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Therapie des akuten konvulsiven Anfalls und Status epilepticus im Kindesalter

Treatment of acute convulsive seizures and status epilepticus in childhood

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Zusammenfassung

Der Status epilepticus ist der häufigste neuropädiatrische Notfall. Seit der Zulassung eines Fertigpräparates von bukkalem Midazolam hat sich dieses in der Erst- und Laientherapie etabliert. Benzodiazepine in anderer Verabreichungsform wie Midazolam nasal oder Diazepam rektal zeigen keinen Unterschied hinsichtlich der Wirksamkeit und können alternativ eingesetzt werden. Für die Therapie des Status epilepticus im Kindesalter ist derzeit keine aktuelle deutsche Leitlinie verfügbar. Nach Versagen von Benzodiazepinen ist der intravenöse Einsatz von Antikonvulsiva der nächste Schritt. Neben den etablierten Substanzen wie Phenobarbital und Phenytoin erweisen sich dabei auch neuere Antikonvulsiva wie Levetiracetam und Lacosamid als wirksam. Dabei gibt es unter den neueren Antikonvulsiva deutlich weniger Interaktionen, es besteht nicht die Gefahr der Atemsuppression und Intoxikation. Im refraktären und superrefraktären Status epilepticus kommen neben Anästhetika auch die ketogene Diät, immunmodulatorische Therapien oder eine akute Epilepsiechirurgie zum Einsatz.

Abstract

Status epilepticus is the most common neuropediatric emergency. Since the approval of a prefabricated compound of buccal midazolam, this has become established for initial treatment by caregivers and first-responders. Other nonintravenous benzodiazepines, such as nasal midazolam or rectal diazepam show no differences in efficacy and can be used as an alternative. At the moment there are no current German guidelines available for the treatment of status epilepticus in children. Escalation of treatment with intravenous anticonvulsants is recommended after failure of benzodiazepines. In addition to phenytoin and phenobarbital, recent studies have shown that newer anticonvulsants, such as levetiracetam and lacosamide are effective. There are far fewer interactions of the new anticonvulsants and no risks of respiratory suppression or intoxication. Anesthetics are the next therapeutic option for refractory and super-refractory status epilepticus, as well as a ketogenic diet, immunomodulatory treatment, other oral anticonvulsants and epilepsy surgery.

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Authors and Affiliations

  1. Zentrum für Kinder- und Jugendmedizin, Neuropädiatrie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, Deutschland

    Susanne Schubert-Bast

  2. Epilepsiezentrum Frankfurt Rhein-Main, Zentrum der Neurologie und Neurochirurgie, Goethe-Universität Frankfurt, Schleusenweg 2–16, Frankfurt am Main, Deutschland

    Susanne Schubert-Bast & Adam Strzelczyk

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Correspondence to Susanne Schubert-Bast.

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S. Schubert-Bast erhielt Beratungs- und Referentenhonorare von Desitin Arzneimittel, Eisai, UCB Pharma, LivaNova und Zogenix. A. Strzelczyk erhielt Beratungs‑, Referentenhonorare und/oder Unterstützung für Forschungsvorhaben von Desitin Arzneimittel, Eisai, LivaNova, Sage Therapeutics, UCB Pharma und Zogenix.

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Schubert-Bast, S., Strzelczyk, A. Therapie des akuten konvulsiven Anfalls und Status epilepticus im Kindesalter. Z. Epileptol. 32, 116–125 (2019). https://doi.org/10.1007/s10309-018-0232-8

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