Vorhersage epileptischer Anfälle

Zusammenfassung

Das unvorhergesehene Auftreten epileptischer Anfälle trägt nicht nur wesentlich zu den physischen, psychischen und sozialen Risiken der Epilepsien bei, sondern limitiert auch derzeitige therapeutische Optionen. Eine Reihe von Hinweisen machen es wahrscheinlich, dass zumindest bei fokalen Epilepsien dem Anfallsereignis charakteristische Veränderungen der EEG-Dynamik in einem Zeitraum von Minuten bis Stunden vorausgehen. Im vergangenen Jahrzehnt wurden mittels linearer und non-linearer EEG-Analyseverfahren präiktale Veränderungen von verschiedenen abgeleiteten Parametern gefunden. Bislang ist die Sensitivität und Spezifität für einen klinischen Einsatz noch nicht ausreichend. Sowohl von der Europäischen Union als auch vom National Institute of Health in den USA werden daher Anstrengungen unterstützt, die Entwicklung der Anfallsvorhersage in den nächsten Jahren voranzutreiben.

Summary

The unpredictable occurrence of epileptic seizures not only contributes to physical, psychic and social risks of epilepsy, but also limits present-day therapeutic options. There is some evidence that at least in focal epilepsies there are characteristic alterations in EEG dynamics which precede seizure events for minutes up to hours. During the last decade, preictal changes could be shown to occur using various linear and non-linear methods of time series analysis. So far their sensitivity and specificity are not sufficient for clinical applications. Both European Union and the National Institutes of Health in the US thus support efforts to push forward the development of seizure prediction during the years to come.

Schlüsselwörter

Epilepsie - Anfallsvorhersage - präiktale Phase

Keywords

Epilepsy - seizure prediction - preictal phase

• Literatur

• 1 Andrzejak RG. et al. Testing the null hypothesis of the nonexistence of a preseizure state. Phys Rev E Stat Nonlin Soft Matter Phys 2003; 67: 010901.
• 2 Aschenbrenner-Scheibe R. et al. How well can epileptic seizures be predicted? An evaluation of a nonlinear method. Brain 2003; 126: 2616-2626.
• 3 Baumgartner C. et al. Preictal SPECT in temporal lobe epilepsy: regional cerebral blod flow is increased prior to electroencephalography-seizure onset. J Nucl Med 1998; 39: 978-982.
• 4 Berger H. Über das Elektronenzephalogramm des Menschen. Die vierzehn Originalarbeiten von 1929–1938. Freiburg: Deutsche GEsellschaft für Klinische Neurophysiologie; 2004. 34
• 5 Chávez M. et al. Spatio-temporal dynamics prior to neocortical seizures: amplitude versus phase couplings. IEEE Trans Biomed Eng 2003; 50: 571-583.
• 6 Feldwisch genannt Drentrup H. et al. Joining the Benefits: Combining Epileptic Seizure Prediction Methods. Submitted.
• 7 Gotman J. Seizure detection, past and present. Vortrag: 3rd International Seizure Prediction Conference, Freiburg, 30.9.2007.
• 8 Gotman J, Koffler DJ. Interictal spiking increases after seizures but does not after decrease in medication. Electroencephalogr Clin Neurophysiol 1989; 72: 7-15.
• 9 Haut SR. et al. Can patients with epilepsy predict their seizures?. Neurology 2007; 68: 262-266.
• 10 Iasemidis LD, Sackelares JC. Chaos theory and epilepsy. Neuroscientist 1996; 2: 118-126.
• 11 Jachan M. et al. Automated multiband detection of high-frequency oscillations in intracranial eeg and evaluation of their prediction performance. Poster, 3rd International Seizure Prediction Conference, Freiburg: 29.9.-2.10.2007.
• 12 Jirsch JD. et al. High-frequency oscillations during human focal seizures. Brain 2006; 129: 1593-1608.
• 13 Lehnertz K, Elger C. Can epileptic seizure be predicted? Evidence from nonlinear time series of brain electrical activity. Phys Rev Lett 1998; 80: 5019-5022.
• 14 LeVanQuyen M. et al. Anticipation of epileptic seizure from standard EEG recordings. Lancet 2001; 357: 183-188.
• 15 Litt B. et al. Epileptic seizures may begin hours in advance of clinical onset: A report of five patients. Neuron 2001; 30: 51-64.
• 16 Maiwald T. et al. PDA based prospective assessment of the predictive power of prodromal symptoms. Submitted.
• 17 Mormann F. et al. Seizure prediction: the long and winding road. Brain 2007; 130: 314-333.
• 18 Mormann F. et al. Epileptic seizures are preceded by a decrease in synchronization. Epilepsy Res 2003; 53: 173-185.
• 19 Mormann F. et al. On the predictability of epileptic seizures. Clin Neurophysiol 2005; 116: 569-587.
• 20 Ortiz R, Liporace J. ,,Seizure-alert dogs“: observations from an inpatient video/EEG unit. Epilepsy Behav 2005; 6: 620-622.
• 21 Schad A. et al. Application of a multivariate seizure detection and prediction method to non-invasive and intracranial long-term EEG recordings. Clin Neurophysiol 2008; 119: 197-211.
• 22 Schelter B. et al. Seizure prediction: the impact of long prediction horizons. Epilepsy Res 2007; 73: 213-217.
• 23 Schelter B. et al. Testing statistical significance of multivariate time series analysis techniques for epileptic seizure prediction. Chaos 2006; 16: 013108.
• 24 Schelter B. et al. Do false predictions of seizures depend on the state of vigilance? A report from two seizure-prediction methods and proposed remedies. Epilepsia 2006; 47: 2058-2070.
• 25 Schulze-Bonhage A, Buller A. Unpredictability and the burden of epilepsy. In: Schelter B, Timmer J, und Schulze-Bonhage A. (Hrsg.) Seizure prediction in epilepsy: From basic mechanisms to clinical applications. Berlin: Wiley; 2008
• 26 Schulze-Bonhage A. et al. Seizure anticipation by patients with focal and generalized epilepsy: a multicentre assessment of premonitory symptoms. Epilepsy Res 2006; 70: 83-88.
• 27 Stead M. et al. Multiscale electrophysiology in human epileptogenic brain: microseizures, DCfluctuations, and high frequency oscillations. Poster, 3rd International Seizure Prediction Conference, Freiburg: 29.9.-2.10.2007.
• 28 Weinand M. et al. Cerebral blood flow and temporal lobe epileptogenicity. J Neurosurg 1997; 86: 226-232.
• 29 Winterhalder M. et al. The seizure prediction characteristic: a general framework to assess and compare seizure prediction methods. Epilepsy Behav 2003; 4: 318-325.
• 30 Winterhalder M. et al. Spatio-temporal patient-individual assessment of synchronization changes for epileptic seizure prediction. Clin Neurophysiol 2006; 117: 2399-2413.
• 31 Maiwald T. et al. Comparison of three nonlinear seizure prediction methods my means of the seizure prediction characteristic. Physica D 2004; 194: 357-368.