Medikamentöse Therapie fokaler Anfälle bei Kindern View Full Text


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Article Info

DATE

2018-12-06

AUTHORS

Thomas Bast

ABSTRACT

Fokale Epilepsien machen mehr als die Hälfte der Anfallserkrankungen im Kindesalter aus. Auf der Basis von Familien‑, Entwicklungs- und Anfallsanamnese, Elektroenzephalographie (EEG) im Wachen und im Schlaf, Magnetresonanztomographie (MRT) und neurologischer Untersuchung erfolgen eine Einteilung nach der Ursache (strukturelle Epilepsie vs. MRT-negative Epilepsie) und ggf. Klassifikation mit Syndromzuordnung, z. B. verschiedene selbstlimitierende fokale Epilepsien im Kindesalter. Letztere werden in der Regel anders und kürzer medikamentös behandelt. Bewährt haben sich beispielsweise Sultiam bei Rolando-Epilepsie und Oxcarbazepin bei benigner (familiärer/sporadischer) infantiler Epilepsie oder Panayiotopoulos-Syndrom. Die medikamentöse Therapie anderer MRT-negativer unterscheidet sich dagegen meist nicht von der struktureller fokaler Epilepsien. Mittel der ersten Wahl sind Lamotrigin, Levetiracetam, Oxcarbazepin/Eslicarbazepinacetat und Lacosamid. Eine Ausnahme stellt beispielsweise die tuberöse Sklerose dar, bei der im Säuglingsalter Vigabatrin und bei refraktärem Verlauf Everolimus eine Rolle spielen. Bei einer strukturellen Genese wird bei anhaltender Anfallsfreiheit in der Regel kein Absetzversuch empfohlen. Bei dringendem Wunsch sollte ein Absetzversuch vergleichbar wie bei den MRT-negativen, nichtsyndromalen Epilepsien nach 3 bis 5 Jahren und dringend vor dem Erwachsenenalter erfolgen. Bei Pharmakoresistenz stellt die Epilepsiechirurgie für geeignete Kandidaten mit einer Chance auf Anfallsfreiheit von etwa 60 % die mit Abstand aussichtsreichste Therapie dar. Weitere nichtmedikamentöse Therapiealternativen sind die ketogenen Diäten und die Vagusnervstimulation. More... »

PAGES

1-9

Journal

TITLE

Zeitschrift für Epileptologie

ISSUE

N/A

VOLUME

N/A

Author Affiliations

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10309-018-0233-7

DOI

http://dx.doi.org/10.1007/s10309-018-0233-7

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41 schema:description Fokale Epilepsien machen mehr als die Hälfte der Anfallserkrankungen im Kindesalter aus. Auf der Basis von Familien‑, Entwicklungs- und Anfallsanamnese, Elektroenzephalographie (EEG) im Wachen und im Schlaf, Magnetresonanztomographie (MRT) und neurologischer Untersuchung erfolgen eine Einteilung nach der Ursache (strukturelle Epilepsie vs. MRT-negative Epilepsie) und ggf. Klassifikation mit Syndromzuordnung, z. B. verschiedene selbstlimitierende fokale Epilepsien im Kindesalter. Letztere werden in der Regel anders und kürzer medikamentös behandelt. Bewährt haben sich beispielsweise Sultiam bei Rolando-Epilepsie und Oxcarbazepin bei benigner (familiärer/sporadischer) infantiler Epilepsie oder Panayiotopoulos-Syndrom. Die medikamentöse Therapie anderer MRT-negativer unterscheidet sich dagegen meist nicht von der struktureller fokaler Epilepsien. Mittel der ersten Wahl sind Lamotrigin, Levetiracetam, Oxcarbazepin/Eslicarbazepinacetat und Lacosamid. Eine Ausnahme stellt beispielsweise die tuberöse Sklerose dar, bei der im Säuglingsalter Vigabatrin und bei refraktärem Verlauf Everolimus eine Rolle spielen. Bei einer strukturellen Genese wird bei anhaltender Anfallsfreiheit in der Regel kein Absetzversuch empfohlen. Bei dringendem Wunsch sollte ein Absetzversuch vergleichbar wie bei den MRT-negativen, nichtsyndromalen Epilepsien nach 3 bis 5 Jahren und dringend vor dem Erwachsenenalter erfolgen. Bei Pharmakoresistenz stellt die Epilepsiechirurgie für geeignete Kandidaten mit einer Chance auf Anfallsfreiheit von etwa 60 % die mit Abstand aussichtsreichste Therapie dar. Weitere nichtmedikamentöse Therapiealternativen sind die ketogenen Diäten und die Vagusnervstimulation.
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