{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:00:27Z","timestamp":1790755227362,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The classification of the epilepsies has traditionally relied on clinical and electroencephalographic features. However, advancements in molecular genetics, neuroimaging, and our understanding of epilepsy pathophysiology necessitate a shift toward an etiology\u2010based approach. Etiology\u2010specific classification enables precision diagnosis and precision management by integrating genetic, structural, metabolic, infection, and immune\u2010related insights. Genetic advances have identified more than 1000 epilepsy\u2010related genes, revealing how variations in a single gene can produce diverse phenotypes and syndromes. Similarly, neuroimaging innovations, such as high\u2010resolution magnetic resonance imaging and functional imaging, have enhanced detection of subtle structural abnormalities and epileptogenic zones. In 2022, the International League Against Epilepsy introduced the concept of etiology\u2010specific epilepsy syndromes, emphasizing the interplay between etiology and syndrome. This paradigm shift moves beyond traditional classifications, offering tailored treatments that address seizures and comorbidities to improve prognosis and quality of life. Despite this progress, challenges persist. These include the complexity of defining genotype\u2013phenotype functional relationships, limitations in diagnostic accessibility in resource\u2010limited settings, and the integration of multifactorial causes. This article proposes extending the concept of etiology\u2010specific epilepsy syndromes to encompass broader spectrums of phenotypes within each etiology, supported by detailed frameworks for analyzing clinical, imaging, genetic, and functional data. The aim is to refine the classification system to guide personalized, evidence\u2010based care. This etiology\u2013syndromic spectrum model underscores the importance of lifelong, multidisciplinary approaches to epilepsy management, balancing the value of syndrome\u2010based insights with the transformative potential of precision medicine.<\/jats:p>","DOI":"10.1002\/epi.70467","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T07:35:10Z","timestamp":1790753710000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How should etiology change the classification of the epilepsies? Report from the ILAE 2021\u20132025 Terminology Commission"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8120-0287","authenticated-orcid":false,"given":"Nicola","family":"Specchio","sequence":"first","affiliation":[{"name":"Neurology, Epilepsy, and Movement Disorders, Bambino Ges\u00f9 Children's Hospital IRCCS, full member of European Reference Network EpiCARE  Rome Italy"},{"name":"University Hospitals KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3874-9749","authenticated-orcid":false,"given":"St\u00e9phane","family":"Auvin","sequence":"additional","affiliation":[{"name":"APHP, Robert Debr\u00e9 University Hospital, Pediatric Neurology Department CRMR Epilepsies Rares, member of European Reference Network EpiCARE  Paris France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Inserm NeuroDiderot  Paris France"},{"name":"Institut Universitaire de France  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1109-7296","authenticated-orcid":false,"given":"Francesca","family":"Bisulli","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences University of Bologna  Bologna Italy"},{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna full member of European Reference Network EpiCARE  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4544-3724","authenticated-orcid":false,"given":"Scott","family":"Demarest","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neurology, School of Medicine University of Colorado  Boulder Colorado USA"},{"name":"Precision Medicine Institute Children's Hospital Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7138-6022","authenticated-orcid":false,"given":"Elena","family":"Gardella","sequence":"additional","affiliation":[{"name":"Department of Epilepsy Genetics and Personalized Medicine Danish Epilepsy Center, member of European Reference Network EpiCARE  Dianalund Denmark"},{"name":"Department of Clinical Neurophysiology Danish Epilepsy Center, member of European Reference Network EpiCARE  Dianalund Denmark"},{"name":"Department of Regional Health Research, Faculty of Health Sciences University of Southern Denmark, Odense  Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1189-3671","authenticated-orcid":false,"given":"Angelina Kakooza","family":"Mwesige","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5877-4074","authenticated-orcid":false,"given":"Rima","family":"Nabbout","sequence":"additional","affiliation":[{"name":"Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Necker\u2013Enfants Malades Hospital, APHP, member of European Reference Network EpiCARE, Institut Imagine, Inserm, UMR 1163 Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0976-9011","authenticated-orcid":false,"given":"Alshimaa","family":"S. Othman","sequence":"additional","affiliation":[{"name":"Neurology Department, Kasr\u2010Alainy Faculty of Medicine Cairo University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1435-3619","authenticated-orcid":false,"given":"Kollencheri Puthenveettil","family":"Vinayan","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology Amrita Institute of Medical Sciences  Cochin India"},{"name":"Amrita Advanced Center for Epilepsy, Amrita Institute of Medical Sciences  Cochin India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6851-0646","authenticated-orcid":false,"given":"Robyn","family":"Whitney","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Paediatrics McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3015-8282","authenticated-orcid":false,"given":"Elaine","family":"Wirrell","sequence":"additional","affiliation":[{"name":"Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0853-1223","authenticated-orcid":false,"given":"Hideo","family":"Yamanouchi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Comprehensive Epilepsy Center Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7242-9779","authenticated-orcid":false,"given":"Ji Yeoun","family":"Yoo","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4489-4697","authenticated-orcid":false,"given":"Sameer M.","family":"Zuberi","sequence":"additional","affiliation":[{"name":"School of Health &amp; Wellbeing University of Glasgow  Glasgow UK"},{"name":"Royal Hospital for Children  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7345-4829","authenticated-orcid":false,"given":"J. 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