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Kognition und Epilepsien

Cognition and epilepsies

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Zusammenfassung

Die vorliegenden Befunde sprechen insgesamt dafür, dass kognitive Defizite in unterschiedlichem Ausmaß bei chronischen, auch nicht symptomatischen Epilepsien initial vorhanden und als Symptome im Rahmen der den Anfällen zugrunde liegenden oder deren Entwicklung begleitenden hirnphysiologischen Veränderungen aufzufassen sind. Der mutmaßlich additive Effekt der Anfälle ist noch eine nicht abschließend beantwortete Frage. Sekundär kann das Ausmaß der kognitiven Beeinträchtigung über einen 3 Jahrzehnte langen, ungünstigen Verlauf mit häufigen sekundär generalisierten Anfällen hinweg zunehmen. Hier ist die Untersuchung von Langzeitverläufen der kognitiven Leistungen bei den verschiedenen Epilepsiesyndromen wichtig, um deren Rolle bei der kognitiven Entwicklung zu erforschen. Aber auch die erfolgreiche Behandlung birgt Risiken. So stehen bei der operativen Behandlung linksseitiger Temporallappenepilepsie Gedächtnisdefizite im Vordergrund. Die kognitiven Nebenwirkungen der medikamentösen Behandlung können für den Patienten erheblich benachteiligende Wirkungen haben. Die Notwendigkeit ihrer individuellen Erfassung rückt heute zunehmend in den Blickpunkt der Aufmerksamkeit. Sie liefert die Voraussetzung für eine individuell optimierte medikamentöse und epilepsiechirurgische Therapie.

Summary

It is evident that in chronic epilepsy – both symptomatic and nonsymptomatic – cognitive dysfunction precedes the onset of seizures. Cognitive disorders emerge with the underlying lesion or the concomitant physiological process. The presumed additive effect of seizures has not been decisively clarified. The degree of damage may consecutively accumulate with a disease duration of more than three decades and an unfavorable course with frequent secondary generalized seizures. Long-term follow-up investigation of cognition in different epileptic syndromes is needed to address the question of their specific role in cognitive decline. Treatments successful in seizure control may however also hold cognitive risks. Additional memory impairment due to the surgical treatment of left-sided temporal lobe epilepsy ranks first among them. Cognitive side effects of antiepileptic medication may have considerable adverse effects on patients. The need of individual assessment of cognitive side effects draws increasing attention as a precondition for treatment optimized to each patient.

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  1. Epilepsiezentrum – Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland

    H. Stefan & E. Pauli

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  2. E. Pauli
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Correspondence to H. Stefan.

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Stefan, H., Pauli, E. Kognition und Epilepsien. Nervenarzt 79 (Suppl 2), 77–92 (2008). https://doi.org/10.1007/s00115-008-2463-9

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