Skip to main content
SpringerLink
Log in

Oberstes Ziel ist Anfallsfreiheit

State of the Art bei der antikonvulsiven Pharmakotherapie

  • Fortbildung
  • Published:
Pädiatrie Aims and scope

Trotz der Einführung und Verbesserung verschiedenster Therapiemöglichkeiten, v. a. der Epilepsiechirurgie, aber auch der ketogenen Diät oder Stimulationsverfahren, ist und bleibt die medikamentöse Behandlung die Standardtherapie bei den meisten Epilepsiepatienten. Dabei hat sich durch die Generation neuerer Antikonvulsiva seit 1992 allerdings nicht wirklich nennenswert häufiger eine dauerhafte und verlässliche Anfallsfreiheit erreichen lassen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Arif H, Buchanan R, Pierro J et al (2010) Comparative effectiveness of 10 antiepileptic drugs in older adults with epilepsy. Arch Neurol 67:408–415

    Article  PubMed  Google Scholar 

  2. Baulac M, Brodie MJ, Patten A et al (2012) Efficacy and tolerability of zonisamide versus controlled-release carbamazepine for newly diagnosed partial epilepsy: a phase 3, randomised, double-blind, non-inferiority trial. Lancet Neurol 11:579–588

    Article  CAS  PubMed  Google Scholar 

  3. Baumgartner C, Beyenburg S, Dennig D et al (2012) Erster epileptischer Anfall und Epilepsien im Erwachsenenalter. In: Diener HC, Weimar C, Berlit P et al (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie, 5. Aufl. Thieme, Stuttgart, S 28–47

    Google Scholar 

  4. Beghi E, De Maria G, Gobbi G, Veneselli E (2006) Diagnosis and treatment of the first epileptic seizure: guidelines of the Italian League against Epilepsy. Epilepsia 47(Suppl 5):2–8

    Article  CAS  PubMed  Google Scholar 

  5. Beghi E, Gatti G, Tonini C et al (2003) Adjunctive therapy versus alternative monotherapy in patients with partial epilepsy failing on a single drug: a multicentre, randomised, pragmatic controlled trial. Epilepsy Res 57:1–13

    Article  CAS  PubMed  Google Scholar 

  6. Berg AT, Berkovic SF, Brodie MJ et al (2010) Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia 51:676–685

    Article  PubMed  Google Scholar 

  7. Brodie MJ, Overstall PW, Giorgi L (1999) Multicentre, double-blind, randomised comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. The UK Lamotrigine Elderly Study Group. Epilepsy Res 37:81–87

    Article  CAS  PubMed  Google Scholar 

  8. Brodie MJ, Perucca E, Ryvlin P et al (2007) Comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy. Neurology 68:402–408

    Article  CAS  PubMed  Google Scholar 

  9. Brodie MJ, Richens A, Yuen AW (1995) Double-blind comparison of lamotrigine and carbamazepine in newly diagnosed epilepsy. Lancet 345:476–479

    Article  CAS  PubMed  Google Scholar 

  10. Callaghan BC, Anand K, Hesdorffer D et al (2007) Likelihood of seizure remission in an adult population with refractory epilepsy. Ann Neurol 62:382–389

    Article  PubMed  Google Scholar 

  11. Chadwick D (1999) Safety and efficacy of vigabatrin and carbamazepine in newly diagnosed epilepsy: a multicentre randomised double-blind study. Vigabatrin European Monotherapy Study Group. Lancet 354:13–19

    Article  CAS  PubMed  Google Scholar 

  12. Chadwick DW, Anhut H, Greiner MJ et al (1998) A double-blind trial of gabapentin monotherapy for newly diagnosed partial seizures. International Gabapentin Monotherapy Study Group 945-77. Neurology 51:1282–1288

    Article  CAS  PubMed  Google Scholar 

  13. Christe W, Krämer G, Vigonius U et al (1997) A double-blind controlled clinical trial of oxcarbazepine versus sodium valproate in adults with newly diagnosed epilepsy. Epilepsy Res 26:451–460

    Article  CAS  PubMed  Google Scholar 

  14. (o A) (1989) Commission on classification and terminology of the international league against epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 30:389–399

  15. Dam M, Ekberg R, Loyning Y et al (1989) A double-blind study comparing oxcarbazepine and carbamazepine in patients with newly diagnosed, previously untreated epilepsy. Epilepsy Res 3:70–76

    Article  CAS  PubMed  Google Scholar 

  16. Deckers CL, Hekster YA, Keyser A et al (2001) Monotherapy versus polytherapy for epilepsy: a multicenter double-blind randomized study. Epilepsia 42:1387–1394

