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In this prospective,population-based study of 594 cases of newly diagnosed epilepsy,proportions in categories as defined by the International League Against Epilepsy(ILAE)were as follows:(1)localization-related epilepsies; 1.1*idiopathic,1.2%;1.2*symptomatic,16.2%;and 1.3 cryptogenic,24.6%;(2) generalized epilepsies:2.1*idiopathic(idiopathic generalized epilepsy)with 3-Hz spike and wave:absence epilepsy,2.2%;juvenile myoclonic epilepsy,1. 5%;and nonspecific idiopathic generalized epilepsy,5.6%;2.3.1*symptomatic generalized epilepsies,1.5%;2.3.2*specific syndromes with generalized epilepsy,0.3%;3.2 seizures without unequivocal focal or generalized features,32%;4.1 situation-related syndromes,isolated seizures,9.9%; seizures due to acute toxic or metabolic cause,*4.5%.Only 33.6%were in diagnostic ILAE categories(asterisks)and many rare syndromes were not represented.The remainder(66.4%)were in various nonspecific categories. Only 24%of localization-related epilepsies could be clinically localized to a single ILAE-proposed site of origin and of these best localized cases,14%had strongly discordant imaging or electroencephalograms.These major problems in applying the ILAE classification to epilepsy in the general population and its underemphasis of modern imaging techniques are discussed. |
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