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Antiepileptika – Besonderheiten bei Menschen mit geistiger Behinderung

Antiepileptics – special aspects in people with intellectual disabilities

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Zusammenfassung

Die Häufigkeit von Epilepsien ist bei Patienten mit geistiger Behinderung im Vergleich zu anderen Patienten deutlich erhöht. Nicht selten handelt es sich dabei um therapieschwierige Epilepsien. Die ätiologische Klärung des Epilepsiesyndroms hat zum Teil therapeutische Konsequenzen z. B. durch Einsatz oder Vermeiden bestimmter Antiepileptika und muss daher am Anfang einer gezielten Behandlung stehen. Die zahlreichen medikamentösen Optionen werden in diesem Artikel charakterisiert. Dabei wird v. a. auf die neueren Antiepileptika (Zulassung seit 1990) eingegangen. Die Datenlage zu den einzelnen Substanzen ist für die Gruppe der Menschen mit geistiger Behinderung nach wie vor überschaubar. Trotzdem ergeben sich aus diesen Arbeiten wichtige Hinweise für die Behandlung. Zusätzlich wird auf die sog. Orphan drugs mit eingeschränkter Indikation eingegangen.

Abstract

The prevalence of epilepsy in patients with intellectual disabilities is markedly increased compared to patients without disability. The etiology of the epilepsy might be important as this might entail a specific therapeutic approach, e. g. administration or avoidance of certain anticonvulsive drugs. Therefore, the etiologic clarification must be the first step of a well-directed treatment. A variety of drugs are available; these are characterized in this article with a focus on the newer drugs labeled since 1990. Data for specific drugs are sparse, but the available data give important information about treatment options in epilepsy patients with intellectual disabilities. Orphan drugs are an option for patients with rare epilepsy syndromes.

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Literatur

  1. Andrade-Machado R, Benjumea-Cuartas V, Jaramillo-Jimenez E (2012) Lacosamide in Lennox-Gastaut syndrome: case report. Clin Neuropharmacol 35(3):148–149

    Article  PubMed  Google Scholar 

  2. Andres E, Kerling F, Winterholler M (2017) Behavioural changes in patients with intellectual disability treated with perampanel. Acta Neurol Scand. doi:10.1111/ane.12781

    PubMed  Google Scholar 

  3. Beavis J, Kerr M, Marson AG (2007) Pharmacological interventions for epilepsy in people with intellectual disabilities. Cochrane Database Syst Rev. doi:10.1002/14651858.cd005399

    Google Scholar 

  4. Beran RG, Gibson RJ (1998) Aggressive behaviour in intellectually challenged patients with epilepsy treated with lamotrigine. Epilepsia 39:280–282

    Article  CAS  PubMed  Google Scholar 

  5. Brandt C, Lahr D, May TW (2015) Cognitive adverse events of topiramate in patients with epilepsy and intellectual disability. Epilepsy Behav 45:261–264

    Article  PubMed  Google Scholar 

  6. Brandt C, May TW, Bien CG (2016) Brivaracetam as adjunctive therapy for the treatment of partial-onset seizures in patients with epilepsy: the current evidence base. Ther Adv Neurol Disord 9:474–482

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Chiron C, Marchand MC, Tran A, Rey E, d’Athis P, Vincent J, Dulac O, Pons G, the STICLO study group (2000) Stiripentol in severe myoclonic epilepsy in infancy: a randomised placebo-controlled syndrome-dedicated trial. Lancet 356(9242):1638–1642

    Article  CAS  PubMed  Google Scholar 

  8. Coppola G, Verrotti A, Resicato G, Ferrarelli S, Auricchio G, Operto FF, Pascotto A (2007) Topiramate in children and adolescents with epilepsy and mental retardation. A prospective study on behavior and cognitive effects. Epilepsy Behav 12:253–256

    Article  PubMed  Google Scholar 

  9. Crawford P, Brown S, Kerr M, Parke Davis Clinical Trials Group (1998) A randomized open-label study of gabapentin and lamotrigine in adults with learning disability and resistant epilepsy. Seizure 10:107–1156

    Article  Google Scholar 

  10. Curatolo P (2015) Mechanistic target of rapamycin (mTOR) in tuberous sclerosis complex-associated epilepsy. Pediatr Neurol 52(3):281–289

