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Capítulo 10: Nuevas definiciones y clasificaciones de crisis epilépticas y epilepsias

que existe epilepsia después de una crisis, cuando el riesgo de tener otra es superior al 60%. La epilepsia se resuelve cuando una per- sona está libre de crisis durante 10 años, los últimos cinco sin medi- camentos, o cuando ha superado el rango de edad de un síndrome epiléptico. La clasificación del tipo de crisis epiléptica se ha revisado, pero sigue siendo estructuralmente similar a la que se usa con frecuencia desde 1981. Las crisis son de inicio focal, generalizado o descono- cido. Las crisis parciales simples ahora se denominan crisis focales sin alteración de la consciencia y las crisis parciales complejas se denominan crisis focales con alteración de la consciencia . Las cri- sis motoras pueden ser focales o generalizadas. Se incluyen algunos nuevos tipos de crisis en las categorías de inicio focal y generalizado. Las epilepsias se clasifican por el tipo de crisis epiléptica, causas, comorbilidades y síndromes. Se reconoce la creciente importancia de la genética y de las causas inmunitarias en la clasificación. El uso de la nueva terminología debería aumentar con el tiempo, para ser eventualmente reemplazada por una clasificación basada en la investigación que se ocupa de la epilepsia. Referencias 1. Engel J Jr, Berg A, Andermann F, et al. Are epilepsy classifications based on epileptic syndromes and seizure types outdated? Epileptic Disord . 2006;8:159–160. 2. Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and con- cepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia . 2010;51:676–685. 3. Berg AT, Scheffer IE. New concepts in classification of the epilepsies: entering the 21st century. Epilepsia . 2011;52:1058–1062. 4. Scheffer IE. Epilepsy: a classification for all seasons? Epilepsia . 2012;53(suppl 2):6–9. 5. Korff CM, Scheffer IE. Epilepsy classification: a cycle of evolution and revolution. Curr Opin Neurol . 2013;26:163–167. 6. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epi- lepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia . 2017;58:512–521. 7. Zuberi SM, Perucca E. A new classification is born. Epilepsia . 2017;58:511. 8. Brodie MJ, Zuberi SM, Scheffer IE, et al. The 2017 ILAE classification of seizure types and the epilepsies: what do people with epilepsy and their caregivers need to know? Epileptic Disord . 2018;20:77–87. 9. Falco-Walter JJ, Scheffer IE, Fisher RS. The new definition and classifica- tion of seizures and epilepsy. Epilepsy Res . 2018;139:73–79. 10. Fisher RS. An overview of the 2017 ILAE operational classification of seizure types. Epilepsy Behav . 2017;70(Pt A):271–273. 11. Fisher RS. The new classification of seizures by the International League Against Epilepsy 2017. Curr Neurol Neurosci Rep . 2017;17:48. 12. Fisher RS, Bonner AM. The revised definition and classification of epi- lepsy for neurodiagnostic technologists. Neurodiagn J . 2018;58:1–10. 13. Fisher RS, Cross JH, D’Souza C, et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia . 2017;58:531–542. 14. Fisher RS, Cross JH, French JA, et al. Operational classification of sei- zure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia . 2017;58:522–530. 15. Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia . 1993;34:592–596. 16. Fisher RS, Boas WV, Blume W, et al. Epileptic seizures and epilepsy: defi- nitions proposed by the International League against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia . 2005;46:470–472. 17. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a prac- tical clinical definition of epilepsy. Epilepsia . 2014;55:475–482. 18. Hauser WA, Rich SS, Lee JR, et al. Risk of recurrent seizures after two unprovoked seizures. N Engl J Med . 1998;338:429–434. 19. Sillanpaa M, Schmidt D, Saarinen MM, et al. Remission in epilepsy: how long is enough? Epilepsia . 2017;58:901–906. 20. Fisher RS, Acevedo C, Arzimanoglou A, et al. How long for epilepsy remission in the ILAE definition? Epilepsia . 2017;58:1486–1487.

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