only is 'anti-seizure' logical in describing its use for all types of seizures, but the language is user-friendly to the consumer. I am very practiced at saying anti-convulsant medication and now realize - although sounding knowledgeable, nursing, medically versed - the client often does not know what you mean. Yes, the client sees you as knowledgeable on your topic, but it is demeaning to the client's common usage of language, snobby, and makes the client feel overwhelmed and unqualified to manage their own condition without a professional to guide them. I try very hard to have clients learn about their condition and work to empower the client to be accountable for their own health and wellness. To feel secure in their knowledge of their condition and treatment plan, and advocate for themselves going forward in their epilepsy journey. Using plain descriptive language 'anti-seizure medication' is logical.

Jo-Anne Welton


30 August 2022

Anti-seizure medication - I agree with the limitation given by this term.

Saly Elkholy


29 August 2022

Antiseizure Medication (ASM) and Antiseizure Therapy (AST)

Use of term 'antiseizure medication (ASM)' is appropriate instead of the use of term 'antiepileptic drugs (AED)'.

These agents are also used in many non-epileptic conditions, like trigeminal neuralgia, migraine, painful peripheral neuropathy, and in some psychiatric disorders.

So use of terminology like 'antiepileptic drugs (AED)' may stigmatize the people who are taking these medications.

I am also requesting you to add one more terminology in epileptic treatment. We can consider introducing the term 'antiseizure therapy (AST)' for all the other modes of treatment without drugs for epilepsy, like vagal nerve stimulation, surgery, ketogenic diet and DBS, etc.

Prof. Dr. M .A. Aleem


29 August 2022

If anti-epileptic is stigmatising, why is anti-seizure not considered to be the same? Especially considering people with hard to treat epilepsy may continue to have seizures despite maximal therapies. Use of the term ‘seizure inhibitors’ (SIs) or ‘seizure inhibiting medications’ (SIMs) eliminates the ‘anti’ in anything, so these might be a better fit. You could then divide the treatments up into classes e.g. Class 1- channel modifier, etc., as well.

Rebecca Paff


29 August 2022

I agree with the position paper. It is well-written and clearly thought out.

Sam Berkovic


29 August 2022

I agree with the positions expressed the draft. I suggest that mention be made of the Institute of Medicine report, Epilepsy Across the Spectrum, which was instrumental in moving our terminology away from 'antiepileptic drug'. 'Throughout the report the committee suggests using more precise—and less negative terms—such as “seizure medications” (to replace “anti-epileptic drugs”), epilepsy seizures (to replace “epileptic seizures”), and “seizure-like events with a psychological basis” (rather than psychogenic, non-epileptic seizures)' (chapter 1, page 62 of the pdf version).

Thomas Bleck


29 August 2022

While the term ASM is technically correct, changing from AED will cause confusion. Search terms will not be adjusted to convert to ASM, leading to faulty results. Over time, AED will be forgotten and not recognized. Much of what I see reported in journals relates to earlier work. In the future, these links will be lost. Is there a way to combine/connect the terms to aid future researchers?

Joyce Cramer


29 August 2022

'Seizure' should be used instead of 'epileptic seizure' - more refined. 'Epileptic' automatically implies convulsions, loss of consciousness, contagious (?).

'Medication' should be used instead of 'medicine' or 'drug'. 'Medicine' implies temporary and/or given to a child from a doctor's office. 'Drug' implies stronger than ordinary treatment with beyond normal side effects.

Paul Delaup


29 August 2022

ASM seems to be the most inclusive and accurate term. Everyone that treats epilepsy or has an epilepsy diagnosis deals with seizures, but the inverse is not always true.

Chris Rush


29 August 2022

As we have seen recently, no one on the author list represents the surgeons viewpoint on this topic, and thus, the paper is written one-sided. It would also be appropriate to have the editors of Epilepsia on the author list and discussion panel.

Gary Mathern


29 August 2022

What happens when we offer anti-seizure medications for non-epileptic conditions, for example 'valproic acid in bipolar disorders'? Should we maintain the term 'anti-seizure medication'?

Mijail Rivas


29 August 2022

I think the paper if excellent and agree with the rationale for clarity around terminology.

Sandra Dewar PhD, RN, FAES, FAAN


29 August 2022

ASMs will be a great match as most medications are aimed at reducing seizures, and we see that clients who stop treatment with hopes that they are healed always return with relapses, meaning the underlying cause of epilepsy wasn't treated. Also, it will help to reduce stigma associated with epilepsy. However a clear caution should be put in place because not all seizures are epileptic, so the term ASMs may be - to a small extent - misleading, which may cause irrational medicine use while dealing with non-epileptic seizures.

Bwete Damyano Z


29 August 2022

I agree with the draft position for the nomenclature clarification.

Paul C. Van Ness, MD


29 August 2022

Antiseizure - best terminology

Mary Vasseghi


29 August 2022

I agree we should choose antiseizure medications rather than AEDs.

Omar A Danoun


29 August 2022

I agree totally. However, the peculiar decision of the German Chapter to translate this is almost a semantic suicide. But this is beyond the scope of this international proposal....

Bernhard Prof. Dr. Steinhoff


29 August 2022

Very nice and reasonable paper, I have no comments to add.

Holger Lerche