Behandlungsbeginn bei Epilepsien im Jugend- und Erwachsenenalter

Zusammenfassung

Der Beginn einer antiepileptischen Medikation muss sehr sorgfältig abgewogen werden, da häufig eine lebenslange Behandlung notwendig wird. Liegen Risikofaktoren vor, beginnt man heute schon nach einem ersten An-fall mit der medikamentösen Behandlung. Initial muss aber sorgfältig abgeklärt werden, ob es sich um einen Gelegenheitsanfall handelt oder um symptomatische Anfälle im Rahmen einer Grunderkrankung, die kausal behandelt werden kann.

Die Auswahl des Medikamentes hat nach Wirksamkeit und Verträglichkeit zu erfolgen. Die neuen Antiepileptika sind gerade unter dem Aspekt der Langzeitverträglichkeit vorzuziehen. Bei Versagen der Monotherapie kann man auf eine Mehrfachtherapie übergehen, wobei es keine evidenzbasierten Daten für diese gibt. Die Beratung des Patienten bezüglich seiner weiteren Lebensführung hat sehr individuell zu erfolgen und erfordert eine differenzierte Syndromdiagnose.

Summary

The start of antiepileptic medication has to be discussed carefully, because in most cases a lifelong treatment is required. In the presence of risk factors, the drug treatment should already start after the first seizure. Event related seizures and seizures related to diseases, which could be treated causally, should be carefully identified.

The efficacy and tolerability of the drug have to be taken into account when choosing the drug. In respect of long term tolerability the “new AED” are preferred. After a monotherapy has failed a multidrug treatment should be discussed, although there are no evidence based data. Life style counseling should be conducted very individually and needs a differentiated diagnosis of the distinct syndrome.

Schlüsselwörter

Erster epileptischer Anfall - antiepileptische Behandlung - Wirksamkeit und Verträglichkeit - Lebensführung

Keywords

First epileptic seizure - antiepileptic treatment - efficacy and tolerability - life style

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