[1] In Engel's 1993 summary of the 1992 Palm Desert Conference on Epilepsy Surgery, he annotated his classification system with more detail.
[1] The annotation was as follows: The subjectivity of the Engel system leaves much of the postoperative class assignment process to the patients.
[4] Proponents of the Engel classification guidelines argue that the patients are best able to perceive the worth of the operation because they are the ones experiencing the seizures before and after the treatment.
[citation needed] As is the case for all current methods of reviewing epilepsy surgery outcomes, the Engel classification system has subjective components.
Continuing to have to endure a large number of tonic-clonic seizures (grand mal seizures) over a period of days, months, or even over the course of a year or two, would make it impossible to drive and very hard to hold a job away from home entailing much stress, and would pose limits on one's abilities to safely carry out the activities of daily living without at least some monitoring or assistance.