Neurologische und psychiatrische Notfälle

Zusammenfassung

Bei der myasthenen Krise sind Plasmapherese und intravenöse Immunglobuline gleichwertig. Influenzaimpfungen führen nicht signifi-kant zu einer Risikoerhöhung eines GuillainBarré-Syndroms (GBS), während die Infektionen mit Influenzaviren und H1N1 mit einer erhöhten GBS-Rate assoziiert sind. Die intra -venöse und intraarterielle Lyse der Basilaris -thrombose sind möglicherweise gleichwertig, Bridging-Konzepte sind eventuell mit einer erhöhten Rekanalisierungsrate verbunden. Metaanalysen lassen an der Wirksamkeit von Dexamethason bei bakterieller Meningitis zweifeln. In der FAST-Studie konnte keine Verbesserung des Outcomes von Patienten mit intrazerebraler Blutung durch Gabe von rekombinantem Faktor VII a erzielt werden. Clazosentan (Endothelinrezeptorantagonist) war in der Prophylaxe von Vasospasmen nach SAB in der CONSCIOUS-I-Studie sicher und wirksam. Die Phase-III-Studie war negativ.

Summary

Recent trials showed no significant difference in efficacy between IVIG and plasmapheresis in the treatment of severe Myasthenia gravis. Vaccinations against influenza do not lead to a significant increased risk for GBS, whereas seasonal influenza and H1N1 infections are associated with an increased rate of GBS. In case of basilar artery occlusion no significant superiority can be found for treatment with intravenous or intra-arterial thrombolysis. Bridging concepts might provide better recanalization rates. The benefit of adjunctive dexamethasone in the treatment of acute bacterialmeningitis remains unproven. In FAST recombinant factor VII a did not improve clinical outcomes of patients with intra -cerebral hemorrhage. In CONSCIOUS-I Clazosentan (endothelin receptor antagonsist) significantlyprevented the occurrence of cerebral vasospasms following a SAH. However, CONSCIOUS- II showed negative results.

