# Epilepsy Classification > Epilepsy classification for NEET-PG Medicine: ILAE 2017 focal vs generalised seizures, syndromes like JME and West, and EEG correlates with exam favourites. - Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/epilepsy-classification - Exam / course: NEET-PG · Subject: Medicine - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Epilepsy Classification", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/epilepsy-classification ## Direct answer Focal or generalised — that first split in the 2017 ILAE classification decides everything else, because focal seizures arise within one hemisphere (with or without impaired awareness) while generalised seizures rapidly engage both hemispheres from the outset. The second axis describes the dominant feature: motor (tonic, clonic, myoclonic, atonic, hyperkinetic) versus non-motor (absence, cognitive, emotional, autonomic). Classification then climbs from seizure type to epilepsy type to a defined syndrome — West syndrome, juvenile myoclonic epilepsy, childhood absence epilepsy, temporal lobe epilepsy — because the syndrome, not the seizure description alone, determines the drug, the prognosis and the investigations. ## What you must remember - ILAE 2017 replaced "partial" with "focal"; focal seizures are further described as aware or with impaired awareness, replacing the old simple and complex labels. - Generalised seizures include tonic-clonic, absence, myoclonic, tonic and atonic types; atonic seizures produce sudden "drop attacks" and often injure the face. - Absence epilepsy: onset 4 to 10 years, frequent brief staring spells, 3 Hz spike-and-wave on EEG, ethosuximide is the drug of choice; most remit by adolescence. - Juvenile myoclonic epilepsy: adolescence onset, early-morning myoclonic jerks plus generalised tonic-clonic seizures, 4 to 6 Hz polyspike-and-wave; valproate controls most, and lifelong treatment is traditionally advised. - West syndrome (infantile spasms): clusters of flexor or extensor spasms in infancy, hypsarrhythmic EEG, ACTH or vigabatrin (vigabatrin especially in tuberous sclerosis). - Mesial temporal lobe epilepsy follows hippocampal sclerosis in a high proportion of cases; childhood febrile seizures lasting long are the classic precedent, and MRI shows the atrophic, hyperintense hippocampus. - Unknown-onset seizures are a legitimate category when the beginning was not witnessed — classify what you can, do not force a label. - Epilepsy is diagnosed after two unprovoked seizures more than 24 hours apart, or one seizure with a high recurrence risk (for instance an epileptogenic lesion on MRI). ## A classification walked through one vignette A 19-year-old college student is brought in after a generalised tonic-clonic seizure at breakfast; his roommate recalls that for the previous week he had been dropping his toothbrush every morning, and his mother remembers single jerks of the arms since age 16, dismissed as clumsiness. Work down the axes. The witnessed event is a generalised tonic-clonic seizure, but the morning myoclonus tells you the tonic-clonic event was itself generalised from onset — this is a generalised epilepsy, almost certainly juvenile myoclonic epilepsy. The confirmatory moves are interictal EEG showing 4 to 6 Hz polyspike-and-wave discharges, and MRI that is typically normal or shows a nonspecific pattern. Drug choice follows the classification: valproate is the classical drug of choice; lamotrigine or levetiracetam are alternatives for a woman of childbearing age. Contrast the pathway had the story been an aura of rising epigastric sensation followed by lip-smacking and postictal confusion — a focal aware progressing to focal-to-bilateral tonic-clonic seizure, pointing to temporal lobe epilepsy, demanding MRI for hippocampal sclerosis, and treated with carbamazepine or another focal agent. Same word "seizure", completely different syndromes, different scans, different drugs — which is why examiners keep returning to classification. ## Where students slip The favourite trap is mislabelling a focal-to-bilateral tonic-clonic seizure as a "primary generalised" seizure because the bystander only saw the convulsion — the aura, the unilateral head turn or the postictal focal weakness (Todd's paresis) is the evidence of focal onset, and ignoring it sends the patient down the wrong drug pathway. The second slip is treating absence seizures with carbamazepine or phenytoin, which can worsen absence and even precipitate absence status. Third is calling every infantile spasm "tonic-clonic"; the clusters on waking and the hypsarrhythmic EEG define West syndrome, and the exam expects ACTH as first-line therapy. ## Frequently asked questions ### Which EEG pattern characterises childhood absence epilepsy? Regular, symmetric 3 Hz spike-and-wave discharges, provoked by hyperventilation in the unmedicated child — a viva favourite demonstration. ### How does ILAE 2017 replace the terms simple and complex partial seizures? Both become "focal seizures", qualified as "focal aware" (former simple) or "focal with impaired awareness" (former complex); awareness, not impairment of consciousness alone, is the divider. ### Which syndrome pairs infantile spasms with hypsarrhythmia? West syndrome — the triad of spasms, hypsarrhythmic EEG and developmental arrest; ACTH is first-line, with vigabatrin preferred when tuberous sclerosis is the cause. ### Why does a history of prolonged febrile seizures matter in temporal lobe epilepsy? Prolonged or focal febrile seizures are the classical antecedent of mesial temporal (hippocampal) sclerosis, the commonest substrate of drug-resistant focal epilepsy and the best surgical candidate. ### Which drugs are preferred and avoided in juvenile myoclonic epilepsy? Valproate classically, with lamotrigine or levetiracetam as alternatives; avoid carbamazepine, phenytoin and gabapentin, which may aggravate myoclonus.