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Epilepsiebehandlung

Periphere und zentrale Stimulationsverfahren

Treatment of epilepsy

Peripheral and central stimulation techniques

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Zusammenfassung

Die Wirksamkeit elektrischer Stimulationsverfahren zur Behandlung epileptischer Anfälle wurde experimentell bereits in den 1970er Jahren belegt. Klinische Studien zeigten zunächst die Wirksamkeit der Vagusnervstimulation, in den letzten Jahren auch der Stimulation des N. trigeminus, der anterioren Thalamuskerne und des epileptischen Fokus zur effektiven Behandlung fokaler Epilepsien. Die Wirkmechanismen hängen von Stimulationsort und Stimulusform ab und umfassen die Aktivierung endogener antiepileptischer Projektionsareale, die Modulation der Ausbreitung epileptischer Aktivität und eine Verhinderung oder Unterbrechung von Anfallsaktivität im Bereich der Anfallsgenerierung. Nach bislang vorliegenden Daten erscheint die Verträglichkeit peripherer wie zentraler Stimulationsverfahren gut, Erfahrungen aus einem breiten Einsatz sind jedoch noch abzuwarten.

Summary

The efficacy of electrical stimulation in the treatment of epileptic seizures was demonstrated experimentally even in the 1970s. Clinical studies have proven the efficacy of vagus nerve stimulation and in recent years also of stimulation of the trigeminal nerve, the anterior nucleus of the thalamus and of the epileptic focus in treating focal epilepsy. Mechanisms of action depend on the stimulation site and parameters and include activation of endogenous antiepileptic nuclei, modulation of propagation of epileptic activity and suppression of ictal activity at the site of generation. Based on available data the tolerability of peripheral and central brain stimulation appears to be good but experiences from wider clinical use are still lacking.

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Literatur

  1. Schulze-Bonhage A (2010) Epilepsien und ihre medikamentöse Behandlung. Med Monatsschrift Pharmakol 33:207–214

    Google Scholar 

  2. Schulze-Bonhage A (2007) Epilepsiechirurgie – Welche Patienten profitieren am meisten? Nervenheilkunde 26:1006–1012

    Google Scholar 

  3. Schulze-Bonhage A (2009) Tiefe Hirnstimulation als neuer Therapieansatz bei Epilepsien. Dtsch Arztebl 106:407–412

    Google Scholar 

  4. Galenus (1976) On the affected parts. Krager, Basel, S 96

  5. Maksimow K (1976) Interruption of grand mal epileptic seizures by the trigeminal nerve stimulation. Neurol Neurochir Pol 10:205–208

    PubMed  CAS  Google Scholar 

  6. Woodbury DM, Woodbury JW (1990) Effects of vagus nerve stimulation on experimentally induced seizures in the rat. Epilepsia 31:7–19

    Article  Google Scholar 

  7. McLachlan RS (1993) Suppression of interictal spikes and seizures by stimulation of the vagus nerve. Epilepsia 34:918–923

    Article  PubMed  CAS  Google Scholar 

  8. Lockard JS et al (1990) Feasibility and safety of vagal stimulation in monkey model. Epilepsia 31:20–29

    Article  Google Scholar 

  9. Woodbury JW, Woodbury DM (1991) Vagal stimulation reduces the severity of maximal electroshock seizures in intact rats: use of a cuff electrode for stimulating and recording. Pacing Clin Electrophysiol 14:94–110

    Article  PubMed  CAS  Google Scholar 

  10. Zabara J (1992) Inhibition of experimental seizures in canines by repetitive vagal stimulation. Epilepsia 33:1005–1012

    Article  PubMed  CAS  Google Scholar 

  11. Krahl SE, Clark KB, Smith DC, Browning RA (1998) Locus coeruleus lesions suppress the seizure-attenuating effects of vagus nerve stimulation. Epilepsia 39:709–714

