Klinik und Therapie des konvulsiven Status epilepticus

Zusammenfassung

Status epilepticus (SE) als die schwerste und extremste Ausprägung eines epileptischen Anfalls weist eine Sterblichkeit von ca. 20% auf. Der generalisiert tonisch klonische SE (GTKSE) wird nach dem zeitlichen Auftreten in 4 Stufen eingeteilt: (Stufe1) Frühphase, (Stufe 2) etablierter SE, (Stufe 3) fortgeschrittener SE, (Stufe 4) superrefraktärer SE. Die Therapiestrategie ist abhängig von der jeweiligen Stufe. Therapie der Wahl sind bei Stufe 1 die Benzodiazepine. Bei Versagen folgt in Stufe 2 die rasche Gabe von Antiepileptika (Phenytoin/Fosphenytoin, Phenobarbital, Valproat, Levetiracetam). Bei Nichtsistieren des SE folgen in Stufe 3 Anästhetika (Thiopental, Midazolam, Propofol). Zur Therapie in Stufe 4 existieren lediglich Fallserien. Dieser Review spiegelt die aktuellen klinischen Erfahrungen und Evidenz der Therapiestrategie bei GTKSE wieder.

Abstract

Status epilepticus (SE) is one of the most common and severe neurological emergencies, associated with a mortality up to 20%. Depending on time course, tonic clonic status epilepticus (CSE) is divided into: (phase 1) premonitory SE; (phase 2) established SE; (phase 3) subtle SE and (phase 4) super-refractory SE. Standard treatment options for phase 1 are benzodiazepines, after failure in phase 2 intravenous phenytoin/fosphenytoin, phenobarbital, valproic acid or levetiracetam; thiopental, midazolam and propofol are recommended in phase 3 and for the treatment of phase 4 only case reports exist. This review summarises the current clinical experience and evidence concerning the treatment for CSE.

Schlüsselwörter

Status epilepticus - intravenöse antiepileptische Therapie - akute Anfälle

Key words

status epilepticus - intravenous antiepileptic therapy - acute seizures

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