Antiepileptikabehandlung bei Hirntumor-bedingten epileptischen Anfällen

Zusammenfassung

Das Lebenszeitrisiko von Patienten mit Hirntumoren für das Auftreten von fokalen epileptischen Anfällen wird mit 20 – 80 % angegeben. Beim derzeitigen Wissensstand unterscheidet sich die medikamentöse Behandlung Hirntumor-bedingter fokaler Anfälle nicht von der Behandlung von Anfällen anderer Ätiologie. Die Auswahl der Antiepileptika richtet sich daher vor allem nach dem Nebenwirkungsspektrum und den pharmakokinetischen Interaktionen mit der Chemotherapie. Das in den deutschen Therapie-Leitlinien bei fokalen Anfällen als Mittel erster Wahl empfohlene Levetiracetam wird auch bei Hirntumor-bedingten Anfällen von zahlreichen Autoren als Mittel erster Wahl bezeichnet. Eine prophylaktische Antiepileptikagabe wird nach der derzeitigen Studienlage in der Regel abgelehnt. Nach einem ersten eindeutigen epileptischen Anfall sollte wegen des Rezidivrisikos in der Regel antiepileptisch behandelt werden.

Abstract

The lifetime risk of patients with brain tumours to have focal epileptic seizures is 20 – 80 %. Based on current evidence the management of tumour-related seizures does not differ substantially from that applied to epilepsies from other aetiologies. Therefore, the choice of an anticonvulsant is based, above all, on tolerability and pharmacokinetic interactions with chemotherapeutic drugs. Levetiracetam is recommended by many authors as first-line therapy in brain tumour-related epilepsy; this corresponds with the recommendation of the German guidelines on the treatment of focal seizures of any aetiology. Based on current evidence, the prophylactic prescription of long-term antiepileptic drugs in brain tumour patients who have not presented with seizures is not justified. Because of the high risk of recurrence, however, antiepileptic treatment should be strongly considered after a single brain tumour-related seizure.

Schlüsselwörter

Hirntumor - Antiepileptika - Epilepsie

Key words

brain tumours - antiepileptic drugs - epilepsy

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