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Zeitschrift für Epileptologie

, Volume 32, Issue 1, pp 21–28 | Cite as

Epilepsie und Parasomnien

Differenzialdiagnose und Pathophysiologie schlafgebundener Ereignisse
  • Berthold VogesEmail author
Leitthema
  • 36 Downloads

Zusammenfassung

Zur Differenzierung von schlafgebundenen Ereignissen in epileptische Anfälle oder Parasomnien sind als diagnostische Merkmale hilfreich: Familienanamnese, Manifestationsalter, Bindung an erste oder zweite Nachthälfte, Häufigkeit und Dauer der Ereignisse, Stereotypie und Komplexität von Handlungsabläufen oder Sprache, Ausmaß an Zielrichtung und Konsequenz in der Durchführung der Handlungen, Weckbarkeit und Interaktionsfähigkeit in der Episode sowie Verhalten und Erinnerung nach den Ereignissen. Keines dieser Merkmale ist für sich allein beweisend oder ausschließend für die eine oder andere Diagnose. Auch können Epilepsie und Parasomnie im selben Patienten koinzident vorkommen. In unklaren Fällen kann ein LZ-EEG-Monitoring, idealerweise ergänzt mit einer Polysomnographie, zur Erfassung der in Rede stehenden Ereignisse notwendig sein. Die gelegentlich frappierende Ähnlichkeit in der Semiologie von NREM(„non-rapid eye movement“)-Parasomnien und epileptischen Anfällen ist begründbar durch eine Überlappung der pathophysiologischen Abläufe: Bei NREM-Parasomnien führt ein dissoziiertes, lokales Arousal subkortikaler Netzwerke bei gleichzeitiger Persistenz von Tiefschlaf im frontoparietalen Kortex zum Ausagieren subkortikal gespeicherter, primitiver Verhaltensschablonen. Bei epileptischen Anfällen kann fokale Hyperexzitation in cingulären oder limbischen Netzwerken die Manifestation derselben Handlungsschablonen induzieren. Die Suppression von NREM-Parasomnien gelingt meist gut mittels Vermeidung auslösender Medikamente, Behandlung Arousal-induzierender somnologischer Erkrankungen, verhaltenstherapeutischer Stabilisierung der Schlafstruktur und symptomatischer Medikation mit Low-dose-Clonazepam als First-line-Drug.

Schlüsselwörter

Semiologie Differenzialdiagnose Pathophysiologie Dissoziiertes Arousal Central Pattern Generators 

Epilepsy and parasomnias

Differential diagnosis and pathophysiology of sleep-related events

Abstract

For differentiation of sleep-related events in epileptic seizures or parasomnia, the following diagnostic features may be helpful: family history, age of first manifestation, appearance in 1st or 2nd half of night, frequency and duration of events, stereotype and complexity of behavior or speech during the event, extent of target orientation and consistency of actions, arousal and interactivity during the event as well as behavior and memory after the event. None of these items alone can prove or exclude one diagnosis or the other. In addition, epilepsy and parasomnia may be coincident in the same patient. For this, in ambiguous cases long-term video electroencephalograph (EEG) monitoring, preferably together with polysomnography, is required to find the correct diagnosis. The sometimes striking similarity in the semiology of non-rapid eye movement (NREM) parasomnia and epileptic seizures can be explained by an overlap in the pathophysiological processes. In NREM parasomnia a dissociated, local arousal of subcortical networks, together with persistence of deep sleep in the frontoparietal cortex, may induce an “acting-out” of subcortically stored, primitive behavior patterns. In epiletic seizures, focal hyperexcitation of cingulate or limbic networks may induce the manifestation of the same behavior patterns. Therapeutic strategies for the suppression of NREM parasomnia are avoidance of triggering medication, treatment of arousal-inducing somnological diseases, behavioral therapy for stabilization of sleep structure and finally symptomatic medication treatment with low-dose clonazepam as first-line drug.

Keywords

Semiology Differential diagnosis Pathophysiology Dissociated arousal Central pattern generators 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

B. Voges gibt an, in den letzten 5 Jahren Reisekostenerstattungen und Vortragshonorare von den Firmen LivaNova, Medtronic, Eisai, UCB, Desitin und Bioprojet erhalten zu haben.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Epilepsiezentrum HamburgEvangelisches Krankenhaus AlsterdorfHamburgDeutschland

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