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Empfehlungen zu Endokrinologischen Aspekten bei Jugendlichen mit Epilepsie

Recommendations for endocrinological aspects in adolescents with epilepsy

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Zusammenfassung

Während der Phase von Wachstum und Pubertät begleiten profunde Veränderungen metabolischer/endokrinologischer Kompartimente die Reifung verschiedenster Hormonsysteme (Geschlechts-, Schilddrüsenhormone, Knochengesundheit, Fett- und Glukosestoffwechsel). Einerseits kann die Erkrankung Epilepsie per se Auswirkungen auf diverse endokrine Systeme haben, andererseits ist bekannt, dass antikonvulsive Medikamente neuro-endokrine Veränderungen vor allem im Bereich der Geschlechtshormone, des Glukose- und Fettstoffwechsels aber auch im Bereich der Knochengesundheit hervorrufen können. Veränderungen von Schilddrüsenhormonen sind derzeit in ihrer klinischen Relevanz noch strittig, regelmäßige Laborkontrollen insbesondere bei Therapie mit Valproinsäure, Carbamazepin und Oxcarbazepin sind empfehlenswert. Zum Ausschluss von Veränderungen der Knochendichte erscheint eine genaue Risikostratifizierung und regelhafte Bestimmung der Vitamin-D-Spiegel sinnvoll. Die Kontrazeption bei Jugendlichen mit Epilepsie sollte entweder durch ein Pillenpräparat mit ausreichend hohem Östrogengehalt und dem Verzicht auf ein pillenfreies Intervall in Kombination mit zusätzlichem Schutz (Kondom) oder alternativ durch eine Hormonspirale erfolgen. Die Empfehlungen bei Eintritt einer Schwangerschaft beinhalten die genaue Instruktion in Bezug auf Anfallshygiene sowie engmaschige Spiegelkontrollen. Bei Einnahme von Lamotrigin (LTG) in Kombination mit oralen Kontrazeptiva (OCs) sind engmaschige Spiegelkontrollen mit gegebenenfalls Dosisanpassungen notwendig, midzyklische Blutungen können auf ein Versagen der kontrazeptiven Sicherheit hinweisend sein. Die Auswirkungen von Sport und Fitness auf die Epilepsie sind insgesamt, eine stabile Anfallssituation vorausgesetzt, als durchwegs positiv zu bewerten und gehen gerade im Kindes- und Jugendalter weit über ein reines Lifestyle-Thema hinaus. Insgesamt erscheint gerade deshalb bei jungen Frauen mit Epilepsie ein interdisziplinärer Ansatz (Gynäkologie, Endokrinologie, Neuropädiatrie) wünschenswert und notwendig.

Abstract

During growth and puberty profound changes in metabolic/endocrine compartments are paralleled by the maturation of various hormone systems (e. g. sex-steroid axis, bone health, lipid and glucose homeostasis). On the one hand, things often change with epilepsy and the disease per se might influence enzyme systems. On the other hand, antiepileptic drugs (AED) are well known to elicit diverse neuroendocrine changes. Data concerning the thyroid axis are far from conclusive but regular measurement of serum hormones is recommended. Monitoring of bone health in children and adolescents with epilepsy comprises a thorough evaluation of the risk profile and periodic determination of vitamin D concentrations. To achieve maximum safety, the use of an oral contraceptive containing a progestin dose above that needed to inhibit ovulation without a pill-free interval (a so-called “long cycle”) is suggested. Furthermore, the use of additional barrier methods or – alternatively – classic or levonorgestrel-releasing intrauterine devices should be taken into consideration. In the case of pregnancy, extensive instruction concerning sleep and compliance, as well as frequent determination of AED serum levels are necessary. When lamotrigine is combined with an oral contraceptive, physicians should be aware of decreasing lamotrigine concentrations, whereas mid-cycle bleedings might point towards loss of contraceptive safety. To sum up, a multidisciplinary approach is necessary to monitor possible neuro-endocrine alterations that warrant further examination and treatment, especially in adolescent girls and boys.

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Rauchenzauner, M. Empfehlungen zu Endokrinologischen Aspekten bei Jugendlichen mit Epilepsie. Z. Epileptol. 28, 279–288 (2015). https://doi.org/10.1007/s10309-015-0002-9

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