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Anfälle in der Neugeborenenperiode

Seizures in the postnatal period

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Zusammenfassung

In den USA erleiden 1,5–3,0/1000 Neugeborene (NG) einen Anfall in der Neugeborenenperiode; die Rate bei Frühgeborenen (FG) ist deutlich größer. Das Erkennen von Anfällen bei reifen und v. a. bei unreifen NG ist unverändert schwierig. Die Semiologie der Anfälle im NG-Alter unterscheidet sich erheblich von der in späteren Lebensabschnitten. Nicht immer kommen das klinische und das EEG-Anfallsbild zur Deckung. Die Einführung von amplitudenintegrierten EEG als „bedside monitoring“ hat sicherlich dazu beigetragen, Anfälle früher zu erkennen und die Therapie besser zu steuern. Die Grunderkrankung bestimmt in erster Linie die Prognose der Kinder. In den letzten Jahren erhobene tierexperimentelle Daten weisen jedoch nach, dass die Anfälle selbst zu morphologischen Veränderungen beitragen können. Diese sind bei Vorschädigungen des Zentralnervensystems (ZNS) stärker ausgeprägt. Die Bedeutung dieser zusätzlichen Schädigung durch Anfälle tritt jedoch hinter die durch die Grunderkrankung deutlich zurück. Für zahlreiche Antiepileptika [u. a. Phenobarbital (PB), Valproat (VPA), Phenytoin (PHT), Carbamazepin (CBZ), Lamotrigin (LTG)], nicht jedoch für Levetiracetam (LEV) und Topiramat (TPM) konnte eine gesteigerte Apoptoserate bei der neonatalen Ratte nachgewiesen werden. Ob diese Daten wirklich vollständig auf den Menschen übertragen werden können, ist noch nicht entschieden. Diese Diskussion hat aber dazu beigetragen, dass LEV, für das in kleinen Fallserien die Wirksamkeit belegt werden konnte und keine gesteigerte Apoptose berichtet wurde, von vielen Kliniken als Alternative bzw. sogar als 1. Medikament bei Anfällen in der NG-Periode eingesetzt wird.

Abstract

In the USA 1.5–3.0/1,000 neonates suffer an epileptic seizure in the postnatal period while the rate is even higher in preterm babies. In neonates and preterm babies it is often difficult to clinically recognize a seizure. Seizure semiology greatly differs from what is seen at a later age and the correlation between clinical seizures and electroencephalographic (EEG) patterns is weak. The introduction of amplitude-integrated EEGs as bedside monitoring in neonatal intensive care units has had a great impact on the recognition and treatment of seizures. The prognosis of children is determined primarily by the underlying disease, such as hypoxic ischemic encephalopathy (HIE), infarct/bleeding and central nervous system (CNS) infections. However, in recent papers it was demonstrated that a seizures can itself provoke morphological changes and inhibit brain development, which is even more pronounced in cases with preexisting CNS lesions (e.g. HIE). An increase of apoptotic necrosis of neuronal cells was found in neonatal rats after various antiepileptic (AE) drugs, e.g. phenobarbital (PB), valproate (VPA), phenytoin (PHT), carbamazepine (CBZ) and lamotrigine (LTG), but not after levetiracetam (LEV) or topiramate (TPM). The discussion that PB might hamper and inhibit brain development triggered the use of LEV and TPM in newborns. At least in some small cohorts the results are indicative for the efficacy of LEV in preterm and term babies to control seizures: therefore, LEV is used nowadays in some hospitals as the first drug in neonatal seizures.

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Rating, D. Anfälle in der Neugeborenenperiode. Z. Epileptol. 26, 126–133 (2013). https://doi.org/10.1007/s10309-013-0304-8

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