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Bewusstseinsstörungen während epileptischer Anfälle

Disturbances of consciousness during epileptic seizures

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Zusammenfassung

Jeder Anfall verändert das Bewusstsein, sei es quantitativ (Wachheit) oder qualitativ (Inhalte). Absencen und fokale komplexe Anfälle sowie deren Statusformen sind durch Bewusstseinsstörungen mit Reaktions- und Erinnerungslosigkeit gekennzeichnet. Aufgrund von Befunden simultaner Untersuchungen durch Elektroenzephalographie (EEG) und funktioneller Magnetresonanztomographie wurde eine kausale Funktionsstörung der Wecksysteme angenommen. Klinische und EEG-Untersuchungen hingegen favorisieren eine rein kortikale Ausbreitung der inhibitorischen Komponente des Anfallsgeschehens. Ausgedehnte kortikale Defizitsymptome im „unresponsive wakefullness syndrome“ oder im minimal-bewussten Zustand gehen einher mit einer kompensatorischen Überaktivität der Wecksysteme. Die Befunde bei Anfällen könnten analog erklärt werden. Die Propagation des Anfalls mündet in einer diffusen kortikalen Inhibition (Bewusstseinsstörung) und tiefe Strukturen reagieren sekundär mit einem Weckversuch. Im Grand mal hingegen sind die Patienten komatös, eine direkte Rolle der Wecksysteme scheint wahrscheinlich. Bewusstseinsstörungen dienen als Kriterium für die Klassifikation von Anfällen. Die Überbetonung dieses Kriteriums geht mit einem Informationsverlust einher. Ein einfaches Sammeln von verifizierbaren Symptomen kann davor schützen.

Abstract

Every epileptic seizure changes consciousness in terms of wakefulness or the contents of consciousness. Absence and focal complex seizures are characterized by a loss of both reaction and memory. The results of simultaneous electroencephalography (EEG)/functional magnetic resonance imaging studies suggest a pivotal role of the arousal systems. Clinical and EEG observations, however, stress a purely cortical propagation of the inhibitory components of seizure activities. Unresponsive wakefulness syndrome or minimally conscious state is characterized by severe cortical deficits accompanied by a compensatory over-activation of the arousal systems. The sequence of events in seizures might be explained in a similar way. Diffuse cortical inhibition results in loss of reaction and memory and leads to secondary activation of the arousal systems. In generalized tonic–clonic seizures, patients are truly comatose, probably due to a causal involvement of the deep structures. Seizures are classified according to disturbances of consciousness; however, classifications based solely on this criterion neglect important details. Therefore, a simple collection of verifiable symptoms can avoid loss of information.

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    G. Bauer, G. Walser & I. Unterberger

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Bauer, G., Walser, G. & Unterberger, I. Bewusstseinsstörungen während epileptischer Anfälle. Z. Epileptol. 28, 213–219 (2015). https://doi.org/10.1007/s10309-015-0418-2

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