Alternativpsychose und forcierte Normalisierung durch Antiepileptika unter besonderer Berücksichtigung der neuen Antiepileptika

Zusammenfassung

Bei der Alternativpsychose und der forcierten Normalisierung alternieren Perioden von epileptischen Anfällen bei normalem Verhalten mit Perioden von Anfallsfreiheit (oder wesentlicher Anfallsreduktion) mit gleichzeitigem Bestehen einer Psychose oder anderen psychischen Störungen. Anders als die klinisch definierte Alternativpsychose geht die forcierte Normalisierung vom EEG-Befund aus. In der klinischen Praxis und in der Literatur werden die beiden Begriffe meist synonym gebraucht und beschreiben auch die gleichen Krankheitsbilder. Dies erlaubte eine zusammenfassende Auswertung der Publikationen über Alternativpsychose und forcierte Normalisierung. Meist ist eine Alternativpsychose oder eine forcierte Normalisierung Folge der Anfallsunterdrückung durch Antiepileptika. In der Zeit der älteren Antiepileptika wurde eine Alternativpsychose bzw. eine forcierte Normalisierung vor allem bei der Behandlung von Absencen mit Succinimiden beobachtet. In der Ära der neuen Antiepileptika, die mit der Einführung von Vigabatrin begann, waren vor allem Patienten mit relativ pharmakoresistenten fokalen Epilepsien betroffen. 1987 - vor 31 Jahren - wurde erstmals über eine paranoid-halluzinatorische Psychose bei Epilepsie durch die Behandlung mit Vigabatrin berichtet. Sukzessive folgten bis heute bei den meisten neuen Antiepileptika Berichte über eine Alternativpsychose bzw. eine forcierte Normalisierung. Eine umfassende Literatursuche ergab in diesem Zeitraum 66 Fälle mit detaillierten Angaben. Frauen waren mehr als doppelt so häufig betroffen wie Männer; der Grund ist nicht klar. In 4 retrospektiven Studien wurden weitere 176 alternative Ereignisse in pauschalerer Form mitgeteilt. Bei den wichtigeren neuen Antiepileptika scheint das Risiko einer Alternativpsychose oder einer forcierten Normalisierung bei Oxcarbazepin, Eslicarbazepin, Gabapentin und Pregabalin besonders gering zu sein.

Abstract

In the case of alternative psychosis and forced normalization, the patient alternates between periods of clinically manifest seizures and normal behavior, and other periods of seizure freedom (or significant seizure reduction) accompanied by psychosis or behavioral disturbances. Unlike the clinically defined alternative psychosis, forced normalization is based on EEG findings. In clinical practice and in the literature, both terms are mostly used synonymously, and they also describe the same clinical pictures. This allowed a joint evaluation of the publications about alternative psychosis and forced normalization. Most often, these two disorders occur after seizure control by anticonvulsants. In the period of older anticonvulsants, the succinimides for the treatment of absence seizures were most often associated with the development of an alternative psychosis or forced normalization. In the era of newer anticonvulsants that started with the introduction of vigabatrin, mostly patients with intractable focal seizures were affected. In 1987 - 31 years ago - paranoid hallucinatory psychosis, triggered by vigabatrin in a patient with epilepsy was reported for the first time. In the following years, reports of alternative psychosis and forced normalization appeared to be related to most of the new anticonvulsants. A comprehensive literature search provided 66 cases with detailed information on such events. More than twice as many women were likely to be affected as compared to men; the reason for this phenomenon is unclear. In four retrospective studies, another 176 alternative events were reported but no details were given. The risk of alternative psychosis and forced normalization seems to be particularly low with the new anticonvulsants oxcarbazepine, eslicarbazepine, gabapentin and pregabalin.

Schlüsselwörter

Alternativpsychose - Forcierte Normalisierung - Antiepileptika - Epilepsie

Key words

Alternative psychosis - Forced normalization - Anticonvulsants - Epilepsy

Publication History

Received: 26 May 2018

Accepted: 07 December 2018

Article published online:
20 February 2019

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