Epileptic Disorders


Classification of paroxysmal events and the four-dimensional epilepsy classification system Volume 21, issue 1, February 2019


  • Classification of paroxysmal events and the four-dimensional epilepsy classification system
  • Classification of paroxysmal events and the four-dimensional epilepsy classification system
  • Classification of paroxysmal events and the four-dimensional epilepsy classification system


  • Figure 1

  • Figure 2

  • Figure 3

  • Figure 4

  • Figure 5


1 Case medical Center - Neurology, Cleveland, Ohio, USA
2 University Hospitals Ringgold standard institution - Neurology, Cleveland, Ohio, USA
3 International University of Health and Welfare School of Medicine, Department of Neurology, Narita, Japan
4 Kaiser Permanente Northern California, Neuroscience Department, Redwood City, California, USA
5 Department of Clinical Epileptology, Sleep Disorders and Functional Pediatric Neurology, University Hospitals of Lyon; Member of the European Reference Network on Rare and Complex epilepsies, ERN EpiCARE, Lyon, France
6 Sigmund Freud Privat Universitat Wien Paris Ringgold standard institution, Department for Epileptology and Clinical Neurophysiology, and General Hospital Hietzing with Neurological Center Rosenhuegel, Department of Neurology, Vienna, Austria
7 University of South Florida, Department of Neurology, Tampa, Florida, USA
8 Westmead Hospital-Neurology, Wentworthville, New South Wales, Australia
9 Rush University Medical Center - Department of Neurological Sciences Section of Epilepsy, Chicago, Illinois, USA
10 St. Elizabeth Mercy hospital, - Neurology, Youngstown, Ohio, USA
11 Hospital Clínic - Epilepsy Unit, Department of Neurology; Member of the European Reference Network on Rare and Complex epilepsies, ERN EpiCARE, Barcelona, Spain
12 Case medical Center – Neurology, Cleveland, Ohio, USA
13 Claudio Munari Epilepsy Surgery Centre - Department of Neuroscience, Milan, Italy
14 University Hospitals Cleveland Medical Center – Neurology, Cleveland, Ohio, USA
15 Epilepsy Center – Neurology, Erlangen, Germany
16 Schoen-Klinik Vogtareuth - Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany
17 University Hospital Cleveland Medical Center - Neurology, Epilepsy Center, Cleveland, Ohio, USA
18 University of Florida - Department of Neurology, Gainesville, Florida, USA
19 University of Miami, Miller School of Medicine - Department of Neurology, Miami, Florida, USA
20 Universitatsklinikum Giessen und Marburg - Standort Marburg Ringgold standard institution - Epilepsy Center, Neurology, Marburg, Hessen, Germany
21 University Hospitals - Neurology (Epilepsy), Cleveland Heights, Ohio, USA
22 UT Health Memorial Hermann Hospital, Texas Medical Center - Texas Epilepsy, Neurotechnologies and Neuroinformatics Institute, Houston, Texas, USA
23 National Neuroscience Institute, and Duke-NUS Medical School, Singapore
24 Neuromédica IPS – Epilepsy, Medillin, Colombia
25 Kokilaben Dhirubhai Ambani Hospital - Department of Brain and Nervous System, Mumbai, India
26 Kobe University Graduate School of Medicine - Division of Neurology, Kobe, Japan
27 University Hospitals Case Medical Center/Case Western Reserve University – Neurosurgery, Cleveland, USA
28 Ludwig Maximilians University, Munich - Department of Neurology, Epilepsy Center, Munich, Germany
29 School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS) - Neurology Service, Porto Alegre Epilepsy Surgery Program, Porto Alegre, Brazil
30 Case Medical Center – Pediatrics, Cleveland, Ohio, USA
31 Hospital of the Goethe-University Frankfurt am Main - Epilepsy Center Frankfurt Rhine-Main, Frankfurt, Germany
32 Rainbow Babies & Children's Hospital, Case Western University School of Medicine – Pediatrics, Cleveland, Ohio, USA
33 Northwestern University Feinberg School of Medicine Ringgold standard institution – Neurology, Chicago, Illinois, USA
34 Kork - Epilepsy Center, Kehl-Kork, Germany
35 UTHSCSA - Neurology, San Antonio and South Texas Comprehensive Epilepsy Center, San Antonio, Texas
36 University of Texas Health Science Center – Neurosurgery, Houston, Texas, USA
37 National Hospital Organization Shizuoka Institute of Epilepsy and Neurological Disorders, Department of Epileptology, Urushiyama, Japan
38 Stichting Epilepsie Instellingen Nederland Ringgold standard institution – Neurology, Hoofddorp, Noord-Holland, The Netherlands
39 Beaumont Hospital - Department of Neurology, Dublin, Ireland
40 Grenoble-Alpes Hospital and University - Neurology Department and GIN INSERM U-1216, Grenoble, France
* Correspondence: Hans Lüders Case medical Center - Neurology, 11100 Euclid Ave Cleveland, Ohio 44106-6058, USA

This educational review describes the classification of paroxysmal events and a four-dimensional epilepsy classification system. Paroxysmal events are classified as epileptic and non-epileptic paroxysmal events. Non-epileptic events are, in turn, classified as psychogenic and organic paroxysmal events. The following four dimensions are used to classify epileptic paroxysmal events: ictal semiology, the epileptogenic zone, etiology, and comorbidities. Efforts are made to keep these four dimensions as independent as possible.

The review also includes 12 educational vignettes and three more detailed case reports classified using the 2017 classification of the ILAE and the four-dimensional epilepsy classification. In addition, a case is described which is classified using the four-dimensional epilepsy classification with different degrees of precision by an emergency department physician, a neurologist, and an epileptologist. [Published with video sequences on www.epilepticdisorders.com]