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Epileptische Anfälle und Epilepsien nach „Schlaganfällen“

Seizures and epilepsies after stroke

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Zusammenfassung

Epilepsien nach „Schlaganfällen“ repräsentieren ca. 20% aller Epilepsien im Erwachsenenalter. Häufig scheinen die Patienten selber eine Amnesie für ihre epileptischen Anfälle zu haben, die symptomarm verlaufen können. Postiktal wurden Tage andauernde Todd-Paresen und Verwirrtheitszustände beschrieben, die die Diagnose weiter erschweren können. Einzelne epileptische Anfälle wurden nach Schlaganfällen in 2–10% der Fälle beobachtet, während populationsbasierte Studien eine Epilepsierate von 3–4% angegeben. Subgruppenanalysen ergaben nach ischämischen Hirninfarkten eine Häufigkeit von Epilepsien von ca. 3%, nach intrazerebralen Blutungen von 6–10% und nach Subarachnoidalblutungen (SAB) von ca. 9%. Ein Status epilepticus entwickelte sich nach einem Schlaganfall in weniger als 1%. Hinsichtlich Diagnose und Behandlung weisen Epilepsien nach Schlaganfällen Besonderheiten auf, die in der Übersichtsarbeit näher dargestellt werden. Die Prognose von Epilepsien nach Schlaganfällen ist mit Anfallsfreiheitsraten von 67 und 54% günstig.

Abstract

Epilepsies after stroke represent about 20% of all adult onset epilepsies. The patients are frequently amnestic about having the seizures, which can be very subtle. Postictal pareses and confusional states can last for days, which further complicate diagnosis. Single seizures after stroke were reported in 2–10% of cases and community-based studies report epilepsies in 3–4% of stroke patients. Analyses of subgroups identified a 3% risk of epilepsies after ischemic infarction, a risk of 6–10% after intracerebral hemorrhages, and a 9% risk after subarachnoid hemorrhages. Status epilepticus developed in less than 1% of stroke patients. Concerning diagnosis and treatment, epilepsies after stroke tend to have specific features as described in the article. The prognosis of post-stroke epilepsies is good. Prospective studies reported seizure-free rates of 67 and 54%.

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Der korrespondierende Autor weist auf folgende Beziehung/en hin: Berater- und/oder Vortragshonorare von Desitin Arzneimittel GmbH, Eisai GmbH, GSK GmbH & Co.KG, Novartis GmbH, Pfizer Pharma GmbH, UCB GmbH.

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    H.M. Hamer

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Hamer, H. Epileptische Anfälle und Epilepsien nach „Schlaganfällen“. Z. Epileptol. 22, 72–79 (2009). https://doi.org/10.1007/s10309-009-0033-1

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