The Spectrum of Seizures and Epilepsies

There has been an evolution of seizure and epilepsy classification systems, from the foundational work of Gastaut to the most recent updates by the International League Against Epilepsy (ILAE) in 2025. There has been a progressive refinement of classification criteria, shaped by advances in neuroimaging, electrophysiology, and genetics, which have enhanced the precision and clinical relevance of seizure and epilepsy taxonomy. In parallel, there has been the development of the ILAE Epilepsy Classification frameworks in 2017 and 2022, emphasising their multi-axial structure—incorporating seizure type, epilepsy type, aetiology, and comorbidities—and their relevance for clinical decision-making and research. The 2025 update of the ILAE Seizure Classification introduced key changes in terminology, including the re-framing of ‘consciousness’ as a classifier. Semiological features of seizures arising from different brain structures highlight ictal features that reflect underlying cortical networks.