Medikamentöse Therapie von epileptischen Anfällen und Epilepsien

ZUSAMMENFASSUNG

Fast jede aktive Epilepsie bedarf einer medikamentösen Therapie durch Antianfallsmedikamente (Antiiktalia). Ziel ist die Anfallsfreiheit des Patienten bei gleichzeitig guter Tolerabilität. Zur Dauertherapie fokaler Epilepsien steht eine Reihe von Antianfallsmedikamenten zur Verfügung, bei generalisierten Epilepsien ist die Auswahl kleiner. Die Wahl des Antianfallsmedikamentes sollte neben dem Epilepsiesyndrom an den individuellen Wünschen und der Lebenssituation des Patienten, seinen Komorbiditäten und dem Nebenwirkungsprofil ausgerichtet werden. Meist wird man deshalb neuere Antianfallsmedikamente bevorzugen. Durch die Entwicklung neuer Medikamente erhöht sich die Chance einer individuell gut verträglichen und erfolgreichen Therapie. Dem gegenüber stehen höhere Therapiekosten der meisten neueren Antianfallsmedikamente. Die meisten epileptischen Anfälle sind selbstlimitierend. Ein prolongierter epileptischer Anfall muss jedoch schnell und ausreichend hoch dosiert mit Benzodiazepinen behandelt werden, um so einen therapierefraktären Verlauf abwenden zu können und das Outcome des Patienten zu verbessern.

ABSTRACT

Almost every active epilepsy requires medical treatment. The aim is to keep the patient free of seizures while at the same time ensuring good tolerability. A number of drugs are available for the long-term treatment of focal epilepsies, whereas the choice is more limited for generalized epilepsies. The choice of an anti-seizure drug should be based on the patient’s expectations and life situation, his co-morbidities and the side effect profile of the anti-seizure drug, in addition to the epilepsy syndrome. Newer anti-seizure drugs will therefore usually be preferred. The development of newer drugs increases the chance of an individually well-tolerated and successful therapy. On the other hand, the therapy costs of most of the newer anti-seizure drugs are higher. Most epileptic seizures are self-limiting. However, a prolonged epileptic seizure must be treated with benzodiazepines quickly and in sufficiently high doses to avert a refractory course of status epilepticus and to improve the outcome of the patient.

Key words

Epilepsy - antiepileptic drugs - status epilepticus - benzodiazepines

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