Neuropsychologie bei Epilepsie

Zusammenfassung

Um die kognitiven Beeinträchtigungen bei Epilepsie zu verstehen, ist es erforderlich, statische und dynamische Einflussfaktoren zu unterscheiden. Während morphologische Läsionen oder Strukturveränderungen zu eher irreversiblen Defiziten führen, ergeben sich aus der epileptischen Aktivität, Anfällen und der pharmakologischen Behandlung der Epilepsie dynamische und prinzipiell reversible Beeinträchtigungen. Der relative Beitrag dieser Faktoren variiert abhängig von der Art der Epilepsie, dem Erkrankungsalter, der Lokalisation und Lateralisation der Epilepsie und individuellen demografischen Personenvariablen. Veränderte Hirnstruktur und Funktion kann zu Epilepsie führen, aber Epilepsie kann ihrerseits auch die Hirnstruktur und die funktionale zerebrale Organisation beeinflussen. Insofern muss die kognitive Beeinträchtigung bei Epilepsie in einen entwicklungsneuropsychologischen Kontext gesetzt werden. Die Ätiologie der Epilepsie steht in enger Beziehung zum Alter bei Beginn der Epilepsie und es macht einen erheblichen Unterschied, ob das reifende oder ausgereifte Gehirn betroffen ist. Je nachdem resultieren Entwicklungsbehinderungen, Verluste bereits erworbener Funktionen oder gar ein beschleunigter Altersabbau. So wird diskutiert, dass kognitive Beeinträchtigungen meist schon bei Beginn der Epilepsie bestehen, dass früh beginnende Epilepsien mit der geistigen Entwicklung interferieren und dass eine progressive Ätiologie, schwere Anfälle und sekundär zur Epilepsie erworbene Läsionen den Altersabbau beschleunigen. Weiter wird diskutiert, wie eine unkontrollierte Epilepsie und die medikamentöse Behandlung der Epilepsie zu reversiblen und irreversiblen Defiziten führen können. Schließlich werden die kognitiven Chancen und Risiken epilepsiechirurgischer Eingriffe besprochen. Die Konsequenzen für die Diagnostik sind Gegenstand von Teil II dieser Übersicht.

Abstract

In order to understand cognitive impairment associated with epilepsy, it is essential to appreciate that independent static and dynamic factors affect brain function in this disease. Whereas morphological lesions or structural changes are associated with more or less irreversible deficits, epileptic activity, seizures, and the treatment of epilepsy can cause dynamic and principally reversible impairment. The relative contribution of these factors differs depending on the type of epilepsy, the age at lesion/epilepsy onset, the localization and lateralization of epilepsy and individual demographic patient characteristics. Altered brain structure and function can result in epilepsy, but epilepsy can also alter the functional cerebral organization of the brain. Thus epilepsy-related cognitive impairment must be integrated within a developmental neuropsychological framework. The aetiology of epilepsy is strongly related to the age of onset. From a neuropsychological point of view, it makes a big difference for cognitive outcome as to whether epilepsy hits the maturing versus mature or aging brain. Dependent on this, epilepsy can result in retardation, loss of acquired functions, or accelerated mental decline. It will be demonstrated that cognitive impairments in epilepsy mostly exist from the beginning of epilepsy, that early onset lesions/epilepsy interfere with mental development, and that a progressive aetiology, severe seizures, and lesions secondary to epilepsy may accelerate mental decline. It will furthermore be discussed that uncontrolled epilepsy and epileptic activity may reversibly and irreversibly contribute to cognitive impairment. The same is demonstrated with regard to the pharmacological treatment of epilepsy. Finally, the cognitive risks and benefits of epilepsy surgery and the advantages of selective surgery will be addressed. The consequences for the neuropsychological assessment are discussed in part two of this review.

Schlüsselwörter

Epilepsie - Neuropsychologie - Kognition

Key words

epilepsy - neuropsychology - cognition

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