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Medikamentöse Epilepsietherapie

Die Innenwelt der Außenwelt

Medical treatment of epilepsy

Hidden dimensions

  • Leitthema
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Zusammenfassung

Antiepileptika (AED) erhöhen die Chance auf eine dauerhafte Anfallsfreiheit insbesondere in der ersten (Mono-)Therapiephase. Bis zu 28% der nicht anfallsfrei gewordenen Patienten erreichen eine Anfallskontrolle durch eine Kombinationstherapie. In eigenen Untersuchungen an Patienten mit fokalen Epilepsien überwiegt dabei die Wirksamkeit von Levetiracetam (Anfallsfreiheit >6 Monate bei 22,8%, Anfallsminderung ≥50% bei 58,8%) gegenüber anderen AED. Zu beachten ist, dass bis zu 50% der Anfälle vom Patienten nicht registriert werden, insbesondere komplex-fokale Anfälle und Anfälle im Schlaf. Somit muss davon ausgegangen werden, dass die Anfallsprophylaxe soweit möglich und nicht absolut gelingt. Die damit verbundene soziale Teilhabe ist ein wesentliches und erreichbares Ziel der AED-Therapie. Zusätzlich zur Therapie mit AED sollten auch Begleitsymptome diagnostiziert und behandelt werden. Dies betrifft insbesondere depressive Störungen, die bei 30–50% der Patienten auftreten. Etwa die Hälfte der betroffenen Patienten lehnt eine Behandlung der Depression jedoch ab.

Summary

Treatment with antiepileptic drugs (AED) increases the chance of seizure control in patients with epilepsy. This control is best achieved with AED monotherapy in the early stages of the disease. In up to 28% of the remaining patients, complete seizure control is obtained with AED combination therapy. In our own retrospective studies, levetiracetam proved to be the most effective drug in add-on treatment of focal epilepsies. Seizure control for at least 6 months was seen in 22.8% of patients, and reduction of seizure frequency by more than 50% was achieved in 58.8%. One must however consider that up to 50% of all seizures are not recognized by the patients. This is especially the case in complex partial seizures and in seizures during sleep. Seizure control (as recognized by the patient) allows better social reintegration, e.g. by obtaining a driving license. In addition to AED therapy other epilepsy-related symptoms such as depression need diagnosis and treatment. Of all patients with epilepsy, 30–50% suffer from depression, but about 50% of these are not willing to start antidepressant drug therapy.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: J. Bauer erhielt in den letzten Jahren Vortragshonorare verschiedener Arzneimittelhersteller. Von Firmen gesponsorte Studien oder Datenanalysen wurden nicht durchgeführt. Die Vortragsdarstellungen bezogen sich allein auf eigene, unabhängig gewonnene Erkenntnisse. C. Kronisch erhielt keine Zuwendungen.

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  1. Klinik für Epileptologie, Universitätsklinikum Bonn, Sigmund Freud Straße 25, 53105, Bonn, Deutschland

    J. Bauer & C. Kronisch

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  1. J. Bauer
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  2. C. Kronisch
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Correspondence to J. Bauer.

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Bauer, J., Kronisch, C. Medikamentöse Epilepsietherapie. Nervenarzt 80, 386–398 (2009). https://doi.org/10.1007/s00115-008-2635-7

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