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MORTALITY IN LOW BIRTHWEIGHT INFANTS

will no doubt be raised that this takes no cognizance of EEG findings, nor of aetiology, but it has the merit of being consistent within itself. Recently a working party from a number of international organizations concerned with epilepsy attempted in one day to produce a new classification, ostensibly based on clinical and EEG phenomena.’ The result is not a happy one. The epilepsies are first divided into generalized or partial (focal), but partial epilepsies which become generalized are classified under partial, which seems a disadvantage. Moreover, the status of the aura as distinct from the initial manifestation of the seizure is not made clear. Within these categories of clinical phenomena, there are aetiological categories labelled as primary and secondary epilepsy. These are to be diagnosed by a composite of clinical criteria-including seizure type-the neurological status of the patient, the age of onset and EEG criteria. It seems unlikely that the general physician, who it is hoped will adopt this scheme, will find it practicable. Moreover, it fails to provide what for him is vital information. It makes a vast difference to a patient’s employability and social acceptability whether he is only having absences or whether he is experiencing tonic-clonic seizures, yet patients with absences, bilateral myoclonus and tonic-clonic seizures are grouped together under primary generalized epilepsy. In the present state of knowledge of epilepsy it has to be accepted that an all-embracing classification is impossible. Rather must there be three parallel categories. The first should classify the clinical type of seizure (generalized, focal, absence, etc.); the second the type of EEG interictal and ictal disturbance; the third the aetiology, where this is known. Thus it might be said of a patient that he has tonic-clonic seizures associated with polyspike wave complexes due to birth trauma, etc. In this way a classification of practical value to those concerned with all aspects of management ranging from electrophysiological study to placement at work could be developed. Without this the present confusion about the epilepsies will continue and the international collection and comparison of data and exchange of information will be impeded.