Schlüsselwörter

Notfall - Neurologie - Psychiatrie - Therapie

Keywords

Emergency - neurology - psychiatry - therapy

• Literatur

• 1 Barth D. et al. Comparison of IVIG and PLEX in patients with myasthenia gravis. Neurology 2011; 76: 2017-23.
• 2 Brouwer MC. et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2010; 9: CD004405.
• 3 Centers for Disease Control and Prevention (CDC).. Preliminary results: surveillance for Guillain-Barré syndrome after receipt of influenza A (H1N1) 2009 monovalent vaccine – United States, 2009-2010. MMWR Morb Mortal Wkly Rep 2010; 59: 657-61.
• 4 Chandra RV. et al. Glasgow coma scale does not predict outcome post-intra-arterial treatment for basilar artery thrombosis. Am J Neuroradiol 2011; 32: 576-80.
• 5 Dalmau J. et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 2007; 61: 25-36.
• 6 de Gans J, van de Beek D. European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators.. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347: 1549-56.
• 7 Desmond RA. et al. Enteroviral meningitis: natural history and outcome of pleconaril therapy. Anti-microb Agents Chemother 2006; 50: 2409-14.
• 8 Docherty JP. et al. Effect of aripiprazole versus haloperidol on PANSS Prosocial items in early-episode patients with schizophrenia. Schizophr Res 2010; 120: 199-203.
• 9 Flensborg-Madsen T. et al. Alcohol use disorders increase the risk of completed suicide-irrespective of other psychiatric disorders. A longitudinal cohort study. Psychiatry Res 2009; 167 1–2 123-30.
• 10 Galldiks N. et al. Selective immune adsorption treatment of severe Guillain Barré syndrome in the Iitensive care unit. Neurocrit Care 2009; 12.
• 11 Kawai N. et al. A comparison of the effectiveness of Zanamivir and Oseltamivir for the treatment of influenza A and B. J Infect 2008; 56: 51-7.
• 12 Kuitwaard K. et al. Pharmacokinetics of intravenous immunoglobulin and outcome in Guillain-Barré syndrome. Ann Neurol 2009; 66: 597-603.
• 13 Larsen KK. et al. Myocardial infarction and risk of suicide: a population-based case-control study. Circulation 2010; 122: 2388-93.
• 14 Lehmann HC. et al. Guillain-Barré syndrome after exposure to influenza virus. Lancet Infect Dis 2010; 10: 643-51.
• 15 Lim HK. et al. Risperidone orodispersible tablet and intramuscular haloperidol in the treatment of acute psychotic agitation: a randomized open, prospective study. Neuropsychobiology 2010; 62: 81-6.
• 16 Macdonald RL. et al. Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet Neurol 2011; 10: 618-25.
• 17 Mandawat A. et al. Comparative analysis of therapeutic options used for myasthenia gravis. Ann Neurol 2010; 68: 797-805.
• 18 Mayer SA. Recombinant activated factor VII for acute intracerebral hemorrhage. Stroke 2007; 38: 763-7.
• 19 Meierkord H. et al. FNS guideline on the management of status epilepticus in adults. Eur J Neurol 2010; 17: 348-55.
• 20 Mendelow AD. et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005; 365: 387-97.
• 21 Murphy TM. et al. Risk and protective genetic variants in suicidal behaviour: association with SLC1A2, SLC1A3, 5-HTR1B &NTRK2 polymorphisms. Behav Brain Funct 2011; 7: 22.
• 22 Naidech AM. et al. Prospective, randomized trial of higher goal hemoglobin after subarachnoid hemorrhage. Neurocrit Care 2010; 13: 313-20.
• 23 Nguyen TH. et al. Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. N Engl J Med 2007; 357: 2431-40.
• 24 Oh SJ, Claussen GG, Hatanaka Y, Morgan MB. 3,4-Diaminopyridine is more effective than placebo in a randomized, double-blind, cross-over drug study in LEMS. Muscle Nerve 2009; 40: 795-800.
• 25 Pfefferkorn T. et al. Staged escalation therapy in acute basilar artery occlusion: intravenous thrombolysis and on-demand consecutive endovascular mechanical thrombectomy: preliminary experience in 16 patients. Stroke 2008; 39: 1496-500.
• 26 Power KN. et al. Propofol treatment in adult refractory status epilepticus. Mortality risk and outcome. Epilepsy Res 2011; 94: 53-60.
• 27 Rossetti AO. et al. A randomized trial for the treatment of refractory status epilepticus. Neurocrit Care 2011; 14: 4-10.
• 28 Rucci P. et al. Treatment-emergent suicidal ideation during 4 months of acute management of unipolar major depression with SSRI pharmacotherapy or interpersonal psychotherapy in a randomized clinical trial. Depress Anxiety 2011; 28: 303-9.
• 29 Sakurai T. et al. [Case of adult influenza type A virus-associated encephalopathy successfully treated with primary multidisciplinary treatments]. Rinsho Shinkeigaku 2007; 47: 639-43.
• 30 Schonewille WJ. et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 2009; 8: 724-30.
• 31 Sevy S. et al. Olanzapine vs. risperidone in patients with first-episode schizophrenia and a lifetime history of cannabis use disorders: 16-week clinical and substance use outcomes. Psychiatry Res 2011; 188: 310-4.
• 32 Thwaites GE. et al. Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study. Lancet Neurol 2007; 6: 230-6.
• 33 van de Beek D. et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol 2010; 9: 254-63.
• 34 van der Maas NA. et al. Guillain-Barré syndrome: background incidence rates in The Netherlands. J Peripher Nerv Syst 2011; 16: 243-9.
• 35 Walgaard C. et al. Early recognition of poor prognosis in Guillain-Barre syndrome. Neurology 2011; 76: 968-75.
• 36 Weisfelt M. et al. Dexamethasone and long-term outcome in adults with bacterial meningitis. Ann Neurol 2006; 60: 456-68.
• 37 Zebardast N. et al. Rituximab in the management of refractory myasthenia gravis. Muscle Nerve 2010; 41: 375-8.