Interdisziplinäre Konzepte von Pädiatrie und Klinischer Pharmazie zur Optimierung der Antikonvulsivatherapie

Zusammenfassung

Für die Diagnostik von Epilepsien im Kindes- und Jugendalter und deren Behandlung mit Antikonvulsiva ist Expertise in unterschiedlichen Bereichen nötig. Der Patient profitiert dabei vom Zusammenwirken verschiedener Berufsgruppen. Risiken müssen reduziert und die in klinischen Studien gezeigte Wirksamkeit auch in eine möglichst gute Effektivität unter Routinebedingungen umgesetzt werden. Dabei sollten zunächst Aspekte der Arzneimittelverschreibung durch den Arzt berücksichtigt werden, wie etwa die Auswahl, Kombination und Dosierung der Antikonvulsiva. Dabei sollte die Arzneimittelanwendung nicht vergessen werden. Erst, wenn ein Antikonvulsivum richtig angewendet wird, kann der vom verordnenden Arzt gewünschte Therapieerfolg auch erreicht werden. Dabei sollten sich Maßnahmen nicht nur auf den Pflegedienst, sondern auch auf die Eltern, die Kinder und Jugendlichen selbst sowie Betreuer in Schulen und Kindertageseinrichtungen erstrecken. Durch theoretische Schulungen, praktische Übungen und regelmäßige Einbindung von Apothekern ins interdisziplinäre Behandlungsteam wird vermeidbaren arzneimittelbezogenen Problemen, die zu mangelnder Effektivität und dem Auftreten erhöhter Risiken führen können, vorgebeugt. Auf diese Weise wird nicht nur die Arzneimittel(therapie)sicherheit qualitativ verbessert, sondern auch die Teilhabe und Lebensqualität der Patienten und deren Familien positiv beeinflusst.

Abstract

Summary Expertise in a variety of fields is required for the diagnostic process of epilepsies in children and adolescents as well as for their treatment with anticonvulsants. Patients benefit in the process from the cooperation of different health care professionals. It is of critical importance for risks to be minimised and for the efficacy shown in controlled clinical trials to be maintained in routine conditions. In the first instance, drug prescription procedures, including the choice of anticonvulsants and combinations of drugs and dosing, have to be considered. The administration of drugs has, of course, also to be taken into account. Only if patients are given their anticonvulsants appropriately, the intended success of the therapy can be accomplished. Strategies aimed at improving drug administration have to be directed not only at nurses but also at parents, children and adolescents themselves, as well as caregivers in schools and children's day-care facilities. By providing theoretical teaching, practical training, and routinely including pharmacists in the therapeutic team, drug-related problems that may result in limited effectiveness and increased risks are prevented. As a result, drug (therapy) safety is not only qualitatively improved, but the degree of participation and quality of life of patients and families is improved as well.

Schlüsselwörter

Kinder - Jugendliche - Antikonvulsiva - arzneimittelbezogene Probleme - Arzneimittel (therapie) sicherheit - Interdisziplinarität

Key words

children - adolescents - anticonvulsants - drug-related problem - drug (therapy) safety - interdisciplinarity

