Zusammenfassung
Epilepsien im Kindesalter beeinflussen über ätiologische Faktoren, Zeitvariablen und behandlungsspezifische Aspekte direkt und indirekt die kognitive Entwicklung. Strukturelle, z. B. durch ausgedehnte kongenitale Malformationen bedingte Epilepsien sind im Vergleich zu selbst limitierenden Epilepsien mit schwächeren kognitiven Leistungen assoziiert. Ein früher Epilepsiebeginn und ein chronischer, therapieschwieriger Verlauf sind wesentlich mit kognitiven Einschränkungen verbunden. Die Studienlage zu negativen Effekten der pharmakotherapeutischen Behandlung verweist konsistent auf die gravierenden Auswirkungen einer Polytherapie auf die Kognition. Auch wenn die Mehrzahl der pädiatrischen Epilepsiepatienten eine normale kognitive Entwicklung zeigt, liegen die Intelligenzleistungen der Patienten im Mittel unter denen von gesunden Kontrollen. Darüber hinaus finden sich auch hinsichtlich spezifischer kognitiver Funktionen Besonderheiten: Einerseits erreichen Patienten mit Epilepsie bereits früher als gesunde Kontrollen ein Maximum ihrer Lern- und Gedächtnisleistungen und zeigen früher Hinweise auf altersübliche Verluste. Andererseits können Kinder/Jugendliche nach temporaler Epilepsiechirurgie postoperative Verluste besser kompensieren als Erwachsene. Im Hinblick auf die für Lernprozesse besonders wichtigen Aufmerksamkeits- und Exekutivfunktionen erweist sich der „drug load“ bei einer Polytherapie als besonders ungünstiger Faktor. Die vielfältigen Zusammenhänge zwischen pädiatrischer Epilepsie und kognitiver Entwicklung sind mit Risiken für den Schulerfolg verbunden. Deshalb sollte pädiatrische Epilepsiebehandlung von Anfang an interdisziplinär erfolgen und die kognitive Entwicklung mit fokussieren.
Abstract
Pediatric epilepsy directly and indirectly affects cognitive development due to etiological factors, time variables and treatment-specific aspects. Structural epilepsy, e.g. due to extensive congenital malformations, is more often associated with poorer cognitive performance when compared to self-limiting epilepsies. An early onset of epilepsy and a chronic pharmacoresistant course are strongly associated with cognitive deficits. Studies on the negative effects of pharmacological treatment consistently point to the severe impact of the drug load in multidrug treatment on cognition. Even though the majority of pediatric patients with epilepsy show normal cognitive development, the mean intelligence performance of patients is below that of healthy controls. Furthermore, there are also some special features with respect to specific cognitive functions: on the one hand, patients with epilepsy reach the maximum peak of learning and memory performance earlier than healthy controls and also show signs of mental aging earlier. On the other hand, children and adolescents can more effectively compensate for postoperative memory deficits after temporal epilepsy surgery than adults. With respect to the attention and executive functions, which are important prerequisites for the learning process, the drug load in multidrug treatment has been proven to be a particularly unfavorable factor. The complex interplay between pediatric epilepsy and cognitive development is highly related to the risk of reduced school performance. Consequently, an interdisciplinary treatment of pediatric epilepsy is highly recommended with a focus on cognitive development.
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Reuner, G. Kognitive Entwicklung im Kontext pädiatrischer Epilepsie. Z. Epileptol. 32, 141–145 (2019). https://doi.org/10.1007/s10309-018-0243-5
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DOI: https://doi.org/10.1007/s10309-018-0243-5
Schlüsselwörter
- Pädiatrische Epileptologie
- Kognitive Entwicklung
- Chronische Erkrankung
- Interdisziplinäre Behandlung
- Exekutive Funktionen