    Article  PubMed  CAS  Google Scholar 

  12. Raedt R, Clinckers R, Mollet L et al (2011) Increased hippocampal noradrenaline is a biomarker for efficacy of vagus nerve stimulation in a limbic seizure model. J Neurochem 117:461–469

    Article  PubMed  CAS  Google Scholar 

  13. Furmaga H, Shah A, Frazer A (2011) Serotonergic and noradrenergic pathways are required for the anxiolytic-like and antidepressant-like behavioral effects of repeated vagal nerve stimulation in rats. Biol Psychiatry 70:937–945

    Article  PubMed  CAS  Google Scholar 

  14. Uthman BM, Reichl AM, Dean JC et al (2004) Effectiveness of vagus nerve stimulation in epilepsy patients: a 12-year observation. Neurology 63(6):1124–1126

    Article  PubMed  CAS  Google Scholar 

  15. Carius A, Schulze-Bonhage A (2005) Trigeminal pain under vagus nerve stimulation. Pain 118:271–273

    Article  PubMed  Google Scholar 

  16. Alexopoulos AV, Kotagal P, Loddenkemper T et al (2006) Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy. Seizure 15:491–503

    Article  PubMed  Google Scholar 

  17. Elliott RE, Morsi A, Tanweer O et al (2011) Efficacy of vagus nerve stimulation over time: review of 65 consecutive patients with treatment-resistant epilepsy treated with VNS > 10 years. Epilepsy Behav 20:478–483

    Article  PubMed  Google Scholar 

  18. Ben-Menachem E, Mañon-Espaillat R, Ristanovic R et al (1994) Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. First International Vagus Nerve Stimulation Study Group. Epilepsia 35:616–626

    Article  PubMed  CAS  Google Scholar 

  19. The Vagus Nerve Stimulation Study Group (1995) A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 45:224–230

    Article  Google Scholar 

  20. Klinkenberg S, Aalbers MW, Vles JS et al (2012) Vagus nerve stimulation in children with intractable epilepsy: a randomized controlled trial. Dev Med Child Neurol 54:855–861

    Article  PubMed  Google Scholar 

  21. De Herdt V, Boon P, Ceulemans B et al (2007) Vagus nerve stimulation for refractory epilepsy: a Belgian multicenter study. Eur J Paediatr Neurol 11:261–269

    Article  Google Scholar 

  22. Ghaemi K, Elsharkawy AE, Schulz R et al (2010) Vagus nerve stimulation: outcome and predictors of seizure freedom in long-term follow-up. Seizure 19:264–268

    Article  PubMed  Google Scholar 

  23. Boon P, Vonck K, Van Walleghem P et al (2001) Programmed and magnet-induced vagus nerve stimulation for refractory epilepsy. J Clin Neurophysiol 18:401–407

    Google Scholar 

  24. Hellwig S, Mamalis P, Feige B et al (2012) Psychiatric comorbidity in patients with pharmacoresistant focal epilepsy and psychiatric outcome after epilepsy surgery. Epilepsy Behav 23:272–279

    Article  PubMed  Google Scholar 

  25. Metternich B, Wagner K, Buschmann F et al (2012) Depressionsscreening bei Epilepsiepatienten. Z Epileptologie 25:283–288

    Article  Google Scholar 

  26. Hoppe C, Helmstaedter C, Scherrmann J, Elger CE (2001) No evidence for cognitive side effects after 6 months of vagus nerve stimulation in epilepsy patients. Epilepsy Behav 2:351–356

    Article  PubMed  CAS  Google Scholar 

  27. Fanselow EE, Reid A, Nicolelis AL (2000) Reduction of pentylenetetrazone induced seizure activity in awake rats by seizure-triggered trigenimal nerve stimulation. J Neurosci 20:8160–8168

    PubMed  CAS  Google Scholar 

  28. Fanselow EE (2012) Central mechanisms of cranial nerve stimulation for epilepsy. Surg Neurol Int 3(Suppl 4):247–254

    Article  Google Scholar 

  29. Pop J, Murray D, Markovic D, DeGiorgio CM (2011) Acute and long-term safety of external trigeminal nerve stimulation for drug-resistant epilepsy. Epilepsy Behav 22:574–576

