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To classify postoperative outcomes for

Jerome Engel proposed the following scheme,[1] which has become the de facto standard when reporting results in the medical literature:[2]

  • Class I: Free of disabling seizures
  • Class II: Rare disabling seizures ("almost seizure-free")
  • Class III: Worthwhile improvement
  • Class IV: No worthwhile improvement

History

The Engel classification guidelines were devised in 1987 and made public at the 1992 Palm Desert Conference on Epilepsy Surgery. [3][4] The method was proposed by UCLA Neurologist Jerome Engel Jr.

Overview

In Engel's 1993 summary of the 1992 Palm Desert Conference on Epilepsy Surgery, he annotated his classification system with more detail.[1] The annotation was as follows:

  • Class I: Seizure free or no more than a few early, nondisabling seizures; or seizures upon drug withdrawal only
  • Class II: Disabling seizures occur rarely during a period of at least 2 years; disabling seizures may have been more frequent soon after surgery; nocturnal seizures
  • Class III: Worthwhile improvement; seizure reduction for prolonged periods but less than 2 years
  • Class IV: No worthwhile improvement; some reduction, no reduction, or worsening are possible

Disadvantages

As is the case for all current methods of reviewing epilepsy surgery outcomes, the Engel classification system has subjective components.[5] A disabling seizure is subjective and can vary in definition from person to person. While one epileptic experiencing a seizure when driving a car may find it disabling, the same magnitude of seizure may be interpreted as mild by an epileptic resting in bed. Everything beyond Class I is also subjective because there is no quantitative definition of what qualifies as a rare occurrence. One doctor may consider 2 seizures a year as a rare occurrence while another doctor may consider 5 a year as a rare occurrence. The worthwhileness of the operation is also ambiguous because the worth can be interpreted differently by various patients and healthcare professionals.[6]

The Engel classification system has been thought of as a cross-sectional grading system by medical professionals because it does not account for long term changes in patients.[6] It has been proposed that it would be more beneficial to reevaluate patients on an annual basis, and the International League Against Epilepsy devised a separate rating scale that reevaluates patients on every anniversary of their surgery.

References

  1. ^
    ISBN 0-88167-988-7
    .
  2. PMID 15519134.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  3. ^ Massachusetts General Hospital. "Engel Epilepsy Surgery Outcome Scale". Massachusetts General Hospital. Retrieved 31 March 2014.
  4. ^ Passaro, Erasmo A. "Outcome of Epilepsy Surgery". Medscape. Retrieved 31 March 2014.
  5. ^ Passaro, Erasmo A. "Outcome of Epilepsy Surgery". Medscape. Retrieved 31 March 2014.
  6. ^ a b Yan, Chaohua (2009). "Comparison of 2 Classifications of Postoperative Seizure Outcome, Engel vs ILAE Classification, Following Epilepsy Surgery in Adults with Medically Refractory Epilepsy". John Hopkins University School of Medicine. Retrieved 3 April 2014. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

External links

Category:Medical terminology Category:Neurological disorders Category:Neurology Category:Epilepsy


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