Psychische Störungen bei Epilepsie

Zusammenfassung

Psychische Begleiterkrankungen treten bei Menschen mit Epilepsien gehäuft auf. Ihre erfolgreiche Behandlung ist von entscheidender Bedeutung für die Lebensqualität der Betroffenen, insbesondere wenn keine Anfallsfreiheit erreicht werden kann. Trotzdem wird psychische Komorbidität bei Epilepsie oft übersehen und nicht angemessen behandelt. Neben einer zu starken Fokussierung auf die Therapie der Anfälle bestehen Schwierigkeiten bei der Abschätzung psychotroper Effekte der Antiepileptika oder der Diagnostik epilepsiespezifischer Störungsbilder wie z. B. der interiktalen dysphorischen Verstimmung. Auch unbegründete Befürchtungen, durch Psychopharmaka Anfälle auszulösen, spielen eine erhebliche Rolle. Gegen den Einsatz von z. B. SSRIs bei Epilepsie bestehen aber keine grundsätzlichen Kontraindikationen, es gibt klare Hinweise auf günstige Effekte bezüglich der Anfallsfrequenz. Der aktuelle Klassifikationsvorschlag der Kommission für Psychische Begleiterkrankungen der Internationalen Liga gegen Epilepsie erleichtert die Diagnostik. Bei schwierig gelagerten Fällen stehen spezialisierte ambulante und stationäre epileptologisch-psychiatrische Behandlungsangebote an Epilepsiezentren zur Verfügung.

Summary

Psychic comorbidity is observed more frequently in persons with epilepsy. Nevertheless psychic comorbidity in epilepsy is underdiagnosed and often remains untreated. Predominant focussing on the treatment of seizures, poor knowledge of psychic effects of antiepileptic drugs and difficulties in diagnosing epilepsy-specific disorders like interictal dysphoric disorder are typical problems. Often adequate psychopharmacological treatment is not established due to fears of provoking seizures. In contrast there is clear evidence of positive effects of SSRIs on seizure frequency. The International League against Epilepsy recently proposed an adequate system of classification, which offers support in diagnosis. Treatment should consistently use all options of psychopharmacological and psychotherapeutical therapy. In difficult cases epilepsy centers provide special epileptological-psychiatric treatment offers on an inand out-patient base.

Schlüsselwörter

Epilepsie - Komorbidität - psychische Störungen

Keywords

Epilepsy - comorbidity - mental health problems

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