Elsevier

Epilepsy & Behavior

Volume 64, Part B, November 2016, Pages 300-303
Epilepsy & Behavior

Special Communication
Reprint of: The new approach to classification: Rethinking cognition and behavior in epilepsy

https://doi.org/10.1016/j.yebeh.2016.11.024Get rights and content

Abstract

There has been considerable debate surrounding the benefits and drawbacks of the new approach to classifying the epilepsies released by the ILAE Commission on Classification and Terminology (2005–2009). This new approach has significant implications for the way we conceptualize and assess cognition and behavior in epilepsy; however, as yet, there has been limited discussion of these issues in the field. The purpose of this Targeted Review is to spark this discussion by encouraging researchers and clinicians to think about the changes that the new approach may bring. These may include (i) reframing the way we think about the comorbidities of epilepsy, (ii) more precisely characterizing the cognitive and behavioral phenotypes of electroclinical syndromes, (iii) more carefully mapping the longitudinal trajectory of cognitive and behavioral features relative to the timing of seizures, and (iv) considering the links between cognitive, behavioral, and neurological phenotypes in the new classification scheme. It is hoped that such changes will aid translation of the advances in cognitive and behavioral neuroscience into routine clinical practice by providing purer markers of disease and more targeted treatments. A Special Issue canvassing such issues will be forthcoming that will consider current knowledge of the cognitive and behavioral features of the epilepsies from the view of the new classification scheme.

Section snippets

The new approach to the classification of the epilepsies

In 2010, the ILAE Commission on Classification and Terminology (2005–2009) published a special report recommending a fundamental shift in our understanding of concepts, use of terminology, and approach to classifying seizures and the various forms of epilepsy [1]. The rationale for this shift was to produce a more flexible organization for classifying the epilepsies that could readily incorporate our rapidly advancing knowledge in basic and clinical neuroscience to facilitate its translation to

Rethinking cognition and behavior in epilepsy

From the perspectives of clinical neuropsychology and cognitive and behavioral neuroscience, perhaps the most profound impact of the new descriptive approach is the explicit reconceptualization of focal and generalized seizures as arising out of a disease of brain networks, the cause of which may be genetic, lesion-based, or unknown. Focal seizures are conceived as originating in a network confined to one hemisphere that may be cortical or subcortical, discrete, or more widely distributed. By

The benefits of aligning cognitive, behavioral, and neurological phenotypes

Within the field, it has been increasingly recognized that traditional clinical practice is becoming ‘out of step’ with the rapid advances in cognitive and behavioral neuroscience. For this reason, a special international workshop was convened in Toronto in 2010 under the auspices of the ILAE. The express purpose of this workshop was to review and advance evidence-based neuropsychological practice for pediatric and adult patients with epilepsy by bringing together a range of specialists with

Internalizing new perspectives: the psychology of change

An entire branch of occupational and behavioral psychology is dedicated to the study of resistance to change. The phenomenon is strong in both humans and animals and demonstrably impedes progress. People tend to have an innate preference to keep things as they are, and resistance to change is particularly strong in groups of people. When changes are proposed within a community, the community tends to respond with a low level of tolerance for any ambiguity in the new system and a focus on the

Moving forward: reframing existing findings and developing new research approaches

This Special Communication represents a call for papers that review and reframe cognitive and behavioral research through the prism of the new approach to classifying the epilepsies. It is designed to encourage the field to embrace change and move towards a more complete understanding of cognition and behavior in epilepsy by identifying the psychological, cognitive, and behavioral features that are most relevant to diagnostic classification and treatment. As one example of the type of work we

Acknowledgments

We would like to thank Professor Steven Schachter, Dr. Ennapadam Krishnamoorthy, and Professor Samuel Berkovic for their helpful discussions and comments on earlier drafts of this Special Communication.

Disclosure

The authors have no conflicts of interest to declare.

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The article is reprinted here for reader convenience and for the continuity of the special issue. For citation purposes, please use the original publication details; The new approach to classification: Rethinking cognition and behavior in epilepsy, 41, pp 307-310.

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