Aktuelle Neurologie 2010; 37(8): 372-381
DOI: 10.1055/s-0030-1265943
Aktuelles Thema

© Georg Thieme Verlag KG Stuttgart · New York

Definition der pharmakoresistenten Epilepsie: Konsensusvorschlag der ad hoc-Task Force der ILAE-Kommission für Therapeutische Strategien[1]

Definition of Drug Resistant Epilepsy: Consensus Proposal by the Ad Hoc Task Force of the ILAE Commission on Therapeutic StrategiesP.  Kwan1 *, A.  Arzimanoglou2 , A.  T.  Berg3 , M.  J.  Brodie4 , W.  A.  Hauser5 , G.  Mathern6 **, S.  L.  Moshé7 , E.  Perucca8 , S.  Wiebe9 , J.  French10 ** * Vorsitzender der Task Force, ** Ko-Vorsitzende der Kommission für therapeutische Strategien
  • 1Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
  • 2Institute for Children and Adolescents with Epilepsy-IDEE, University Hospital of Lyon (HCL) und INSERM U821, Lyon, Frankreich
  • 3Department of Biology, Northern Illinois University, DeKalb, Illinois, USA
  • 4Epilepsy Unit, Western Infirmary, Glasgow, England
  • 5G. H. Sergievsky Center, Columbia University, New York, New York, USA
  • 6Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
  • 7The Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience and Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
  • 8Clinical Trial Center, Institute of Neurology IRCCS C. Mondino Foundation, und Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italien
  • 9Department of Clinical Neurosciences, University of Calgary, und Hotchkiss Brain Institute, Calgary, Alberta, Kanada
  • 10New York University Comprehensive Epilepsy Center, New York
Further Information

Publication History

Publication Date:
22 November 2010 (online)

Zusammenfassung

Zur Verbesserung der Patientenversorgung und Förderung der klinischen Forschung hat die Internationale Liga gegen Epilepsie (ILAE) eine Task Force beauftragt, eine Konsensusdefinition der pharmakoresistenten Epilepsie zu erarbeiten. Der Gesamtrahmen der Definition hat 2 „hierarchische” Ebenen: Ebene 1 liefert ein allgemeines Schema zur Kategorisierung des Behandlungsergebnisses jeder therapeutischen Intervention, einschließlich eines minimal erforderlichen Datensatzes zur erfolgten Behandlung; Ebene 2 liefert anhand einer Reihe entscheidender Kriterien, die auf der Kategorisierung des Ansprechens auf Anwendungsversuche mit Antiepileptika (aus Ebene 1) beruhen, eine Kerndefinition der pharmakoresistenten Epilepsie. Als prüfbare Hypothese wird vorgeschlagen, eine pharmakoresistente Epilepsie als Versagen von 2 geeigneten Behandlungsversuchen mit vertragenen sowie angemessen ausgewählten und eingesetzten Antiepileptikaanwendungen (sei es als Mono- oder als Kombinationstherapie) zur Erzielung einer anhaltenden Anfallsfreiheit zu definieren. Diese Definition kann weiterentwickelt werden, wenn neue Daten verfügbar werden. Das Grundprinzip dieser Definition und die wichtigsten Regeln für ihre korrekte Anwendung werden diskutiert, und anhand von Beispielen wird die Anwendung der Definition in der klinischen Praxis veranschaulicht.

Abstract

To improve patient care and facilitate clinical research, the International League Against Epilepsy (ILAE) appointed a Task Force to formulate a consensus definition of drug resistant epilepsy. The overall framework of the definition has two „hierarchical” levels: Level 1 provides a general scheme to categorize response to each therapeutic intervention, including a minimum dataset of knowledge about the intervention that would be needed; Level 2 provides a core definition of drug resistant epilepsy using a set of essential criteria based on the categorization of response (from Level 1) to trials of antiepileptic drugs. It is proposed as a testable hypothesis that drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom. This definition can be further refined when new evidence emerges. The rationale behind the definition and the principles governing its proper use are discussed, and examples to illustrate its application in clinical practice are provided.

1 Autorisierte Übersetzung von Dr. med. Günter Krämer, Medizinischer Direktor, Schweizerisches Epilepsie-Zentrum, Bleulerstr. 60, 8008 Zürich, Schweiz, Tel. +41 44 387 63 02, E-Mail: g.kraemer@swissepi.ch.
Zur Publikation angenommen am 20. September 2009, Original erschienen in Epilepsia 2010; 51: 1069–1077 sowie Erratum in Epilepsia 2010; 51: 1922.

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1 Autorisierte Übersetzung von Dr. med. Günter Krämer, Medizinischer Direktor, Schweizerisches Epilepsie-Zentrum, Bleulerstr. 60, 8008 Zürich, Schweiz, Tel. +41 44 387 63 02, E-Mail: g.kraemer@swissepi.ch.
Zur Publikation angenommen am 20. September 2009, Original erschienen in Epilepsia 2010; 51: 1069–1077 sowie Erratum in Epilepsia 2010; 51: 1922.

Dr. Patrick Kwan

Department of Medicine and Therapeutics
Prince of Wales Hospital

Hong Kong SAR

China

Email: patrickkwan@cuhk.edu.hk

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