Epileptic seizure classification (ilae-1981 and ilae-2017): Comparison of modular education program among residents in pediatrics

EPILEPTIC SEIZURE CLASSIFICATION (ILAE-1981 and ILAE-2017): Comparison of Modular Education Program Among Residents in Pediatrics ABSTRACT Introduction and Purpose: The identification of seizure semiology is of great importance for epilepsy diagnosis. The 1981 and 1989 seizure classification of International League Against Epilepsy (ILAE) are generally found as uneasy and impractical for clinical practice. ILAE presented a new seizure classification in June, 2017. In this study, it was aimed to compare the modular education program (MEP) of epileptic seizure classifications (ILAE-1981 and ILAE-2017) among the residents in pediatrics. Materials and Methods: A MEP consisting of eight modules was prepared for ILAE-1981 and ILAE-2017 seizure classifications. The first five modules were designed for ILAE 2017 classification and the remaining three modules were designed for ILAE 1981 classification; (Module 1) Focal Motor Seizures, (Module 2) Focal Non-Motor Seizures, (Module 3) Generalized Motor Seizures, (Module 4) Generalized Non-Motor Seizures, (Module 5) Unknown and unclassified, (Module 6) Partial seizures, (Module 7) Generalized seizures, (Module 8) Unclassified seizures. On 25th October 2017, MEP was presented to 35 residents in Ege University Medical Faculty, Department of Pediatrics. Subsequently, all types of seizures mentioned in MEP were classified according to ILAE-1981 and ILAE-2017 classifications by using 50 epileptic seizure videos taken from Pediatric Neurology Epilepsy Archive of the Ege University Medical Faculty. Power-point presentation used in modular education and ILAE-1981 and ILAE-2017 Seizure Classification Cards were given to participants on the same day and were used to classify epileptic seizures for 1 month in clinical practice. At the end of this training, MEP evaluation was carried out. Evaluation was made by requesting the participants to classify 58 seizure videos that were not previously used in MEP according to the ILAE-1981 and ILAE-2017 classifications. Results: When the responses given to 58 video recordings by 35 participants were examined, 564 (2.8%) videos were left unresponsive while 1974 (97.2%) were responded according to ILAE 1981 Seizure Classification. Of these, 760 (38.5%) were correct and the remaining 1214 (61.5%) were incorrectly interpreted. When the responses according to the ILAE 2017 Seizure Classification were examined, a total of 2000 (98.5%) responses were given and 30 (1.5%) were not answered. The correct response rate for both classifications was 22.8%, while the false response rate for both classifications was 42.7%. This was also found statistically significant. (P = 0.024) According to the ILAE 2017 Seizure Classification, the ratio of correct anwers were 54.1% for focal seizures, 38.5% for generalized seizures, and 7.3% for unclassified seizures and this was found statistically significant (p = 0.002). When we compared the modules within themselves, it was found that focal motor seizures (module 1) were responded correctly with a ratio of 34.9% while this ratio was 56.3% for focal non-motor seizures (module 2) (p = 0.000). The percentage of correct answers for generalized motor seizures (module 3) was 45.9%, while it was 25.1% for generalized motor seizures (p = 0.000). Partial seizures were 34.1%, generalized seizures 53.0% and unclassified seizures 12.9% were correctly answered according to ILAE 1981 Seizure Classification, and it was found statistically significant (p = 0.000). Conclusion: It was concluded that the MEP for classification of ILAE-1981 and ILAE-2017 epileptic seizures for residents in pediatrics was not sufficiently successful (<50%) and thus MEP should be improved and replicated. This study contributed to the efforts to create a common language in terms of classifying seizures among pediatric residents by being the first to use ILAE 2017 Seizure Classification.