• Literatur

• 1 Arzimanoglou A, Wait S, Auvin S. et al. Survenue d’une crise d’épilepsie prolongée chez l’enfant: quelle prise en charge en dehors du milieu hospitalier?. Arch Pediatr 2014; 21: 1252-1261
• 2 Avanzini G, Depaulis A, Tassinari A. et al. Do seizures and epileptic activity worsen epilepsy and deteriorate cognitive function?. Epilepsia 2013; 54 (Suppl. 08) 14-21
• 3 Battino D, Estienne M, Avanzini G. Clinical pharmacokinetics of antiepileptic drugs in paediatric patients. Part II. Phenytoin, carbamazepine, sulthiame, 3 lamotrigine, vigabatrin, oxcarbazepine and felbamate. Clin Pharmacokinet 1995; 29: 341-369
• 4 Battino D, Estienne M, Avanzini G. Clinical pharmacokinetics of antiepileptic drugs in paediatric patients. Part I: Phenobarbital, primidone, valproic acid, ethosuximide and mesuximide. Clin Pharmacokinet 1995; 29: 257-286
• 5 Berg AT, Berkovic SF, Brodie MJ. et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia 2010; 51: 676-685
• 6 Bertsche A, Dahse AJ, Neininger MP. et al. Ambulatory care of children treated with anticonvulsants – pitfalls after discharge from hospital. Klin Padiatr 2013; 225: 277-282
• 7 Bertsche T, Bertsche A, Krieg EM. et al. Prospective pilot intervention study to prevent medication errors in drugs administered to children by mouth or gastric tube: a programme for nurses, physicians and parents. Qual Saf Health Care 2010; 19: e26
• 8 Bertsche T, Fleischer M, Pfaff J. et al. Pro-active provision of drug information as a technique to address overdosing in intensive-care patients with renal insufficiency. Eur J Clin Pharmacol 2009; 65: 823-829
• 9 Camfield C, Camfield P. Injuries from seizures are a serious, persistent problem in childhood onset epilepsy: a population-based study. Seizure 2015; 27: 80-83
• 10 Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord 2015; 17: 117-123
• 11 Cross JH, Wait S, Arzimanoglou A. et al. Are we failing to provide adequate rescue medication to children at risk of prolonged convulsive seizures in schools?. Arch Dis Child 2013; 98: 777-780
• 12 d'Aloja E, Paribello F, Demontis R. et al. Off-label drugs prescription in neonatology: a physician's duty or a medical hazardous attitude?. J Matern Fetal Neonatal Med 201 24 (Suppl. 01) 99-100
• 13 Dlugos DJ, Sammel MD, Strom BL. et al. Response to first drug trial predicts outcome in childhood temporal lobe epilepsy. Neurology 2001; 57: 2259-2264
• 14 Doering JH, Reuner G, Kadish NE. et al. Pattern and predictors of complementary and alternative medicine (CAM) use among pediatric patients with epilepsy. Epilepsy Behav 2013; 29: 41-46
• 15 Doerrer SC. Rescue Medicine for Epilepsy in Education Settings. Pediatrics 2016; 137: e20153876
• 16 Dumeier HK, Neininger MP, Bernhard MK. et al. Knowledge and attitudes of school teachers, preschool teachers and students in teacher training about epilepsy and emergency management of seizures. Arch Dis Child 2015; 100: 851-855
• 17 Dumeier HK, Neininger MP, Kaune A. et al. Seizure management by preschool teachers: A training concept focussing on practical skills. Seizure 2017; 50: 38-42
• 18 Elger CE, Helmstaedter C, Kurthen M. Chronic epilepsy and cognition. Lancet Neurol 2004; 3: 663-672
• 19 Fisher RS, Acevedo C, Arzimanoglou A. et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014; 55: 475-482
• 20 Fisher RS, Cross JH, French JA. et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58: 522-530
• 21 Fisher RS, van Emde Boas W, Blume W. et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 2005; 46: 470-472
• 22 Frattarelli DA, Galinkin JL, Green TP. et al. Off-label use of drugs in children. Pediatrics 2014; 133: 563-567
• 23 French JA. Refractory epilepsy: clinical overview. Epilepsia 2007; 48 (Suppl. 01) 3-7
• 24 Hartman AL, Devore CD. Section on Neurology, American Academy of Pediatrics et al. Rescue Medicine for Epilepsy in Education Settings. Pediatrics 2016; 137: e20153876
• 25 Hartmann N, Neininger MP, Bernhard MK. et al. Use of complementary and alternative medicine (CAM) by parents in their children and adolescents with epilepsy - Prevelance, predictors and parents' assessment. Eur J Paediatr Neurol 2016; 20: 11-19
• 26 Hughes JR, Gruener G. The success of EEG in confirming epilepsy--revisited. Clin Electroencephalogr 1985; 16: 98-103
• 27 Kaune A, Schumacher PM, Hoppe SC. et al. Administration of anticonvulsive rescue medication in children-discrepancies between parents' self-reports and limited practical performance. Eur J Pediatr 2016; 175: 1139-1146
• 28 Klingmann V, Seitz A, Meissner T. et al. Acceptability of Uncoated Mini-Tablets in Neonates--A Randomized Controlled Trial. J Pediatr 2015; 167: 893-896 e2
• 29 Knudsen FU. Rectal administration of diazepam in solution in the acute treatment of convulsions in infants and children. Arch Dis Child 1979; 54: 855-857