    Article  PubMed  Google Scholar 

  30. De Giorgio CM, Fanselow EE, Schrader LM, Cook IA (2011) Trigeminal nerve stimulation: seminal animal and human studies for epilepsy and depression. Neurosurg Clin Am 22:449–456

    Article  Google Scholar 

  31. Hamani C, Ewerton FI, Bonilha SM et al (2004) Bilateral anterior thalamic nucleus lesions and high-frequency stimulation are protective against pilocarpine-induced seizures and status epilepticus. Neurosurgery 54:191–195

    Article  PubMed  Google Scholar 

  32. Takebayashi S, Hashizume K, Tanaka T, Hodozuka A (2007) The effect of electrical stimulation and lesioning of the anterior thalamic nucleus on kainic acid-induced focal cortical seizure status in rats. Epilepsia 48:348–358

    Article  PubMed  Google Scholar 

  33. http://www.dgfe.info/home/index,id,621,selid,4446,type,VAL_MEMO.html

  34. Fisher R, Salanova V, Witt T et al (2010) Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia 51:899–908

    Article  PubMed  Google Scholar 

  35. Andrade DM, Zumsteg D, Hamani C et al (2006) Long-term follow-up of patients with thalamic deep brain stimulation for epilepsy. Neurology 66:1571–1573

    Article  PubMed  CAS  Google Scholar 

  36. Sun FT, Morrell MJ, Wharen RE Jr (2008) Responsive cortical stimulation for the treatment of epilepsy. Neurotherapeutics 5:68–74

    Article  PubMed  Google Scholar 

  37. Morrell MJ, RNS System in Epilepsy Study Group (2011) Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology 77(13):1295–1304

    Article  PubMed  Google Scholar 

  38. Stefan H, Kreiselmeyer G, Kerling F et al (2012) Transcutaneous vagus nerve stimulation (t-VNS) in pharmacoresistant epilepsies: a proof of concept trial. Epilepsia 53:115–118

    Article  Google Scholar 

  39. Schulze-Bonhage A, Nikkhah G (2010) Tiefe Hirnstimulation. Neue Entwicklungen in der Epilepsiebehandlung. Z Epileptol 23:179–184

    Article  Google Scholar 

  40. Boon P, Vonck K, De Herdt V et al (2007) Deep brain stimulation in patients with refractory temporal lobe epilepsy. Epilepsia 48:1551–1560

    Article  PubMed  Google Scholar 

  41. Velasco AL, Velasco F, Velasco M et al (2007) Electrical stimulation of the hippocampal epileptic foci for seizure control: a double-blind, long-term follow-up study. Epilepsia 48:1895–1903

    Article  PubMed  Google Scholar 

  42. Miatton M, Van Roost D, Thiery E et al (2011) The cognitive effects of amygdalohippocampal deep brain stimulation in patients with temporal lobe epilepsy. Epilepsy Behav 22:759–764

    Article  PubMed  Google Scholar 

  43. http://www.brainlinks-braintools.uni-freiburg.de/researchprogram

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehung hin: Schulze-Bonhage hat bezahlte Vorträge für Fa. Cyberonics und Fa. Medtronic gehalten und erhielt finanzielle Unterstützung für eine klinische Studie zur Vagusnervstimulation von Fa. Cyberonics.

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Authors and Affiliations

  1. Epilepsiezentrum, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland

    A. Schulze-Bonhage

  2. Abteilung Stereotaktische und Funktionelle Neurochirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland

    V. Coenen

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  1. A. Schulze-Bonhage
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  2. V. Coenen
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Correspondence to A. Schulze-Bonhage.

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Schulze-Bonhage, A., Coenen, V. Epilepsiebehandlung. Nervenarzt 84, 517–529 (2013). https://doi.org/10.1007/s00115-013-3749-0

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  • DOI: https://doi.org/10.1007/s00115-013-3749-0

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