Jo M. Wilmshurst’s research while affiliated with University of Cape Town and other places

The International League Against Epilepsy (ILAE) has updated the operational classification of epileptic seizures, building upon the framework established in 2017. This revision, informed by the implementation experience, involved a working group appointed by the ILAE Executive Committee. Comprising 37 members from all ILAE regions, the group utilized a modified Delphi process, requiring a consensus threshold of more than two thirds for any proposal. Following public comments, the Executive Committee appointed seven additional experts to the revision task force to address and incorporate the issues raised, as appropriate. The updated classification maintains four main seizure classes: Focal, Generalized, Unknown (whether focal or generalized), and Unclassified. Taxonomic rules distinguish classifiers, which are considered to reflect biological classes and directly impact clinical management, from descriptors, which indicate other important seizure characteristics. Focal seizures and those of unknown origin are further classified by the patient's state of consciousness (impaired or preserved) during the seizure, defined operationally through clinical assessment of awareness and responsiveness. If the state of consciousness is undetermined, the seizure is classified under the parent term, that is, the main seizure class (focal seizure or seizure of unknown origin). Generalized seizures are grouped into absence seizures, generalized tonic–clonic seizures, and other generalized seizures, now including recognition of negative myoclonus as a seizure type. Seizures are described in the basic version as with or without observable manifestations, whereas an expanded version utilizes the chronological sequence of seizure semiology. This updated classification comprises four main classes and 21 seizure types. Special emphasis was placed on ensuring translatability into languages beyond English. Its aim is to establish a common language for all health care professionals involved in epilepsy care, from resource‐limited areas to highly specialized centers, and to provide accessible terms for patients and caregivers.

Ideally, pediatric electroencephalograms (EEGs) should be performed by accredited neurophysiology technologists and interpreted by specialists trained in epileptology However, low‐ and middle‐income countries (LMICs) lack such specialists. Aim To collate expert consensus on essential curriculum content for non‐epilepsy specialists in EEG interpretation and safe post‐training practice. Method A qualitative study on pediatric EEG training curricula needs was designed in collaboration with an adult education specialist. Data were collected via interviews from 15 epilepsy experts with training experience across high‐ to low‐income settings. Thematic analysis was used to identify sub‐themes. The experts voted on the key statements in a two‐round Delphi to ascertain consensus. Results Twelve aspects of pediatric EEG training were identified and categorized thematically: relevance; exposure to pediatrics; focus on pediatrics; barriers; resource‐limited setting; entry skills; best pedagogy; assessment; critical skills; reinforcement of skills; training model; and recommendations. Conclusion This study was driven by the inadequate access to training in pediatric EEG for non‐epilepsy specialists, which is further exacerbated by the lack of epileptologists and neurophysiologists. The outcomes from the expert consensus opinions promoted consolidation, adaptation, and evolution of existing models that are viable for practice and to be used worldwide. The Delphi consensus demonstrated alignment among regionally located specialists towards the promotion of effective and maintained training for non‐epilepsy specialists, as well as highlighting barriers that should be considered and addressed.

Abstract The International League Against Epilepsy (ILAE) has updated the operational classification of epileptic seizures, building upon the framework established in 2017. This revision, informed by the implementation experience, involved a working group appointed by the ILAE Executive Committee. Comprising 37 members from all ILAE regions, the group utilized a modified Delphi process, requiring a consensus threshold of more than two thirds for any proposal. Following public comments, the Executive Committee appointed seven additional experts to the revision task force to address and incorporate the issues raised, as appropriate. The updated classification maintains four main seizure classes: Focal, Generalized, Unknown (whether focal or generalized), and Unclassified.

The interaction between basic science epilepsy researchers and clinical epileptologists is a longstanding issue. Efforts to provide opportunities for a dialogue between preclinical and clinical epilepsy professionals are crucial to reduce the knowledge gap between them and improve the translational success of neurobiology‐based research. The International League Against Epilepsy (ILAE) Research and Innovation Task Force circulated a survey to investigate the need for an update on new clinical epilepsy concepts within the basic science community. The 336 respondents included basic scientists (BS), preclinical scientists (PCSs), and/or clinical scientists (CSs). The majority of the 237 BSs/PCSs were engaged in preclinical studies in translational epilepsy research and declared translational research as a priority research interest. Fewer respondents from low‐middle‐income countries than from upper‐middle or high‐income countries (40.7% vs 65%) considered translational research a critical aspect of their research. A broad understanding of both clinical and neurobiological aspects of epilepsy was declared by 48% of BSs/PCSs; 96% of CSs declared a superficial knowledge of neurobiology of epilepsy. Most BSs/PCSs were aware that epilepsy is a complex condition that should be investigated with the help of clinical epileptologists, even though concerns were expressed on the relationship with clinicians. A focused training program on emerging clinical epileptological aspects tailored for BSs/PCSs was recommended by 81% of the participants; the majority of respondents preferred either 1‐ or 2‐week in‐presence tutoring or continuous online training coordinated by ILAE at the regional/national level. The survey also underscored the value of educational programs on neurobiology of epilepsy targeting CSs and low‐middle‐income countries (LMIC) investigators.