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Nervenheilkunde 2004; 23(01): 21-30
DOI: 10.1055/s-0038-1626189
Original- und Übersichtsarbeiten - Original and Review Articles
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Komorbidität bei Epilepsien

Comorbidity and epilepsy
S. Beyenburg
1   Département des Neurosciences, Centre Hospitalier de Luxembourg
2   Klinik für Epileptologie, Universitätsklinikum Bonn
,
D. Schmidt
3   Arbeitsgruppe Epilepsieforschung Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
19 January 2018 (online)

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Zusammenfassung

Die Komorbidität von Epilepsiepatienten umfasst zahlreiche neurologische, psychiatrische und endokrinologische Erkrankungen sowie Verletzungen und erhöhte Mortalität. Die neben dem Anfallsleiden vorliegenden Krankheiten bedürfen besonderer diagnostischer und therapeutischer Beachtung. Beispielsweise müssen Therapiestrategien aufgrund potenzieller medikamentöser Interaktionen modifiziert werden. Depressive Störungen sind besonders häufig, werden aber oft aufgrund ihrer atypischen Symptome nicht erkannt und daher unzureichend behandelt. Eine Komorbidität besteht auch mit Psychosen, Angsterkrankungen, Autismus und psychogenen nicht-epileptischen Anfällen. Letztere haben meist eine ungünstige Anfallsprognose und treten zudem häufig mit epileptischen Anfällen gemeinsam auf. Auch das Migränerisiko ist bei Epilepsiepatienten erhöht, insbesondere bei einer Vorgeschichte mit Schädel-Hirn-Trauma, fokalen epileptischen Anfällen und einer positiven Familienanamnese für Kopfschmerzen. Störungen der Reproduktion und der Fertilität treten bei Patienten mit Epilepsie sehr viel häufiger als in der Normalbevölkerung auf. Ursächlich sind medikamentöse, epilepsiebezogene sowie psychosoziale Faktoren. Darüber hinaus sind epilepsiekranke Menschen gefährdet durch Unfälle, Verletzungen und einen plötzlichen, ungeklärten Tod. Zufällige Koinzidenz häufiger Erkrankungen, ätiopathogenetische Gemeinsamkeiten und iatrogene Einflüsse (z.B. Nebenwirkungen von Medikamenten) sind einige der vielfältigen Ursachen der erhöhten Komorbidität von Patienten mit Epilepsie.

Summary

Comorbidity is common in patients with epilepsy; particularly other neurological, psychiatric, and endocrine disorders as well as injuries and increased mortality may complicate the course of epilepsy. Comorbidity in epilepsy represents challenges for both diagnosis and treatment. Therapeutic strategies may need to be modified to avoid potential drug interactions. Depression in epilepsy is very common, particularly among patients with partial seizures of temporal lobe origin. Despite its high prevalence, depression remains often unrecognized and untreated in patients with epilepsy. Other psychiatric conditions such as psychosis, panic disorders, autism, and psychogenic non-epileptic seizures (PNES) are also frequently found in patients with epilepsy. Recent studies have shown that seizure outcome in PNES remains poor. The risk of migraine in epilepsy is also increased, in particular in individuals with head trauma, partial seizures, and a positive family history of migraine. Furthermore, reproductive endocrine disorders and sexual dysfunction are common among women and men with epilepsy. This may be attributable to epilepsy itself, effects of antiepileptic drugs on endocrine function, and/or psychosocial factors. Patients with seizure disorders are also at increased risk for injuries and death. Comorbidity of epilepsy and other conditions may be due to shared pathophysiological mechanisms, however, coincidence or selection bias cannot always be excluded. Unfortunately, iatrogenic factors may also contribute to the comorbidity in patients with epilepsy.

Schlüsselwörter

Komorbidität - Epilepsie - Depression - Sexualfunktionsstörungen - Migräne - Verletzungen - SUDEP

Keywords

Comorbidity - epilepsy - depression - reproductive and endocrine dysfunction - migraine - injuries - SUDEP
 

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