Epilepsy
Also known as: seizure disorder · status epilepticus
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Practice guideline update: Efficacy and Tolerability of the New Antiepileptic Drugs I: Treatment of New-onset Epilepsy
American Academy of Neurology (AAN) and American Epilepsy Society (AES) · 2018 · 2018 (reaffirmed 2024)
A joint AAN/AES evidence-based practice guideline on drug treatment for newly diagnosed focal or generalised epilepsy in adults and children. It reviews the efficacy, safety and tolerability evidence for second- and third-generation antiseizure medications as monotherapy or add-on therapy. Published in 2018 and reaffirmed by the AAN in October 2024. A companion document (Part II) addresses treatment-resistant epilepsy.
Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy
International League Against Epilepsy (ILAE) · 2025
The ILAE's globally used framework for naming and classifying seizure types, revised through a modified Delphi consensus of experts from all ILAE regions. It keeps the four main seizure classes of the 2017 system while changing several terms and adding a new recognised seizure type, and is designed to work both in resource-limited settings and in specialist epilepsy centres. Published in Epilepsia in 2025.
- Retains four main seizure classes (focal, generalized, unknown origin, unclassified) across 21 seizure types. source
- Developed by a 37-member working group drawn from all ILAE regions using a modified Delphi consensus process. source
- Builds on and revises the 2017 ILAE operational seizure classification. source
US vs EU key differences
- The two documents answer different questions: the 2018 AAN/AES guideline ranks antiseizure drugs for new-onset epilepsy, while the 2025 ILAE position paper is a diagnostic classification framework for seizure types and makes no pharmacological recommendations. source
- The US guideline gives graded drug-level guidance for new-onset focal epilepsy: lamotrigine at Level B, with levetiracetam and zonisamide at the weaker Level C; in patients aged 60 and over, lamotrigine is Level B and gabapentin Level C. source
- Currency differs by seven years: the US practice guideline dates to 2018, whereas the ILAE replaced its 2017 seizure classification in 2025, dropping the word 'onset' from the main class names, making consciousness (awareness plus responsiveness) the classifier, replacing the motor/nonmotor split with observable versus nonobservable manifestations, and recognising epileptic negative myoclonus as a seizure type. source
What changed recently
- GLOBAL2017 → 20252025-04-23
The 2025 ILAE position paper revises the 2017 operational seizure classification, keeping the four main classes but separating diagnostic classifiers from descriptors, expanding the scheme to 21 seizure types, classifying focal and unknown-onset seizures by whether consciousness is impaired or preserved, and adding negative myoclonus as a recognised generalised seizure type.
source ↗curation confidence 90% - US2004 → 2018 (reaffirmed 2024)2018-06-13
This update of the 2004 AAN guideline on new-onset epilepsy re-graded the second- and third-generation antiseizure drugs, concluding that lamotrigine should be considered for reducing seizure frequency in adults with new-onset focal epilepsy, that levetiracetam and zonisamide may be considered, and that in patients aged 60 and over lamotrigine should and gabapentin may be considered.
See the full update feed for changes across every system.