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Epilepsiechirurgie bei Erwachsenen mit mentaler Retardierung

Epilepsy surgery in adults with intellectual disabilities

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Zusammenfassung

Epilepsiechirurgie ist bei therapierefraktärer fokaler Epilepsie bei ausgewählten Patienten in der Lage, Pharmakoresistenz zu überwinden und zu anhaltender Anfallsfreiheit zu führen. Ob Patienten mit mentaler Retardierung (MR) geeignete Operationskandidaten sind, wird kontrovers diskutiert und muss im Einzelfall entschieden werden. Ein Cochrane-Review von 2015 weist auf den mangelnden Wissensstand hinsichtlich operativer Epilepsietherapie hin. Je schwerer die MR ist, umso eher wird von einer globalen Schädigung des Gehirns ausgegangen, und die Erfolgschancen einer Resektion werden als geringer eingeschätzt. Bei umschriebener oder auch hemisphärischer MRT-Pathologie mit Nachweis einer korrespondierenden Anfallsursprungszone in der prächirurgischen Epilepsiediagnostik kann hingegen auch bei Patienten mit MR ein Eingriff mit guten Chancen auf Besserung der Epilepsie oder Anfallsfreiheit verbunden sein.

Abstract

Epilepsy surgery should be considered in patients with treatment resistant focal epilepsy because drug resistance can be overcome and even continued seizure freedom may be attained. Whether epilepsy surgery is an option for patients with intellectual disabilities (ID) remains open to discussion. A recent Cochrane review shows insufficient data for resections in patients with pharmacoresistent epilepsy and ID . Each case must be evaluated thoroughly. The rate of seizure free patients seems to be reduced when ID is severe. On the other hand, in case of a circumscribed or even hemispheric pathology with a corresponding seizure onset zone identified by presurgical evaluation, resection might lead to a beneficial outcome even in ID patients.

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Abbreviations

BR:

Brom

CBZ:

Carbamazepin

CLB:

Clobazam

fTCD:

funktionelle transkranielle Dopplersonographie

GTKA:

generalisiert tonisch-klonischer Anfall

IQ:

Intelligenzquotient

LEV:

Levetiracetam

LTG:

Lamotrigin

MR:

mentale Retardierung

NPS:

neuropsychologische Untersuchung

OXC:

Oxcarbazepin

PB:

Phenobarbital

STP:

Stiripentol

SUDEP:

sudden unexpected death in epilepsy

TPM:

Topiramat

VPA:

Valproat

WfbM:

Werkstatt für behinderte Menschen

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Authors and Affiliations

  1. Epilepsie-Zentrum Hamburg, Evangelisches Krankenhaus Alsterdorf, Hamburg, Deutschland

    Jonas M. Hebel &  Matthias D. G. Lindenau

  2. Praxis Bredow & Partner, Neurologie Neuer Wall, Neuer Wall 19, 20354, Hamburg, Deutschland

    Matthias D. G. Lindenau

Authors
  1. Jonas M. Hebel
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Correspondence to Matthias D. G. Lindenau.

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J.M. Hebel und M.D.G. Lindenau geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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Hebel, J.M., Lindenau, M.D.G. Epilepsiechirurgie bei Erwachsenen mit mentaler Retardierung. Z. Epileptol. 30, 276–282 (2017). https://doi.org/10.1007/s10309-017-0135-0

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  • DOI: https://doi.org/10.1007/s10309-017-0135-0

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