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DOI: 10.1055/s-0031-1281688
© Georg Thieme Verlag KG Stuttgart · New York
Kommotionelle Konvulsionen: Epileptischer Anfall oder nicht?
Concussive Convulsions: Seizure or no Seizure?Publication History
Publication Date:
14 October 2011 (online)

Zusammenfassung
Konvulsionen nach Schädel-Hirn-Traumata (SHT) stellen eine differenzialdiagnostische und therapeutische Herausforderung dar. Sie können eingeteilt werden in späte (> 7 Tage nach Trauma), frühe (1 – 7 Tage nach Trauma), sofortige (innerhalb der ersten 24 Stunden nach Trauma) oder unmittelbare Konvulsionen („Aufprallanfälle“, innerhalb der ersten Sekunden nach Trauma). Aufprallanfälle sind möglicherweise nicht epileptischer Genese und werden auch als kommotionelle Konvulsion bezeichnet. Während frühe und späte posttraumatische epileptische Anfälle häufig Indikatoren für strukturelle traumatische Hirnschäden darstellen und mit der Entstehung einer posttraumatischen Epilepsie assoziiert sind, ist die Datenlage für sofortige Anfälle und insbesondere für Aufprallanfälle respektive kommotionelle Konvulsionen weniger homogen. Nur ein kleiner Teil sofortiger Anfälle ist mit strukturellen Hirnschäden und der Entwicklung einer symptomatischen Epilepsie verbunden, in der Mehrzahl der Fälle handelt es sich um benigne und prognostisch günstige Ereignisse. Der hier dargestellte Fall dient als Ausgangspunkt für pathophysiologische und klinische Überlegungen bei unmittelbar nach einem SHT auftretenden Konvulsionen.
Abstract
Convulsions following traumatic brain injury (TBI) represent a diagnostic and therapeutic challenge. They can be differentiated into late (> 7 days after TBI), early (1 – 7 days after TBI), immediate (within the first 24 h after TBI), and impact seizures (within seconds after TBI). Some authors suggest that most impact seizures are non-epileptic in origin and hence coined the term “concussive convulsions” for benign impact seizures. Early and late post-traumatic seizures frequently indicate structural brain damage and transition to chronic, post-traumatic epilepsy. The data for impact seizures or concussive convulsions is less clear: only a small percentage of impact seizures is associated with structural brain damage and the development of post-traumatic epilepsy, rather the majority of cases are benign and associated with an excellent prognosis. Here, we present a case report as a starting point for pathophysiological and clinical considerations regarding convulsions that start within seconds after TBI.
Schlüsselwörter
Schädel-Hirn-Trauma - Epilepsie - kommotionelle Konvulsionen - Aufprallanfälle
Keywords
epilepsy - traumatic brain injury - concussive convulsions - impact seizures
Literatur
- 1
Firsching R, Woischneck D.
Present status of neurosurgical trauma in Germany.
World journal of surgery.
2001;
25 (9)
1221-1223
MissingFormLabel
- 2
Annegers J F et al.
A population-based study of seizures after traumatic brain injuries.
The New England journal of medicine.
1998;
338 (1)
20-24
MissingFormLabel
- 3
Raymont V et al.
Correlates of posttraumatic epilepsy 35 years following combat brain injury.
Neurology.
2010;
75 (3)
224-229
MissingFormLabel
- 4
McCrory P R, Bladin P F, Berkovic S F.
Retrospective study of concussive convulsions in elite Australian rules and rugby
league footballers: phenomenology, aetiology, and outcome.
BMJ.
1997;
314 (7075)
171-174
MissingFormLabel
- 5
Barry E, Bergey G K, Krumholz A et al.
Post-traumatic seizure types vary with the interval following head injury.
Epilepsia.
1997;
38 (Suppl 8)
49
MissingFormLabel
- 6
Frey L C.
Epidemiology of posttraumatic epilepsy: a critical review.
Epilepsia.
2003;
44 (Suppl 10)
11-17
MissingFormLabel
- 7
Parko K L, Abrams G M, Campbell J S, Glass G A.
Epilepsy, Sleep Disturbances and psychiatric consequences. Continuum: Lifelong Learning
in Neurology.
Traumatic Brain Injury.
2010;
16 (6)
110-127
MissingFormLabel
- 8 Jennet B. Character of early epilepsy. Epilepsy After Non-Missile Head Injuries. 1 London: William Heinemann Medical Books LTD; 1975: 179
MissingFormLabel
- 9
D’Ambrosio R, Perucca E.
Epilepsy after head injury.
Current opinion in neurology.
2004;
17 (6)
731-735
MissingFormLabel
- 10
Dias M S, Carnevale F, Li V.
Immediate posttraumatic seizures: is routine hospitalization necessary?.
Pediatric neurosurgery.
1999;
30 (5)
232-238
MissingFormLabel
- 11
Holmes J F et al.
Do children require hospitalization after immediate posttraumatic seizures?.
Annals of emergency medicine.
2004;
43 (6)
706-710
MissingFormLabel
- 12
Emanuelson I, Uvebrant P.
Occurrence of epilepsy during the first 10 years after traumatic brain injury acquired
in childhood up to the age of 18 years in the south western Swedish population-based
series.
Brain injury.
2009;
23 (7)
612-616
MissingFormLabel
- 13
Liesemer K et al.
Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury:
rates, risk factors, and clinical features.
Journal of neurotrauma.
2011;
28 (5)
755-762
MissingFormLabel
- 14
Clear D, Chadwick D W.
Seizures provoked by blows to the head.
