Neurokognitive Effekte häufig in der Epilepsiebehandlung eingesetzter Antiepileptika

Zusammenfassung

Antiepileptika (AED) verändern, basierend auf sehr unterschiedlichen Mechanismen, die Erregbarkeit von Nervenzellen und können so auch neurokognitive Prozesse beeinflussen. In den vergangenen Jahren wurden mehrere neue Antiepileptika zugelassen, die neben der Epilepsie auch zur Behandlung des neuropathischen Schmerzes und zur Stimmungsstabilisierung in der Psychiatrie eingesetzt werden. Es gibt jedoch nur wenige methodisch hinreichend kontrollierte Studien, die die neurokognitiven Wirkungen von Antiepileptika untersucht haben. Weiterhin fehlen Untersuchungen zu kognitiven Wirkungen neuer Antiepileptika in Kombinationstherapie mit älteren und anderen neuen Antiepileptika. Die Mehrzahl der neueren AED (Gabapentin, Lamotrigin, Levetiracetam, Oxcarbazepin) weisen gegenüber den älteren ein günstigeres neurokognitives Profil auf. Unter den neueren AED besteht bei Topiramat das höchste Risiko für kognitive Störwirkungen, die aber reversibel sind. Die Datenlage für Zonisamid ist für eine abschließende Beurteilung noch unzureichend, aber es verdichten sich Hinweise darauf, dass es häufiger kognitive Störwirkungen induziert als Gabapentin, Levetiracetam und Lamotrigin.

Abstracts

Antiepileptic drugs (AED) alter neuronal excitation levels and may lead to neurocognitive changes. In recent years, several new AEDs have been introduced which are additionally used to treat mood disorders, neuropathic pain and migraine. Generally, very few controlled trials have systematically examined the cognitive side effects of AEDs. In particular, polytherapy with the newer AEDs is under-investigated. In this paper we review the most relevant data pertaining to neurocognitive side effects of AEDs that are currently prescribed in Switzerland for the long-term treatment of epilepsies.

Schlüsselwörter

Antiepileptika - Nebenwirkungen - Kognition - Neuropsychologie - Epilepsie

Key words

antiepileptic drugs - side effects - cognition - neuropsychology - epilepsy

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