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Langzeit-Outcome nach epilepsiechirurgischen Eingriffen

Long-term outcome after epilepsy surgery

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Abstract

The long-term outcome of epilepsy after surgical epilepsy therapy is increasingly of interest of both neurologists and patients. A number of recent studies shows that the percentage of seizure-free patients remains relatively stable after three years; individually, seizure recurrences and running down of the epilepsy or newly achieved responsivity to pharmacological treatment balance each other.

Several important positive outcome predictors have emerged from independent studies: these include early surgery, the increasingly sensitive MR tomographic demonstration of an epileptogenic lesion, and the absence of secondarily generalized tonic-clonic seizures, of bilateral propagation and of bilateral independent interictal epileptic activity. Other questions remain open, e.g., the role of continued antiepileptic medication. Prospective studies using standardized outcome classifications and integrating psychosocial and neuropsychologic aspects will be necessary for improved patient counseling.

Zusammenfassung

Die Bedeutung des Langzeitverlaufes von Epilepsien nach epilepsiechirurgischen Eingriffen rückt zunehmend in das Interesse von Ärzten und Patienten. Betrachtet man das Erzielen einer Anfallskontrolle, so belegen eine Reihe neuerer Untersuchungen, dass der Anteil anfallfreier Patienten nach 3 Jahren weitgehend konstant bleibt; individuell gleichen sich dann im Einzelfall auftretende Rezidive und Patienten mit running-down Phänomen oder aber neu erzielter pharmakologischer Responsivität aus.

Eine Reihe wichtiger günstiger Prädiktoren erhärten sich aus unabhängigen Studien: hierzu zählen ein früher Operationszeitpunkt und der zunehmend sensitivere Nachweis kernspintomographischer Läsionen, die Abwesenheit sekundär generalisiert tonischklonischer Anfälle, bilateraler Propagationen und bilateral unabhängiger interiktaler Aktivität. Andere Fragen sind derzeit noch offen, etwa die Rolle der Fortführung einer antiepileptischen Medikation. Prospektive Untersuchungen unter Verwendung einer vereinheitlichten Outcome-Klassifikation und unter Einbeziehung auch psychosozialer und neuropsychologischer Faktoren sind weiterhin erforderlich für eine Verbesserung der Beratung der Patienten.

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  1. Epilepsiezentrum am Neurozentrum, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany

    Andreas Schulze-Bonhage

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Correspondence to Andreas Schulze-Bonhage.

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Schulze-Bonhage, A. Langzeit-Outcome nach epilepsiechirurgischen Eingriffen. Z. Epileptol. 21, 17–25 (2008). https://doi.org/10.1007/s10309-008-0293-1

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  • DOI: https://doi.org/10.1007/s10309-008-0293-1

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