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Temporallappenepilepsien – Ätiologie und elektroklinische Subtypen

Temporal lobe epilepsies—etiology and electroclinical subtypes

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Zusammenfassung

Hintergrund

Temporallappenepilepsien sind die häufigsten fokalen Epilepsien.

Fragestellung

Darstellung von ätiologischen und elektroklinischen Subtypen von Temporallappenepilepsien.

Material und Methode

Zusammenfassung und Diskussion der wesentlichen Literatur über wichtige ätiologische und elektroklinische Subtypen von Temporallappenepilepsien.

Ergebnisse

Die wichtigsten ätiologischen Subtypen sind die mesialen Temporallappenepilepsien mit Hippocampussklerose (MTLE-HS), die läsionellen Temporallappenepilepsien und die MR-negative Temporallappenepilepsien. Bei MTLE-HS sind initial präzipitierende Ereignisse (insbesondere komplizierte Fieberkrämpfe) häufig, der Erkrankungsbeginn ist früh, bilaterale tonisch-klonische Anfälle sind selten, in 50–90 % besteht medikamentöse Therapieresistenz. Häufige Ursachen von läsionellen Temporallappenepilepsien sind langzeitepilepsieassoziierte neuroepitheliale Tumoren (LEAT), fokale kortikale Dysplasien und Kavernome. Bei Magnetresonanz-Tomographie (MR)-negativen Temporallappenepilepsien sind initial präzipitierende Ereignisse selten, der Erkrankungsbeginn ist spät, bilaterale tonisch-klonische Anfälle sind häufig, 55–60 % sind gut behandelbar. Hinsichtlich der elektroklinischen Subtypen können mesiale Subtypen, ein temporopolarer Subtyp, ein mesiolateraler Subtyp, ein lateraler Subtyp und ein Temporal-„Plus“-Subtyp unterschieden werden.

Schlussfolgerungen

Temporallappenepilepsien sind komplexe Netzwerkerkrankungen. Die funktionellen und strukturellen Veränderungen sind im Allgemeinen räumlich wesentlich ausgedehnter als die in der MRT fassbare strukturelle Läsion und gehen oft über den Temporallappen hinaus. Die einzelnen elektroklinischen Subtypen zeigen beträchtliche Überlappungen in der klinischen Anfallssemiologie und können bei allen Ätiologien vorkommen.

Abstract

Background

Temporal lobe epilepsies are the most frequent form of focal epilepsy.

Objective

Presentation of the etiological and electroclinical subtypes of temporal lobe epilepsies.

Material and methods

Summary and discussion of the relevant literature on important etiological and electroclinical subtypes of temporal lobe epilepsies.

Results

The most important etiological subtypes are mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), lesional temporal lobe epilepsies and magnetic resonance (MR) negative temporal lobe epilepsies. In MTLE-HS initially precipitating incidents (especially complicated febrile convulsions) are frequent, seizure onset is at an early age, bilateral tonic-clonic seizures are rare and seizures become drug-refractory in 50–90% of cases. Frequent causes of lesional temporal lobe epilepsies include long-term epilepsy-associated neuroepithelial tumors (LEAT), focal cortical dysplasia and cavernous angiomas. In MR negative temporal lobe epilepsies initially precipitating incidents are rare, seizure onset is at a later age, bilateral tonic-clonic seizures are frequent and seizures can be controlled in 55–60% of cases. With respect to electroclinical subtypes, mesial subtypes, a temporopolar subtype, a mesiolateral subtype, a lateral subtype and a temporal plus subtype can be distinguished.

Conclusion

Temporal lobe epilepsies are complex network diseases. Functional and structural alterations are usually spatially more widely distributed than lesions visible on MRI and frequently extend beyond the temporal lobe. The individual electroclinical syndromes show considerable overlapping in clinical seizure semiology and can occur with all etiologies.

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Authors and Affiliations

  1. Neurologische Abteilung, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Riedelgasse 5, 1130, Wien, Österreich

    Christoph Baumgartner, Johannes P. Koren, Clemens Lang & Lea Zoche

  2. Karl Landsteiner Institut für Klinische Epilepsieforschung und Kognitive Neurologie, Wien, Österreich

    Christoph Baumgartner, Johannes P. Koren, Clemens Lang & Lea Zoche

  3. Medizinische Fakultät, Sigmund Freud Privatuniversität, Wien, Österreich

    Christoph Baumgartner

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  1. Christoph Baumgartner
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  2. Johannes P. Koren
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  3. Clemens Lang
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  4. Lea Zoche
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Correspondence to Christoph Baumgartner.

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Interessenkonflikt

C. Baumgartner, J.P. Koren, C. Lang und L. Zoche geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Baumgartner, C., Koren, J.P., Lang, C. et al. Temporallappenepilepsien – Ätiologie und elektroklinische Subtypen. Z. Epileptol. 33, 6–14 (2020). https://doi.org/10.1007/s10309-020-00312-0

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