Zusammenfassung
Die Neuropsychologie in der Epileptologie beschäftigt sich mit der Darstellung der kognitiven Leistungsfähigkeit in Bezug auf die Erkrankung und ihre Behandlung. Eine Implementierung der Neuropsychologie in den klinischen Alltag ist trotz des breiten wissenschaftlichen Fundaments nicht endgültig gelungen. Der Artikel zeigt auf, welchen diagnostischen Beitrag ein problemorientierter, modularer und evidenzbasierter neuropsychologischer Ansatz zur Diagnosefindung leisten kann. Kognitive und psychiatrische Komorbiditäten bei Epilepsie sind von großer Relevanz, da sie auch unabhängig von der Epilepsie einen starken Einfluss auf die Lebensqualität haben. Der komplexe bidirektionale Zusammenhang zwischen Epilepsie, Kognition und Verhalten ist gut belegt. Im Folgenden wird dargelegt, was Neuropsychologie zur Diagnostik und zur Begleitung des Verlaufs der Erkrankung und ihrer Behandlung leisten kann. Auf nationaler, europäischer und internationaler Ebene gibt es erste Bemühungen, das neuropsychologische Vorgehen zu vereinheitlichen und zu standardisieren. Dies sollte die Kommunikation zwischen Experten erleichtern und eine solide Datengrundlage schaffen, um die Neuropsychologie weiter voranzutreiben.
Abstract
The historical roots of neuropsychological assessment in epilepsy lie in epilepsy surgery. Today neuropsychology can answer a broad range of questions concerning the cognitive outcome of epilepsy surgery and pharmacotherapy, the dynamics and the course of epilepsy as well as the underlying pathology. The question why neuropsychology despite extensive research has not been fully integrated into the routine care of patients with epilepsy remains open. This review attempts to summarize clinically relevant diagnostic advances following a problem-oriented, modular, and evidence-based approach. Cognitive and behavioral comorbidities of epilepsy are relevant since they have a high impact on the patients’ quality of life regardless of whether they suffer from seizures. It is well established that there are complex and bidirectional interactions between epilepsy, cognition, and behavior. Both seizures and problems with cognition and behavior may result from a common underlying pathology. It is demonstrated that neuropsychology can make a highly valuable contribution to the individual care of patients by contributing to the diagnostic process and by serving as a tool for monitoring the course of the disorder and the effects of its treatment. On a national, European, and international level, first efforts are being made to homogenize diagnostics across epilepsy centers and countries to achieve a common core standard. This will improve communication between experts and help to generate multicentric data required for further progress in the field.
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J. Taube und J.-A. Witt geben an, dass kein Interessenkonflikt besteht. C. Helmstaedter erhält Drittmittel vom European Reference Network on Rare and Complex Epilepsies (ERN-EpiCARE), Honorare und nicht-finanzielle Unterstützung von UCB, Honorare von EISAI, nicht-finanzielle Unterstützung von Desitin Pharma, Honorare von GW-Pharma, Honorare vom Elsevier Journal Seizure, außerhalb des eingereichten Artikels.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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Taube, J., Witt, JA. & Helmstaedter, C. Neuropsychologische Diagnostik bei Epilepsie. Z. Epileptol. 31, 22–27 (2018). https://doi.org/10.1007/s10309-017-0148-8
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DOI: https://doi.org/10.1007/s10309-017-0148-8