Fortschr Neurol Psychiatr 2013; 81(1): 9-20
DOI: 10.1055/s-0031-1299361
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Kombinationstherapie bei Epilepsie

Combination Therapy for Epilepsy
W. Fröscher
1   Epilepsiezentrum Bodensee, Zentrum für Psychiatrie Südwürttemberg, Ravensburg-Weissenau
,
J. Rösche
2   Klinik und Poliklinik für Neurologie, Universität Rostock
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
26. März 2012 (online)

Zusammenfassung

Eine Monotherapie ist Standard der medikamentösen Epilepsie-Therapie, führt jedoch nur bei ca. 65 % der Patienten zu Anfallsfreiheit. Daher werden bis zu 50 % der Epilepsiepatienten zumindest zeitweilig mit einer Kombinationstherapie behandelt. Eine Kombination von Antiepileptika kann bei einem kleinen Prozentsatz von Patienten, die auf eine Monotherapie nicht angesprochen haben, zur Anfallsfreiheit führen. Monotherapie und Kombinationstherapie sind nicht immer Gegensätze, viele Substanzen haben mehrere Wirkmechanismen und stellen eine Art Kombinationstherapie in einer Substanz dar. Die Kombination von Substanzen mit unterschiedlichem Wirkungsmechanismus wird als „rationale Polypharmazie“ bezeichnet. Die Überlegenheit solcher Kombinationen gegenüber Kombinationen von Antiepileptika mit gleichem oder ähnlichem Wirkungsmechanismus ist bisher nicht durch randomisierte Studien bewiesen worden. Hinweise auf eine überlegene Verträglichkeit und Wirksamkeit bei Kombinationen mit verschiedenen Wirkmechanismen ergeben sich jedoch bei der Add-on-Gabe von Lacosamid zu Nicht-Natrium-Kanalblockern und bei der Kombination von Lamotrigin und Valproinsäure. Beim Einsatz einer Antiepileptika-Kombination sollten vor allem Wirksamkeit, Nebenwirkungsspektrum, Interaktionen und Kosten der gewählten Substanzen berücksichtigt werden, außerdem eventuell vorliegende Begleitkrankheiten.

Abstract

Use of Monotherapy is acknowledged as the standard anticonvulsant therapy although no more than about 65 % of patients become seizure-free with a single antiepileptic drug. Therefore, up to 50 % of patients with epilepsy are treated at least intermittently with more than one antiepileptic drug. The percentage of patients achieving complete seizure control with combination therapy after ineffective monotherapy is small. Monotherapy and combination therapy are not always contrary to each other; many anticonvulsants have different modes of action and are effectively a combination therapy in one drug. Combinations of anticonvulsants with differing mechanisms of action are called “rational polypharmacy”. A superior efficacy of these combinations over combinations of anticonvulsants with identical or similar mechanisms of action have not been proved by randomised trials. Add-on trials with lacosamide and the combination of lamotrigine and valproic acid, however, suggest a superior tolerability and/or efficacy of combinations with differing mechanisms of action. Treatment with drug combinations should take into account, above all, efficacy and safety, interactions, and costs of each antiepileptic drug as well as comorbidity.

 
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