Zusammenfassung
Die Vagusnervstimulation (VNS) ist eine palliative Behandlungsmethode pharmakoresistenter
Epilepsien, mit der bei ca. 30 - 40 % der Patienten eine Reduktion der Anfallsfrequenz
um mehr als 50 % erreicht werden kann. Die häufigsten Nebenwirkungen dieser im Allgemeinen
gut tolerierten Methode sind Heiserkeit, laryngeale Missempfindungen, Husten oder
Dyspnoe während der Stimulation. Ihr Einsatz sollte ernsthaft erwogen werden, wenn
eine nachgewiesene Pharmakoresistenz besteht und ein resektiver epilepsiechirurgischer
Eingriff nicht oder nur mit relativ hohem Risiko möglich ist. Nach der Implantation
ist eine medikamentöse Behandlung weiterhin zwingend notwendig. Sie kann zum Teil
jedoch vereinfacht werden und somit besser verträglich sein. Die Nachsorge ist teilweise
aufwändig, weshalb die VNS an spezialisierten Zentren durchgeführt werden sollte.
Abstract
Vagus nerve stimulation (VNS) is a palliative method for treatment of medically refractory
epilepsies and can result in a reduction of seizure frequency of more than 50 % in
approximately 30 - 40 % of the patients. Most commonly reported side effects of this
usually well tolerated method are hoarseness, laryngeal dysaesthesia, cough or dyspnea.
Implantation of a vagus nerve stimulator should be considered in pharmacoresistant
epilepsies in which resective epilepsy surgery is not possible or would bear a high
risk. After implantation, further medical therapy is still mandatory. However, it
may be possible to reduce co-medications thus improving tolerability. Follow-up is
essential and in some patients time-consuming. VNS should be performed at specialised
epilepsy centers.
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Dr. med. Günter Krämer
Schweizerisches Epilepsie-Zentrum
Bleulerstraße 60
8008 Zürich · Schweiz
eMail: g.kraemer@swissepi.ch
