Epileptic Seizures and Epilepsy

To the Editor: The article by Fisher et al. (1) introduces a modified consensus on the definition of epilepsy. The new definition appears more appropriate from an epileptologists' perspective other than few shortcomings: The term enduring alteration in the brain is qualitative rather than quantitative. How do we define or measure this enduring alteration? Although enduring alteration in the brain can be appreciated in the presence of epileptiform discharges and certain structural abnormalities, in other situations, this cannot be determined. By this definition, how do we classify a patient immediately after a temporal lobectomy for mesial temporal sclerosis who does not have epileptiform discharges? It would be nice to have guidelines to determine when a patient with a previous diagnosis of epilepsy is no longer considered to have epilepsy and that the enduring alteration in the brain has been fixed. This would do a great service to many patients who have been seizure free for a considerable time. The implications not only will affect their psychological well-being but also will contribute positively to their social and vocational interests.