Frühe Kombinationstherapie bei Epilepsie mit modernen Antiepileptika

Zusammenfassung

Einer von zwei neuerkrankten Patienten mit Epilepsie wird bereits mit dem ersten Antiepileptikum anfallsfrei. Die übrigen Patienten benötigen weitere Medikamente, häufig in Kombinationstherapie. Seit es moderne Medikamente gibt, die an Wirkstärke den klassischen Medikamenten vergleichbar sind, die aber weder in störende Interaktionen mit anderen Medikamenten noch mit körpereigenen Substanzen involviert sind, oder komplizierende Überempfindlichkeitsreaktionen verursachen, ist eine wirksame und sichere Kombinationstherapie deutlich einfacher geworden. Zu den modernen Medikamenten zur Kombinationstherapie gehören in alphabetischer Reihenfolge Gabapentin, langsam eindosiertes Lamotrigin, Levetiracetam, Oxcarbazepin, Pregabalin, niedrig dosiertes Topiramat und Zonisamid. Durch eine frühe Kombinationstherapie mit diesen modernen Medikamenten ist bei bis zu jedem fünften Patienten eine mindestens 12-monatige Anfallsfreiheit zu erzielen. Daher wird zur Prävention von unerwünschten Interaktionen und besserer Verträglichkeit empfohlen, falls möglich bereits zur ersten Kombinationstherapie bevorzugt ähnlich gut wirksame, aber interaktionsfreie und nicht zu Überempfindlichkeitsreaktionen führende moderne Antiepileptika statt klassischer enzyminduzierender oder enzymhemmender Medikamente mit Exanthemrisiko einzusetzen.

Summary

One of two patients with newly diagnosed epilepsy currently become seizure free treated with a first-line antiepileptic drug (AED). The remaining patients require additional AEDs, frequently given in combination with the first AED. Recent reports show that up to 20% of patients receiving a combination of two AED early in the course of the disease become seizure-free for at least 12 months. Fortunately, pharmacokinetic interactions with other drugs or endogenous body substances and hypersensitivity reactions that have often complicated long-term combination treatment in the past are not expected to be a problem with some of the modern AEDs such as, in alphabetical order, Gabapentin, slowly introduced Lamotrigine, Levetiracetam, Oxcarbazepine, Pregabalin, low-dose Topiramate and Zonisamide. For prevention of undesirable interactions and hypersensitivity reactions, we recommend to start combination treatment for epilepsy with AED that are not or to a lesser degree involved in drug interactions or hypersensitivity reactions compared to classic AED.

Schlüsselwörter

Antiepileptika - Epilepsietherapie - Arzneimittelinteraktionen - Kombinationstherapie - unerwünschte Nebenwirkungen

Keywords

Drug interactions - hypersensitivity reactions - antiepileptic drugs - early combination treatment - epilepsy treatment

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