    Article  CAS  PubMed  Google Scholar 

  17. Diaz RA, Sancjo J, Serratosa J (2008) Antiepileptic drug interactions. Neurologist 14(6 Suppl 1):S55–S65

    Article  PubMed  Google Scholar 

  18. Engel J Jr, McDermott MP, Wiebe S et al (2012) Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA 307:922–930

    Article  CAS  PubMed  Google Scholar 

  19. Ficker DM, Privitera M, Krauss G et al (2005) Improved tolerability and efficacy in epilepsy patients with extended-release carbamazepine. Neurology 65:593–595

    Article  CAS  PubMed  Google Scholar 

  20. French JA, Kanner AM, Bautista J et al (2004) Efficacy and tolerability of the new antiepileptic drugs, II: treatment of refractory epilepsy: report of the TTA and QSS Subcommittees of the American Academy of Neurology and the American Epilepsy Society. Epilepsia 45:410–423

    Article  CAS  PubMed  Google Scholar 

  21. French JA, Kanner AM, Bautista J et al (2004) Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 27:1252–1260

    Article  Google Scholar 

  22. French JA, Kanner AM, Bautista J et al (2004) Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 27:1261–1273

    Article  Google Scholar 

  23. Fröscher W, Steinhoff BJ (2011) Laborkontrollen in der Pharmakotherapie von Epilepsien. Z Epileptol 24:12–25

    Article  Google Scholar 

  24. Glauser TA, Ben-Menachem E, Bourgeois B et al (2013) Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 54:551–563

    Article  CAS  PubMed  Google Scholar 

  25. Glauser TA, Cnaan A, Shinnar S et al (2010) Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med 352:790–799

    Article  Google Scholar 

  26. Glauser TA, Cnaan A, Shinnar S et al (2013) Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months. Epilepsia 54:141–155

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Gueler N, Krämer G (2009) Behandlungsstrategien mit Antiepileptika, Ein- und Ausschleichen. Z Epileptol 22:13–19

    Article  Google Scholar 

  28. Guerreiro MM, Vigonius U, Pohlmann H et al (1997) A double-blind controlled, clinical trial of oxcarbazepine versus phenytoin in children and adolescents with epilepsy. Epilepsy Res 27:205–213

    Article  CAS  PubMed  Google Scholar 

  29. Guerrini R, Dravet C, Genton P et al (1998) Lamotrigine and seizure aggravation in severe myoclonic epilepsy. Epilepsia 39:508–512

    Article  CAS  PubMed  Google Scholar 

  30. Hauptmann A (1912) Luminal bei Epilepsie. Munch Med Wochenschr 59:1907–1909

    Google Scholar 

  31. Heller AJ, Chesterman P, Elwes RD et al (1995) Phenobarbitone, phenytoin, carbamazepine, or sodium valproate for newly diagnosed adult epilepsy: a randomised comparative monotherapy trial. J Neurol Neurosurg Psychiatry 58:44–50

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Helmers SL, Paradis PE, Manjunath R et al (2010) Economic burden associated with the use of generic antiepileptic drugs in the United States. Epilepsy Behav 18:437–444

    Article  PubMed  Google Scholar 

  33. Kälviäinen R, Aikia M, Saukkonen AM et al (1995) Vigabatrin vs carbamazepine monotherapy in patients with newly diagnosed epilepsy. A randomized, controlled study. Arch Neurol 52:989–996

    Article  PubMed  Google Scholar 

  34. Krauss GL, Caffo B, Chang Y-T et al (2011) Assessing bioequivalence of generic antiepileptic drugs. Ann Neurol 70:221–228

    Article  CAS  PubMed  Google Scholar 

  35. Kwan P, Arzimanoglou A, Berg AT et al (2010) Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 51:1069–1077

    Article  CAS  PubMed  Google Scholar 

  36. Kwan P, Brodie MJ (2000) Early identification of refractory epilepsy. N Engl J Med 342:314–319

    Article  CAS  PubMed  Google Scholar 

  37. Kwan P, Brodie MJ (2000) Epilepsy after the first drug fails: substitution or add-on? Seizure 9:464–468

    Article  CAS  PubMed  Google Scholar 

  38. Kwan P, Brodie MJ, Kälviäinen R et al (2011) Efficacy and safety of pregabalin versus lamotrigine in patients with newly diagnosed partial seizures: a phase 2, double-blind, randomised, parallel-group trial. Lancet Neurol 10:881–890

    Article  CAS  PubMed  Google Scholar 

  39. Luciano AL, Shorvon SD (2007) Results of treatment changes in patients with apparently drug-resistant chronic epilepsy. Ann Neurol 62:375–381

    Article  CAS  PubMed  Google Scholar 

  40. Marson AG, Al-Kharusi AM, Alwaidh M et al (2007) The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. Lancet 369:1000–1015