    Article  PubMed  Google Scholar 

  11. Dinkelacker V, Dietl T, Widmann G, Lengler U, Elger CE (2003) Aggressive behavior of epilepsy patients in the course of levetiracetam add-on therapy: report of 33 mild to severe cases. Epilepsy Behav 4:537–547

    Article  PubMed  Google Scholar 

  12. Felbamate Study Group in Lennox-Gastaut Syndrome (1993) Efficacy of Felbamate in childhood epileptic encephalopathy (Lennox-Gastaut syndrome). N Engl J Med 328(1):29–33

    Article  Google Scholar 

  13. Forsgren L, Beghi E, Oun A, Sillanpaa M (2005) The epidemiology of epilepsy in Europe – a systematic review. Eur J Neurol 12:245–253

    Article  CAS  PubMed  Google Scholar 

  14. French JA, Lawson JA, Yapici Z, Ikeda H, Polster T, Nabbout R (2016) Adjunctive everolimus therapy for treatment-resistant focal-onset seizures associated with tuberous sclerosis (EXIST-3): a phase 3, randomised, double-blind, placebo-controlled study. Lancet 388(10056):2153–2163

    Article  CAS  PubMed  Google Scholar 

  15. Gaily E, Granström ML, Liukonnen E (1998) Oxcarbazepine in the treatment of epilepsy in children and adolescents with intellectual disability and epilepsy. J Intellect Disabil Res 42(Suppl 1):41–45

    PubMed  Google Scholar 

  16. Gilliam F, Carter J, Vahle V (2004) Tolerability of antiseizure medications: implications for health outcomes. Neurology 63:S9–S12

    Article  CAS  PubMed  Google Scholar 

  17. Glauser TA, Kluger G, Sachdeo R, Krauss G, Perdomo C, Arroyo A (2008) Rufinamide for generalized seizures associated with Lennox-Gastaut syndrome. Neurology 70:1950–1958

    Article  CAS  PubMed  Google Scholar 

  18. Huber B, May T, Seidel M (1998) Lamotrigine in multihandicapped therapy-resistant epileptic patients. Clin Drug Investig 16(4):263–277

    Article  CAS  PubMed  Google Scholar 

  19. Huber B, Tomka-Hoffmeister M (2003) Limited efficacy of gabapentin in severe therapy-resistant epilepsies of learning disabled patients. Seizure 12(8):602–603

    Article  PubMed  Google Scholar 

  20. Huber B, Bömmel W, Hauser I, Horstmann V, Liem S, May T, Meinert T, Robertson E, Schulz L, Seidel M, Tomka-Hoffmeister M, Wagner W (2004) Efficacy and tolerability of levetiracetam in patients with therapy-resistant epilepsy and learning disabilities. Seizure 13(3):168–175

    Article  CAS  PubMed  Google Scholar 

  21. Huber B, Hauser I, Horstmann V, Jokeit G, Liem S, Meinert T (2005) Seizure freedom with different therapeutic regimens in intellectually disabled epileptic patients. Seizure 14(6):381–386

    Article  PubMed  Google Scholar 

  22. Huber B, Bocchicchio M, Feuerbaum E, May T, Meinert T, Robertson E, Schorlemmer H, Wagner W, Wilking E, Seidel M (2008) Epilepsy and tolerability of pregabalin in patients with difficult-to-treat epilepsy and intellectual disability. Epilepsy Behav 13:397–401

    Article  PubMed  Google Scholar 

  23. Huber B (2014) Increased risk of suicidality on perampanel (Fycompa®)? Epilepsy Behav 31:71–72

    Article  PubMed  Google Scholar 

  24. Hurtado B, Koepp MJ, Sander JW, Thompson PJ (2006) The impact of levetiracetam on challenging behavior. Epilepsy Behav 8:588–592

    Article  PubMed  Google Scholar 

  25. Iinuma K, Minami T, Cho K, Kajii N, Tachi N (1998) Long-term effects of zonisamide in the treatment of epilepsy in children with intellectual disability. J Intellect Disabil Res 42(Suppl 1):68–73

