Diagnosis in Epilepsy - 5 axis approach

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865130/

For correct and complete analysis and classification of signs and symptoms the principles of the neurological diagnosis should be followed: what? (clinical diagnosis), where? (topographical diagnosis), and why ? (etiological diagnosis) (4). A detailed history, complete general clinic and neurologic examination, diagnostic hypothesis and wise choice of complementary evaluations are all important elements for epilepsy diagnosis (5).

The use of the 5-axis diagnosis, published in 2001 (6) is very useful. Adapted to daily practice and using also the new concepts and terminology proposed in 2010 by the Commission of Classification and Terminology (CCT) of ILAE (7), these axis are:

Axis 1 – are the paroxysmal events epileptic seizures? (to be diferentiated from nonepileptic events). If epileptic, the seizures semiology should be described, according to the terms from the Glossary published by ILAE in 2001 (8).

Axis 2 – define type of seizures: focal, generalized or unknown if focal or generalized (epileptic spasm belong to this last category). If focal seizures, attempts to define lateralization and localization should be done.

Axis 3 – syndrome diagnosis (electroclinical syndromes are epilepsies with particular clinical and electroencephalographic (EEG) features allowing their recognition; syndrome diagnosis is important for therapeutic approach and prog­nosis estimation).

The following features should be described: age of onset, description of seizure semiology, relation to sleep, precipitant factors, motor and cognitive development, neurological exam and the EEG features.

Axis 4 – etiologic diagnosis (genetic, structural – metabolic or unknown). Detailed description should follow.

Axis 5 – description of associated deficits.