Diagnostic criteria for epilepsy of infancy with migrating focal seizures

	Mandatory	Alerts	Exclusionary
Seizures	Focal/multifocal tonic or clonic seizures, with or without subtle behavioral arrest and prominent autonomic features Seizures migrate from one hemisphere or lobe to another clinically Seizure frequency rapidly increases in the first weeks and months, often progressing to status epilepticus		Myoclonic seizures
EEG	Ictal recording shows a migrating pattern (this might be missed if a prolonged video EEG is not performed) Interictal: Multifocal discharges	Interictal: Suppression burst pattern prior to medication Single persistent epileptic focus on EEG Hypsarhythmia
Age at onset	<12 months	Onset 6 to 12 months
Development at onset		Severe delay prior to seizure onset
Neurologic examination		Significant abnormalities on neurologic examination prior to seizure onset
Comorbidities	Developmental plateauing or regression with frequent seizures
Imaging			Abnormal neuroimaging with structural causal lesion
Course of illness	Neurodevelopmental delay	Seizure freedom Lack of brain atrophy on MRI
Is MRI or ictal EEG required for diagnosis? An MRI is required for diagnosis to exclude a causal structural etiology. An ictal EEG may not be required if clinical migration is observed. However, an ictal EEG is strongly recommended to document a migrating pattern.
Syndrome without laboratory confirmation: In resource-limited regions, EIMFS can be diagnosed on clinical observation of seizure migration without EEG or MRI, provided all other clinical mandatory and exclusionary criteria are met

EEG: electroencephalography; MRI: magnetic resonance imaging; EIMFS: epilepsy of infancy with migrating focal seizures.

From: Zuberi SM, Wirrell E, Yozawitz E, et al. ILAE classification and definition of epilepsy syndromes with onset in neonates and infants: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1349. Copyright © 2022 The Authors. Available at: https://onlinelibrary.wiley.com/doi/10.1111/epi.17239 (Accessed on November 11, 2022). Reproduced under the terms of the Creative Commons Attribution License 4.0.

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Diagnostic criteria for epilepsy of infancy with migrating focal seizures