• 30 Kramme E, Bode A, Steinborn B. et al. Antibiotic Stewardship-Visiten: Zeitverschwendung oder Qualitätssteigerung?. Z Evid Fortbild Qual Gesundhwes 2015; 109: 535-541
• 31 Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000; 342: 314-319
• 32 Lee YK, Ah YM, Choi YJ. et al. Antiepileptic drug adherence and persistence in children with epilepsy attending a large tertiary care children's hospital. Epileptic Disord 2016; 18: 408-417
• 33 Maegaki Y, Kurozawa Y, Tamasaki A. et al. Early predictors of status epilepticus-associated mortality and morbidity in children. Brain Dev 2015; 37: 478-486
• 34 Maljevic S, Vejzovic S, Bernhard MK. et al. Novel KCNQ3 Mutation in a Large Family with Benign Familial Neonatal Epilepsy: A Rare Cause of Neonatal Seizures. Mol Syndromol 2016; 7: 189-196
• 35 Mastrangelo M, Celato A, Leuzzi V. A diagnostic algorithm for the evaluation of early onset genetic-metabolic epileptic encephalopathies. Eur J Paediatr Neurol 2012; 16: 179-191
• 36 May TW, Korn-Merker E, Rambeck B. Clinical pharmacokinetics of oxcarbazepine. Clin Pharmacokinet 2003; 42: 1023-1042
• 37 McIntyre J, Robertson S, Norris E. et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 2005; 366: 205-210
• 38 Mercimek-Mahmutoglu S, Patel J, Cordeiro D. et al. Diagnostic yield of genetic testing in epileptic encephalopathy in childhood. Epilepsia 2015; 56: 707-716
• 39 Mistry P, Batchelor H. SPaeDD-UK project (Smart Paediatric Drug Development - UK). Evidence of acceptability of oral paediatric medicines: a review. J Pharm Pharmacol 2017; 69: 361-376
• 40 Neininger MP, Bertsche A, Frontini R. et al. Salbutamol bei akuter bronchialer Obstruktion Verschreibungspraxis in der Routineversorgung. Kinder- und Jugendmedizin 2015; 15: 433-438
• 41 Neininger MP, Kaune A, Bertsche A. et al. How to improve prescription of inhaled salbutamol by providing standardised feedback on administration: a controlled intervention pilot study with follow-up. BMC Health Serv Res 2015; 15: 40
• 42 Niemann D, Bertsche A, Meyrath D. et al. A prospective three-step intervention study to prevent medication errors in drug handling in paediatric care. J Clin Nurs 2015; 24: 101-114
• 43 Niemann D, Bertsche A, Meyrath D. et al. Drug handling in a paediatric intensive care unit--can errors be prevented by a three-step intervention?. Klin Padiatr 2014; 226: 62-67
• 44 Paldino MJ, Zhang W, Chu ZD. et al. Metrics of brain network architecture capture the impact of disease in children with epilepsy. Neuroimage Clin 2016; 13: 201-208
• 45 Papetti L, Parisi P, Leuzzi V. et al. Metabolic epilepsy: an update. Brain Dev 2013; 35: 827-841
• 46 Pauschek J, Bernhard MK, Syrbe S. et al. Epilepsy in children and adolescents: Disease concepts, practical knowledge, and coping. Epilepsy Behav 2016; 59: 77-82
• 47 Ranmal SR, Cram A, Tuleu C. Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children's Acceptability of Oral Formulations (CALF) Study. Int J Pharm 2016; 514: 296-307
• 48 Sam MC, So EL. Significance of epileptiform discharges in patients without epilepsy in the community. Epilepsia 2001; 42: 1273-1278
• 49 Santucci R, Fothergill H, Laugel V. et al. The onset of acute oxcarbazepine toxicity related to prescription of clarithromycin in a child with refractory epilepsy. Br J Clin Pharmacol 2010; 69: 314-331
• 50 Segal E, Pedro H, Valdez-Gonzalez K. et al. Diagnostic Yield of Epilepsy Panels in Children With Medication-Refractory Epilepsy. Pediatr Neurol 2016; 64: 66-71
• 51 Sharma S, Riviello JJ, Harper MB. et al. The role of emergent neuroimaging in children with new-onset afebrile seizures. Pediatrics 2003; 111: 1-5
• 52 Spina E, Pisani F, Perucca E. Clinically significant pharmacokinetic drug interactions with carbamazepine. An update. Clin Pharmacokinet 1996; 31: 198-214
• 53 Syrbe S, Hedrich UB, Riesch E. et al. De novo loss- or gain-of-function mutations in KCNA2 cause epileptic encephalopathy. Nat Genet 2015; 47: 393-399
• 54 Syrbe S, Zhorov BS, Bertsche A. et al. Phenotypic Variability from Benign Infantile Epilepsy to Ohtahara Syndrome Associated with a Novel Mutation in SCN2A. Mol Syndromol 2016; 7: 182-188
• 55 Tews W, Weise S, Syrbe S. et al. Is there a predictive value of EEG and MRI after a first afebrile seizure in children?. Klin Padiatr 2015; 227: 84-88
• 56 Wilke K, de With K. Dokumentation von Antibiotic Stewardship (ABS)-Interventionen im Rahmen infektiologischer Visiten. Z Evid Fortbild Qual Gesundhwes 2015; 109: 528-534 Z Evid Fortbild Qual Gesundhwes 2015; 109: 528-534
• 57 Zimmer J, Hartl S, Standfuß K. et al. Handling of hazardous drugs – Effect of an innovative teaching session for nursing students. Nurse Educ Today 2017; 49: 72-78
• 58 Zimmer J, Niemann D, Seltmann K. et al. Managing of oral medicines in paediatric oncology: Can a handbook and a pharmaceutical counselling intervention for patients and their parents prevent knowledge deficits? – A pilot study. Eur J Hosp Pharm 2016; 23: 100-105