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Marson AG, Al-Kharusi AM, Alwaidh M et al (2007) The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial. Lancet 369:1016–1026

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Marson A, Jacoby A, Johnson A et al (2005) Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet 365:2007–2013

    Article  CAS  PubMed  Google Scholar 

  43. Mattson RH, Cramer JA, Collins JF et al (1985) Comparison of carbamazepine, phenobarbital, phenytoin and primidone in partial and secondarily generalized tonic-clonic seizures. N Engl J Med 313:145–151

    Article  CAS  PubMed  Google Scholar 

  44. Mattson RH, Cramer JA, Collins JF (1992) The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group. A comparison of valproate with carbamazepine for the treatment of complex partial and secondarily generalized tonic-clonic seizures in adults. N Engl J Med 327:765–771

    Article  CAS  PubMed  Google Scholar 

  45. Mumford JP, Cannon DJ (1994) Vigabatrin. Epilepsia 35(Suppl 5):S25–S28

    Article  PubMed  Google Scholar 

  46. Nunes VD, Sawyer L, Neilson J et al (2012) Diagnosis and management of the epilepsies in adults and children: summary of updated NICE guidance. BMJ 344:e281

    Article  PubMed  Google Scholar 

  47. Porter RJ (1995) How to use antiepileptic drugs. In: Von Levy RH, Mattson RH, Meldrum BS (Hrsg) Antiepileptic drugs, 4. Aufl. Raven Press, New York, S 137–148

    Google Scholar 

  48. Privitera MD, Brodie MJ, Mattson RH et al (2003) Topiramate, carbamazepine and valproate monotherapy: double-blind comparison in newly diagnosed epilepsy. Acta Neurol Scand 107:165–175

    Article  CAS  PubMed  Google Scholar 

  49. Relling MV, Pui CH, Sandlund JT et al (2000) Adverse effect of anticonvulsants on efficacy of chemotherapy for acute lymphoblastic leukaemia. Lancet 356:285–290

    Article  CAS  PubMed  Google Scholar 

  50. Reunanen M, Dam M, Yuen AW (1996) A randomised open multicentre comparative trial of lamotrigine and carbamazepine as monotherapy in patients with newly diagnosed or recurrent epilepsy. Epilepsy Res 23:149–155

    Article  CAS  PubMed  Google Scholar 

  51. Reynolds EH (1983) Mental effects of antiepileptic medication: a review. Epilepsia 24(Suppl 2):85–95

    Article  CAS  Google Scholar 

  52. Reynolds EH, Shorvon SD (1981) Monotherapy or polytherapy for epilepsy. Epilepsia 22:1–10

    Article  CAS  PubMed  Google Scholar 

  53. Rosenow F, Schade-Bettinger C, Burchardi N et al (2012) The LaLiMo trial: lamotrigine compared with levetiracetam in the initial 26 weeks of monotherapy for focal and generalised epilepsy–an open-label, prospective, randomised controlled multicenter study. J Neurol Neurosurg Psychiatry 83:1093–1098

    Article  PubMed  Google Scholar 

  54. Rowan AJ, Ramsay RE, Collins JF et al (2005) New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology 64:1868–1873

    Article  CAS  PubMed  Google Scholar 

  55. Sake J-K, Hebert D, Isojärvi J et al (2010) A pooled analysis of lacosamide clinical trial data grouped by mechanisms of action of concomitant antiepileptic drugs. CNS Drugs 24:1055–1068

    Article  CAS  PubMed  Google Scholar 

  56. Schmidt D (1983) Pharmacotherapy of epilepsy–current problems and controversies. Fortschr Neurol Psychiat 51:363–386

    Article  CAS  PubMed  Google Scholar 

  57. Schmidt D (2009) Drug treatment of epilepsy: options and limitations. Epilepsy Behav 15:56–65

    Article  PubMed  Google Scholar 

  58. Sheth RD, Harden CL (2007) Screening for bone health in epilepsy. Epilepsia 48(Suppl 9):39–41

    Article  PubMed  Google Scholar 

  59. Shorvon SD, Reynolds EH (1977) Unnecessary polypharmacy for epilepsy. Br Med J 1(6077):1635–1637

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. Shorvon SD, Reynolds EH (1979) Reduction in polypharmacy for epilepsy. Br Med J 2(6197):1023–1025

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Steiner TJ, Dellaportas CL, Findley LJ et al (1999) Lamotrigine monotherapy in newly diagnosed untreated epilepsy: a double-blind comparison with phenytoin. Epilepsia 40:601–607

