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Nervenheilkunde 2010; 29(04): 204-208
DOI: 10.1055/s-0038-1628743
Epilepsie
Schattauer GmbH

Beendigung der Pharmakotherapie – warum, wann, wie?

Antiepileptic drug withdrawal – why, when, how?
W. Fröscher
1   Epilepsiezentrum Bodensee, Zentrum für Psychiatrie Weissenau, Abteilung Psychiatrie I der Universität Ulm
› Author Affiliations
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Publication History

Eingegangen am: 10 November 2009

angenommen am: 18 November 2009

Publication Date:
25 January 2018 (online)

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Zusammenfassung

Das Absetzen der Antiepileptika bei anfallsfrei gewordenen Patienten erfolgt vor allem wegen manifester oder potenzieller Nebenwirkungen sowie wegen des Wunsches der Patienten, keine Antiepileptika mehr einnehmen zu müssen. Hauptargument gegen das Absetzen ist das Rückfallrisiko, das in der Mehrzahl der Studien zwischen 20 und 40% liegt. Bei Fortsetzung der medikamentösen Therapie ist das Rückfallrisiko in verschiedenen Studien kleiner, teils signifikant, teils nicht signifikant. Es liegt nur eine kontrollierte, prospektive randomisierte Doppelblindstudie zum Absetzen der Antiepileptika bei Erwachsenen vor. Das Rückfallrisiko ist bei unterschiedlichen Epilepsiesyndromen sehr verschieden. Als Richtwert zum Zeitpunkt des Absetzens gilt eine Anfallsfreiheit von zwei Jahren. Es ergeben sich je nach Epilepsiesyndrom und verschiedenen Prädiktoren erhebliche Abweichungen von dieser Regel. Zur Geschwindigkeit des Absetzens besteht kein Konsens, die Empfehlungen liegen zwischen vier Wochen und zwei Jahren.

Summary

When patients have become seizure-free, antiepileptic drugs are usually withdrawn due to apparent or potential adverse drug reactions and/or because patients wish to discontinue medical treatment. The strongest argument against withdrawing anticonvulsants is the relapse risk ranging from 20 to 40% according to the majority of studies. Several studies have shown that the risk of recurring seizures is lower when treatment is continued. While some studies claim the difference to be significant, other studies do not support this position. There is only one controlled, prospective, randomized, double-blinded withdrawal study conducted among adult patients available. The probability of a relapse is highly dependent on the epileptic syndrome. A seizure-free period of two years before the drug in question is withdrawn is recommendable. This recommendation has to be adjusted depending on the epileptic syndrome and the different predictors. There is no reliable evidence available on the optimal rate of tapering antiepileptic drugs. The recommendations for the withdrawal period range from four weeks to two years.

Schlüsselwörter

Epilepsie - Antiepileptika - Therapiebeendigung

Keywords

Epilepsy - antiepileptic drugs - withdrawal of antiepileptic drugs
 

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