The 2025 updated ILAE classification of epileptic seizures: Scope, challenges, recommendations, and clinical practice guidance
The International League Against Epilepsy (ILAE) seizure classification has undergone progressive revisions to enhance its clinical relevance, culminating in the updated 2025 framework. This update builds upon the 2017 framework while further improving clinical and global applicability, as well as conceptual clarity. The 2017 ILAE seizure classification represented a major paradigm shift by simplifying terminology, introducing seizure onset as the central organizing principle, and promoting patient-centered communication. The 2025 ILAE classification retains this foundational structure and further refines terminology to enhance communication with patients and caregivers. It also expands recognition of seizures with uncertain or mixed onset, places greater emphasis on observable clinical manifestations, and provides a clearer distinction between seizure semiology and etiologic diagnosis. A central feature of the 2025 framework is its multidimensional approach, which integrates seizure semiology, neuroanatomical localization, etiology, and comorbidities. This approach supports timely diagnosis, rational treatment decisions, and improved outcomes, particularly in low- and middle-income countries where diagnostic resources may be limited. In this review, we critically examine the evolution of seizure classification from the 2017 ILAE framework to the 2025 update, highlighting its scope, core framework, and remaining challenges. We analyze terminology that has been retained, modified, or discontinued to clarify the transition between classification models and to promote consistent clinical use. Finally, we offer recommendations to inform future revisions of seizure classification and provide a practical guide for its application in clinical practice.
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