Epilepsie

Zusammenfassung

Epilepsien gehören zu den häufigsten neurologischen Erkrankungen. Die Therapie erfolgt in erster Linie symptomatisch durch Medikamente, die anhand des Epilepsiesyndroms, der Nebenwirkungen und individuellen Patientenbedürfnisse ausgewählt werden. Das Ziel ist die Anfallsfreiheit. Es sollte zunächst ein Medikament erster Wahl in ausreichend hoher Dosierung in Monotherapie gegeben werden, bei Kombinationstherapien ist darauf zu achten, nicht wirksame Medikamente wieder abzusetzen und unwirksame hohe Dosierungen zu vermeiden. Bei idiopathischen generalisierten Epilepsien sind viele der verfügbaren Anti-konvulsiva nicht (ausreichend) wirksam. Mittel der ersten Wahl sind Valproat, Ethosuximid und Lamotrigin. Bei fokalen Epilepsien ist grundsätzlich jedes Antikonvulsivum einsetzbar. Mittel der ersten Wahl sind aufgrund der guten Verträglichkeit und des günstigen Inter-aktionspotenzials Lamotrigin und Levetiracetam. Zu den nicht medikamentösen Therapieoptionen gehören die Epilepsiechirurgie, bei der das epileptogene Gewebe operativ entfernt wird, sowie die Hirnstimulation (Vagusnervstimulation, tiefe Hirnstimulation).

Summary

Epilepsies are among the most common neurologic disorders. Treatment is mainly symptomatic with antiepileptic drugs (AED) which are chosen depending on the epilepsy syndrome, side effects and patient profile. The aim of treatment is seizure freedom. Initially, a first line drug should be given in monotherapy in a sufficiently high dose. If combinations of two or more antiepileptic drugs are administered, unnecessary high doses should be reduced and ineffective drugs discontinued. Many AEDs are not (sufficiently) efficacious in idiopathic generalized epilepsies, first line drugs are valproate, ethosuximide and lamotrigine. Focal epilepsies can be treated with any AED, but because of their tolerability and low interaction profile lamotrigine and levetiracetam are often preferred. Nonpharmaco-logical treatment options include epilepsy surgery, by which the seizure-generating tissue is resected, and brain stimulation (vagus nerve stimulation, deep brain stimulation).

Schlüsselwörter

Epilepsie - Therapie - Antikonvulsiva

Keywords

Epilepsy - treatment - antiepileptic drugs

• Literatur

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