Revising and refining the epilepsy classification system: priorities from a developing world perspective

Although the technical and human resources for epilepsy care and classification are located largely in high income countries, most people with epilepsy reside in developing regions of the world. Advances over the past two decades in the clinical and basic neurosciences have transformed epilepsy care and largely drive the present need for a revised epilepsy classification. These advances have been mirrored by new knowledge about epilepsy in tropical, resource limited settings. A nonhierarchical, multidimensional approach to classification that includes dimensions that can be ascertained in, and are relevant to, resource-limited settings is needed. Such a classification system could be designed for relevance at tertiary care settings in developed regions as well as primary health care settings in developing regions. Insights from the global use of such a classification approach would also offer opportunities to gain complementary information regarding epilepsy across a broad range of settings and could provide new insights into epilepsy and epileptogenesis. Failure to develop a classification inclusive of the developing world would exclude 80% of the epilepsies globally.