Update Epilepsie

Zusammenfassung

In der Epileptologie hat sich eine intensive Diskussion zur Klassifikation epileptischer Anfälle und Syndrome entwickelt, die noch nicht abgeschlossen ist. Sie reflektiert die erheblichen Fortschritte, die im Verständnis der Ätiologie und Pathophysiologie gewonnen wurden, aber auch den lange noch nicht abgeschlossenen Erkenntniszugewinn. Weitere Modifikationen sind daher zwingend zu erwarten. Die diagnostischen Möglichkeiten haben sich weiter verbessert. Hauptproblem ist, dass sie nicht angemessen angewendet werden. Die Grundsätze der Epilepsietherapie haben sich in letzter Zeit nicht verändert. Es hat sich gezeigt, dass Lamotrigin und Levetiracetam zu den Standardantikonvulsiva werden. Neueste Antikonvulsiva haben zum Teil überzeugt. Leider wird ihre nachhaltige Anwendung in Deutschland im Gegensatz zum Rest der Welt durch die Auswirkungen des Arzneimittelmarktneuordnungsgesetzes praktisch verhindert. Neurostimulationsverfahren bieten interessante Perspektiven, aber nicht mehr.

Summary

There has been an ongoing and vivid discussion about the classification of epileptic seizures and syndromes that has not been finished yet. It reflects the substantial progress of understanding etiology and pathophysiology but also the preliminary character of this knowledge. Further modifications are to be expected. The diagnostic possibilities have advanced. The major problem is that these ameliorations are not widely used. The basic rules of anticonvulsant treatment remained the same. It is apparent that lamotrigine and levetiracetam are the modern standard anticonvulsant drugs. The latest anticonvulsant drugs are only partial improvements. Unfortunately, their sustained availability is prevented by the consequences of new regulatory laws in Germany. Neurostimulation methods offer interesting perspectives, not more and not less.

Schlüsselwörter

Epilepsie - Klassifikation - Diagnostik - Therapie - Update

Keywords

Epilepsy - classification - diagnostics - therapy - update

 

Interessenkonflikt

Bernhard J. Steinhoff hat honorarpflichtig Vorträge für Eisai und UCB gehalten. Er hat Beraterfunktionen für die Firmen Actelion, Bial, B. Braun, Melsungen, Desitin, Eisai und UCB wahrgenommen.

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