    Article  CAS  PubMed  Google Scholar 

  62. Steinhoff BJ (1992) Antiepileptic therapy with bromides–historical and actual importance. J Hist Neurosci 1:119–123

    Article  CAS  PubMed  Google Scholar 

  63. Steinhoff BJ (2005) Der Epilepsiepatient in der Praxis. ComMed Verlagsagentur, Basel

    Google Scholar 

  64. Steinhoff BJ (2009) Oxcarbazepine extended-release formulation in epilepsy. Expert Rev Clin Pharmacol 2:155–162

    Article  CAS  PubMed  Google Scholar 

  65. Steinhoff BJ (2009) Verzögert freigesetztes Oxcarbazepin–Überblick und klinische Erfahrungen. Z Epileptol 22:2–8

    Article  Google Scholar 

  66. Steinhoff BJ (2012) Pharmakotherapie der Epilepsie. Klin Neurophys 43:131–137

    Article  Google Scholar 

  67. Steinhoff BJ, Fröscher W (2011) Bedeutung der Serumkonzentrationen von Antikonvulsiva. Z Epileptol 24:6–11

    Article  Google Scholar 

  68. Steinhoff BJ, Kurth C, Dennig D (2012) Levetiracetam bei generalisierten Epilepsien des Erwachsenenalters. Praktische Erfahrungen mit dem Einsatz außerhalb der Zulassung. Z Epileptol 25:118–124

    Article  Google Scholar 

  69. Steinhoff BJ, Runge U, Witte OW et al (2009) Substitution of anticonvulsant drugs. Ther Clin Risk Manag 5:449–457

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  70. Steinhoff BJ, Ueberall MA, Siemes H et al (2005) The LAM-SAFE Study: lamotrigine versus carbamazepine or valproic acid in newly diagnosed focal and generalized epilepsies in adolescents and adults. Seizure 14:597–605

    Article  PubMed  Google Scholar 

  71. Steinhoff BJ, Maren Staack A, Wisniewski I (2012) Seizure control with antiepileptic drug therapy in 517 consecutive adult outpatients at the Kork Epilepsy Centre. Epileptic Disord 14:379–387

    PubMed  Google Scholar 

  72. Steinhoff BJ, Stefan H, Schulze-Bonhage A et al (2012) Retardiertes vs. Schnell freisetzendes Oxcarbazepin bei therapierefraktärer fokaler Epilepsie. Eine offene multizentrische, randomisierte kontrollierte Studie. Nervenarzt 83:1292–1299

    Article  CAS  PubMed  Google Scholar 

  73. Steinhoff BJ, Wendling A-S (2009) Short-term impact of the switch from immediate-release to extended-release oxcarbazepine in epilepsy patients on high dosages. Epilepsy Res 87:256–259

    Article  CAS  PubMed  Google Scholar 

  74. Tanganelli P, Regetsa G (1996) Vigabatrin versus carbamazepine monotherapy in newly diagnosed focal epilepsy: a randomised response conditional cross-over study. Epilepsy Res 25:257–262

    Article  CAS  PubMed  Google Scholar 

  75. Tomson T, Steinhoff BJ (2012) Principles of drug treatment in adults. Handb Clin Neurol 108:683–698

    Article  PubMed  Google Scholar 

  76. Trinka E, Marson AG, Van Paeschen W et al (2012) KOMET: an unblinded, randomised, two parallel-group, stratified trial comparing the effectiveness of levetiracetam with controlled-release carbamazepine and extended-release sodium valproate as monotherapy in patients with newly diagnosed epilepsy. J Neurol Neurosurg Psychiatry (Epub ahead of print)

    Google Scholar 

  77. Warner G, Figgitt DP (2005) Pregabalin: as adjunctive treatment of partial seizures. CNS Drugs 19:265–272

    Article  CAS  PubMed  Google Scholar 

  78. Wiebe S, Blume WT, Girvin JP et al (2001) A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345:311–318

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Epilepsiezentrum Kork, Landstraße 1, 77694, Kehl-Kork, Deutschland

    Bernhard J. Steinhoff

Authors
  1. Bernhard J. Steinhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Interessenkonflikt

Der Autor gibt Vortrags- oder Beratungstätigkeiten für folgende Firmen an: Desitin Arzneimittel GmbH, UCB Pharma GmbH, Eisai GmbH, GlaxoSmithKline GmbH & Co. KG. Der Beitrag wurde selbstständig und ohne jede Einflussnahme von außen durch den Autor erstellt. Die Beurteilungen oder Empfehlungen einzelner Arzneimittel entsprechen der Meinung des Autors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steinhoff, B.J. Oberstes Ziel ist Anfallsfreiheit. Pädiatrie 26, 177–184 (2014). https://doi.org/10.1007/s15014-014-0377-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15014-014-0377-5

Search

Navigation