    PubMed  Google Scholar 

  26. Kelly K, Stephen LJ, Brodie MJ (2004) Levetiracetam for people with mental retardation and refractory epilepsy. Epilepsy Behav 5:878–883

    Article  PubMed  Google Scholar 

  27. Kerr MP, Baker GA, Brodie MJ (2005) A randomized, double-blind, placebo-controlled trial of topiramate in adults with epilepsy and intellectual disability: impact on seizures, severity, and quality of life. Epilepsy Behav 7:472–480

    Article  PubMed  Google Scholar 

  28. Kerr M, Scheepers M, Arvio M, Beavis J, Brandt C, Brown S (2009) Consensus guidelines into the management of epilepsy in adults with an intellectual disability. J Intellect Disabil Res 53(8):687–694

    Article  CAS  PubMed  Google Scholar 

  29. Kwan P, Brodie MJ (2000) Early identification of refractory epilepsy. N Engl J Med 342:314–319

    Article  CAS  PubMed  Google Scholar 

  30. Martin P, Schreiner A, Rettig K, Schäuble B (2009) Topiramate in patients with epilepsy and intellectual disability. Epilepsy Behav 14(3):496–502

    Article  PubMed  Google Scholar 

  31. McDermott S, Moran R, Platt T, Wood H, Isaac T, Dasari S (2005) Prevalence of epilepsy in adults with mental retardation and related disabilities in primary care. Am J Ment Retard 110(1):48–56

    Article  PubMed  Google Scholar 

  32. McGrother CW, Bhaumik S, Thorp CF, Hauck A, Branford D, Watson JM (2006) Epilepsy in adults with intellectual disabilities: prevalence, associations and service implications. Seizure 15:376–386

    Article  PubMed  Google Scholar 

  33. Modur PN, Milteer WE (2008) Adjunctive pregabalin therapy in mentally retarded, developmentally delayed patients with epilepsy. Epilepsy Behav 13:554–556

    Article  PubMed  Google Scholar 

  34. Sunder TR, McKee JR, Hammer AE, Vuong A (2006) Efficacy and tolerability of adjunctive lamotrigine for refractory epilepsy in institutional or community residents with mental retardation. Curr Med Res Opin 22:693–702

    Article  CAS  PubMed  Google Scholar 

  35. Yates SL, Fakhoury T, Liang W, Eckhardt K, Borghs S, D’Souza J (2015) An open-label, prospective, exploratory study of patients with epilepsy switching from levetiracetam to brivaracetam. Epilepsy Behav 52:165–168

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Abteilung konservative Epileptologie, Neurologische Klinik, Epilepsiezentrum Rummelsberg, Sana-Krankenhaus Rummelsberg, Rummelsberg 71, 90592, Schwarzenbruck bei Nürnberg, Deutschland

    Frank Kerling

  2. Klinik Mara, Epilepsiezentrum Bethel, Bielefeld, Deutschland

    Christian Brandt

  3. ZfP-Südwürttemberg, Weissenau, Deutschland

    Hartmut Baier

Authors
  1. Frank Kerling
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  2. Christian Brandt
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  3. Hartmut Baier
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Correspondence to Frank Kerling.

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Interessenkonflikt

F. Kerling hat von den Firmen UCB, Desitin und EISAI als Referent Honorare erhalten. Von den Firmen UCB und EISAI hat Herr Dr. Kerling Beraterhonorare erhalten. C. Brandt hat Vortrags- oder Beratungshonorare von Desitin, Novartis, Otsuka, UCB und Eisai sowie Erstattung von Reisekosten von Desitin, UCB, USL, SKS und Eisai erhalten. Forschungsunterstützung erfolgte durch UCB und Otsuka. H. Baier hat von der Firma UCB und Desitin als Referent Honorare erhalten. Von den Firmen UCB, Novartis und Eisai hat Herr Dr. Baier Beraterhonorare erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kerling, F., Brandt, C. & Baier, H. Antiepileptika – Besonderheiten bei Menschen mit geistiger Behinderung. Z. Epileptol. 30, 266–270 (2017). https://doi.org/10.1007/s10309-017-0134-1

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  • DOI: https://doi.org/10.1007/s10309-017-0134-1

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