Update Epileptologie

Zusammenfassung

Während der vergangenen beiden Jahre konnten entscheidende Verbesserung in der Diagnostik und Therapie der Epilepsien erzielt werden. Die wesentlichen Innovationen sind: Die Verbesserung der MR-Diagnostik epileptogener Läsionen durch 7-Tesla-Gerät (experimentell). MR-Traktografie, Propeller-MRT (Bewegungsartefakte-Unterdrückung) und funktionalisierte Magneto-Nano-Partikel verbessern die Darstellung des epileptischen Herdes sowie funktionell wichtiger Hirnareale. Lacosamid wurde als Zusatztherapie bei fokalen Epilepsien neu zugelassen. Rufinamid wurde bei therapieresistentem Lennox-Gastaut-Syndrom ab vier Jahren neu zugelassen. Die SANAD-Studien zeigten, dass Lamotrigin Vorteile bei der Behandlung fokaler Epilepsien und Valproinsäure Vorteile bei der Behandlung idiopathisch generalisierter Epilepsien hat. Langzeitergebnisse fünf Jahre nach Durchführung eines Epilepsiechirurgischen Eingriffs zeigen eine Wiederverschlechterung der Anfallssituation. Interstitielle Bestrahlung und Gamma-knife-Bestrahlung sind eventuelle Alternativen zur Resektion bei Patienten mit medialer Temporallappenepilepsie.

Summary

MR-Imaging of epileptogenic lesions and depiction of the epileptic focus was improved by 7-Tesla-MRI as well as MR-tractography, propeller-MRI technique which suppresses motion artifacts and application of magnetonano-particles. Lacosamid was licensed in Germany for add-on treatment of focal epilepsies. Rufinamide was licensed in Germany for add-on treatment of intractable Lennox-Gastaut-Syndrome. The SANAD-studies show advantages of lamotrigine for treatment of focal epilepsies and of valproate for treatment of generalized epilepsies. Long-term outcome of epilepsy surgery demonstrate increasing fraction of patients with relapse of seizures. Interstitial radiation and gamma-knife-surgery increasingly appears to be an alternative treatment for patients with medial temporal lobe epilepsy.

Schlüsselwörter

Update Epileptologie - Epilepsie - Lacosamid - Rufinamid - Pharamakotherapie

Keywords

Update epileptology - epilepsy - lacosamide - rufinamide - pharmacotherapy

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