Epilepsien bei demenziellen und neurodegenerativen Erkrankungen

Zusammenfassung

Die Assoziation von Epilepsien zu neurodegenerativen demenziellen Erkrankungen ist bislang wenig untersucht, verdient jedoch schon aufgrund der demografischen Entwicklung, die eine Häufigkeitszunahme beider Erkrankungen vorhersagt, vermehrte Beachtung. Der Begriff der „Altersepilepsie”, durch den eine Einheitlichkeit der Pathogenese und Therapie suggeriert wird, wird jedoch den verschiedenen Aspekten der Epilepsien bei neurodegenerativen und demenziellen Erkrankungen nicht gerecht. Insbesondere die Demenz vom Alzheimer-Typ ist mit epileptischen Anfällen assoziiert, ein hinsichtlich Häufigkeit und Folgen unterschätztes (sozial-)medizinisches Problem. Bezüglich des Auftretens von Epilepsien bei anderen neurodegenerativen Erkrankungen lassen sich keine einheitlichen und umfassenden Aussagen über epidemiologische, pathophysiologische, klinisch-semiologische oder therapeutische Zusammenhänge treffen. Aus diesem Grund erscheint eine syndromale Klassifikation von Epilepsien bei der heterogenen Gruppe neurodegenerativer demenzieller Erkrankungen aktuell noch schwierig. Unsere Übersicht fasst die bisherig vorliegenden Daten über epidemiologische, differenzialdiagnostische, anfalls-semiologische, pathophysiologische und therapeutische Aspekte hinsichtlich Epilepsien bei demenziellen und neurodegenerativen Erkrankungen zusammen.

Abstract

The association between neurodegenerative disorders with dementia and epilepsies has received little attention. However, this connection deserves a higher level of alertness if only due to the expected demographic developments which suggest an increasing prevalence of each disease group. The frequently used term „epilepsy of the eldery” falsely suggests a uniform pathogenesis and therapy, but is clearly insufficient to reflect the different pathopysiological and therapeutic considerations of different neurodegenerative syndromes leading to epilepsy in elderly patients. Especially the frequent association of recurrent seizures and Alzheimer's disease is a problem whose important medical and social implications are often neglected. Concerning epilepsies in other neurodegenerative diseases, there is insufficient and incoherent evidence about epidemiological, pathophysiological, semiological or therapeutic connections and considerations. Therefore it seems difficult to propose a syndromal classification of epilepsies in the heterogeneous group of neurodegenerative disorders with dementia. This review outlines the available data about epidemiological, (differential) diagnostic, semiological, pathophysiological and therapeutic aspects of epilepsies in neurodegenerative disorders with dementia.

Epilepsie - Demenz - neurodegenerative Erkrankungen - Demenz vom Alzheimer-Typ

epilepsy - dementia - neurodegenerative disorders - dementia of the Alzheimer type

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