Over the last few decades the ILAE classifications for seizures and epilepsies (ILAE-EC) have been updated repeatedly to reflect the substantial progress that has been made in diagnosis and understanding of the etiology of epilepsies and seizures and to correct some of the shortcomings of the terminology used by the original taxonomy from the 1980s. However, these proposals have not been universally accepted or used in routine clinical practice. During the same period, a separate classification known as the "Four-dimensional epilepsy classification" (4D-EC) was developed which includes a seizure classification based exclusively on ictal symptomatology, which has been tested and adapted over the years. The extensive arguments for and against these two classification systems made in the past have mainly focused on the shortcomings of each system, presuming that they are incompatible. As a further more detailed discussion of the differences seemed relatively unproductive, we here review and assess the concordance between these two approaches that has evolved over time, to consider whether a classification incorporating the best aspects of the two approaches is feasible. To facilitate further discussion in this direction we outline a concrete proposal showing how such a compromise could be accomplished, the "Integrated Epilepsy Classification". This consists of five categories derived to different degrees from both of the classification systems: 1) a "Headline" summarizing localization and etiology for the less specialized users, 2) "Seizure type(s)", 3) "Epilepsy type" (focal, generalized or unknown allowing to add the epilepsy syndrome if available), 4) "Etiology", and 5) "Comorbidities & patient preferences".

Asklepios Hospital for Neurology Falkenstein Koenigstein Falkenstein Germany

Brno Epilepsy Center Department of Neurology St Anne's University Hospital and Faculty of Medicine Masaryk University Brno Czech Republic

Claudio Munari Epilepsy Surgery Center ASST Grande Ospedale Metropolitano Niguarda Milano Italy

Département des Neurosciences Service de Neurologie Centre Hospitalier de Luxembourg Luxembourg Luxembourg

Department of Brain and Nervous System Kokilaben Dhirubhai Ambani Hospital Mumbai India

Department of Neurology Beaumont Hospital and FutureNeuro Research Centre Royal College of Surgeons in Ireland Dublin Ireland

Department of Neurology General Hospital Hietzing with Neurological Center Rosenhuegel Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology Medical Faculty Sigmund Freud University Vienna Austria

Department of Neurology School of Medicine International University of Health and Welfare Fukuoka Japan

Department of Neurology Shizuoka Institute of Epilepsy and Neurological Disorders Shizuoka Japan

Department of Neurology Vivantes Humboldt Klinikum Berlin Germany

Department of Neurosciences and Behavioral Sciences Ribeirao Preto Medical School University of Sao Paulo Ribeirao Preto SP Brazil

Department of Neurosurgery McGovern Medical School at UT Health Texas Epilepsy Neurotechnologies and Neuroinformatics Institute UT Health Memorial Hermann Hospital Texas Medical Center Houston TX USA

Division of Neurology Kobe University Graduate School of Medicine Kobe Japan

Epilepsy Center Department Neuropediatrics and Epilepsy Center Frankfurt Rhine Main University Children's Hospital Goethe University Frankfurt Frankfurt Germany

Epilepsy Center Department of Neurology University Hospital Erlangen Erlangen Germany

Epilepsy Center Department of Neurology University of Munich Hospital Ludwig Maximilians University Munich Germany

Epilepsy Center Frankfurt Rhine Main Center of Neurology and Neurosurgery University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research Goethe University Frankfurt Germany

Epilepsy Center Hessen Philipps University Marburg Marburg Germany

Epilepsy Center Kork Kehl Germany; Medical Faculty of the University of Freiburg Germany

Epilepsy Center Northwestern University Feinberg School of Medicine; Northwestern Memorial Hospital Chicago IL USA

Epilepsy Center UH Rainbow Babies and Children's Hospital Case Western Reserve University School of Medicine Cleveland OH USA

Epilepsy Center University Hospitals Cleveland Medical Center Cleveland OH USA

Epilepsy Division Department of Neurology University of Kansas Medical Center Kansas City USA

Epilepsy Program Hospital Ruber Internacional Madrid Spain

Epilepsy Section Department of Neurological Sciences Rush University Medical Center Chicago USA

Epilepsy Unit Hospital Clinic Barcelona Spain

Epilepsy Unit Vall dHebron Hospital Barcelona Spain

Formerly Department EEG and EMU Dutch Epilepsy Clinics Foundation SEIN Heemstede and Zwolle The Netherlands

Functional and Restorative Neurosurgery Center Department of Neurological Surgery University Hospitals Cleveland Medical Center Case Western Reserve University School of Medicine Cleveland OH USA

Institute of Neurology University College London London UK

National Neuroscience Institute Singapore and Duke National University of Singapore Medical School Singapore

Neurocenter Bellevue Zurich Switzerland

Neurology Department Grenoble Alpes University Hospital Grenoble France

Neurology Department McGovern Medical School The University of Texas Health Science Center at Houston Houston TX USA

Neuromedica IPS Medellin Colombia

of Neurology with Institute of Translational Neurology University of Muenster Muenster Germany

Rush University Medical Center Department of Neurological Sciences Section of Epilepsy Chicago IL USA

Schoen Klinik Vogtareuth Vogtareuth Germany

School of Medicine Pontificia Universidade Católica do Rio Grande do Sul ; Porto Alegre Epilepsy Surgery Program Hospital São Lucas da PUCRS Porto Alegre Brazil

South Texas Comprehensive Epilepsy Center and Department of Neurology UT Health San Antonio San Antonio TX USA

St Bonifatius Hospital Lingen Germany

St Elizabeth Mercy Hospital Youngstown OH USA

The University of Texas Health Science Center at Houston McGovern Medical School Houston TX USA

University of Florida Department of Neurology Gainesville Florida USA

University of Miami Miller School of Medicine Miami Florida USA

University of South Florida and Tampa General Hospital Tampa FL USA

University of Sydney Westmead Clinical School Sydney Australia

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