Epilepsia.
2000;
41 (2)
5243-244
MissingFormLabel
- 15
Hallen O.
Über „die organische pathologische Rektion des bereits (wenn auch nur im Verborgenen)
kranken“ Gehirns.
Der Nervenarzt.
1969;
40 (10)
460-462
MissingFormLabel
- 16
Krayenbuhl H et al.
Pseudo-traumatic epilepsy.
Epilepsia.
1970;
11 (1)
59-71
MissingFormLabel
- 17
Wolf P.
Minor head trauma unmasking asymptomatic lesions.
Epilepsia.
2001;
42 (4)
573
MissingFormLabel
- 18
Barry E et al.
Nonepileptic posttraumatic seizures.
Epilepsia.
1998;
39 (4)
427-431
MissingFormLabel
- 19
Westbrook L E, Devinsky O, Geocadin R.
Nonepileptic seizures after head injury.
Epilepsia.
1998;
39 (9)
978-982
MissingFormLabel
- 20
McCrory P R, Berkovic S F.
Concussive convulsions. Incidence in sport and treatment recommendations.
Sports medicine.
1998;
25 (2)
131-136
MissingFormLabel
- 21
McCrory P R, Berkovic S F.
Video analysis of acute motor and convulsive manifestations in sport-related concussion.
Neurology.
2000;
54 (7)
1488-1491
MissingFormLabel
- 22
Perron A D, Brady W J, Huff J S.
Concussive convulsions: emergency department assessment and management of a frequently
misunderstood entity. Academic emergency medicine.
official journal of the Society for Academic Emergency Medicine.
2001;
8 (3)
296-298
MissingFormLabel
- 23
Ropper A H, GorsonKC.
Clinical practice. Concussion.
The New England journal of medicine.
2007;
356 (2)
166-172
MissingFormLabel
- 24
Sander J W, O’Donoghue M F.
Epilepsy: getting the diagnosis right.
BMJ.
1997;
314 (7075)
158-159
MissingFormLabel
- 25 Evans R W. Post-traumatic seizures and epilepsy. In: Basow D S UpToDate.. Waltham: MA: UpToDate; 2011
MissingFormLabel
- 26
Anderson-Barnes V CW, Sharon R, Tsao J W.
Mild Traumatic Brain Injury Update. Continuum: Lifelong Learning in Neurology.
Traumatic Brain Injury.
2010;
16 (6)
17-26
MissingFormLabel
- 27
Denny-Brown D, Russell W R.
Experimental cerebral concussion.
The Journal of physiology.
1940;
99 (1)
153
MissingFormLabel
- 28
Walker A E, Kollros J J, Case T J.
The physiological basis of concussion.
J Neurosurg.
1944;
1
103-116
MissingFormLabel
- 29
Foltz E L, Jenkner F L, Ward jr A A.
Experimental cerebral concussion.
Journal of neurosurgery.
1953;
10 (4)
342-352
MissingFormLabel
- 30
Ommaya A K, Gennarelli T A.
Cerebral concussion and traumatic unconsciousness. Correlation of experimental and
clinical observations of blunt head injuries.
Brain – a journal of neurology.
1974;
97 (4)
633-654
MissingFormLabel
- 31
Hayes R L et al.
Activation of pontine cholinergic sites implicated in unconsciousness following cerebral
concussion in the cat.
Science.
1984;
223
301-303
MissingFormLabel
- 32
McCrory P.
The nature of concussion: a speculative hypothesis.
British journal of sports medicine.
2001;
35 (3)
146-147
MissingFormLabel
- 33
Shaw N A.
The neurophysiology of concussion.
Progress in neurobiology.
2002;
67 (4)
281-344
MissingFormLabel
- 34
D’Ambrosio R, Miller JW.
What is an epileptic seizure? Unifying definitions in clinical practice and animal
research to develop novel treatments.
Epilepsy currents/ American Epilepsy Society.
2010;
10 (3)
61-66
MissingFormLabel
- 35
Dudek F E, Bertram E H.
Counterpoint to “what is an epileptic seizure”? by D’ambrosio and Miller.
Epilepsy currents/American Epilepsy Society.
2010;
10 (4)
91-94
MissingFormLabel
- 36 Beer R, Ettlin T, Kampfl A. et al .Leichtes Schädel-Hirn-Trauma. In: Diener H C, Putzki N, [Hrsg.] Leitlinien für Diagnostik und Therapie in der Neurologie.. Stuttgart: Thieme; 2008
MissingFormLabel
- 37
Chadwick D.
Concussive convulsions. Wrong diagnosis may deprive people of their livelihood.
BMJ.
1997;
314
1283
MissingFormLabel
- 38
McCrory P et al.
Consensus statement on concussion in sport – the Third International Conference on
Concussion in Sport held in Zurich, November 2008.
The Physician and sportsmedicine.
2009;
37 (2)
141-159
MissingFormLabel
- 39
Temkin N R.
Preventing and treating posttraumatic seizures: the human experience.
Epilepsia.
2009;
50 (Suppl 2)
10-13
MissingFormLabel
- 40 Lewrenz H. Krankheit und Kraftverkehr. Begutachtungs-Leitlinien des Gemeinsamen Beirats für Verkehrsmedizin beim Bundesminister
für Verkehrsmedizin. In: Schriftenreihe des Bundesministers für Verkehr. 5. Aufl. Bonn; 1996
MissingFormLabel
Dr. Lothar Burghaus
Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
Kerpener Str. 62
50924 Köln
Email: lothar.burghaus@uk-koeln.de