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Medikamentöse Therapie fokaler Anfälle bei Kindern

  • Thomas Bast
Leitthema
  • 3 Downloads

Zusammenfassung

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.

Schlüsselwörter

Epilepsie Klassifikation Antiepileptika Ketogene Diät Epilepsiechirurgie 

Antiepileptic drug treatment of focal seizures in children

Abstract

More than 50% of the childhood epilepsies are focal. Family and developmental history, seizure semiology, electroencephalography (EEG, awake and asleep), magnetic resonance imaging (MRI) and neurological examination enable a first assignment regarding the etiology (structural vs. MRI-negative epilepsy) and if possible the classification of an epilepsy syndrome, e. g. various self-limiting focal epilepsies in childhood. As a rule, the latter are treated differently and typically with a shorter duration of medication. Sulthiame is the established therapy for Rolandic epilepsy and for children with benign (familial or sporadic) epilepsy in infancy and Panayiotopoulos syndrome oxcarbazepine is the first-line treatment. In general, the antiepileptic drug therapy of structural and MRI-negative focal epilepsy do not differ. Antiepileptic drugs of first choice are lamotrigine, levetiracetam, oxcarbazepine/eslicarbazepine acetate, and lacosamide. Treatment differs, for example, in children with tuberous sclerosis for whom vigabatrine plays a role in infancy and everolimus in the case of pharmacoresistance. The continuation of antiepileptic treatment is usually recommended in seizure-free patients with structural focal epilepsy. If there is a strong wish to stop treatment, the attempt should be made before adulthood, comparable to the recommendation in MRI-negative, non-syndromic focal epilepsy after 3–5 years of seizure freedom. Epilepsy surgery is by far the most effective treatment for suitable candidates with pharmacoresistant focal epilepsy rendering approximately 60% of the children seizure-free. Ketogenic diets and vagus nerve stimulation are further nonmedicinal alterative treatment options.

Keywords

Epilepsy Antiepileptic drugs Classification Ketogenic diet Epilepsy surgery 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Bast gibt an, dass er in den vergangenen 3 Jahren Honorare für Vortrags- und/oder Beratertätigkeit von folgenden Firmen erhalten hat: BIAL, Biocodex, Eisai, Desitin Arzneimittel GmbH, GW Pharmaceuticals, Shire, UCB Pharma, Zogenix. Er nimmt oder nahm in dieser Zeit an Studien der Firmen Eisai, Marinus, Novartis, Nutricia und UCB Pharma teil.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Epilepsiezentrum KorkKehlDeutschland

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