Klinische Neurophysiologie 2010; 41(3): 167-182
DOI: 10.1055/s-0030-1248556
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© Georg Thieme Verlag KG Stuttgart · New York

Epilepsie – Diagnostik und Therapie

Epilepsy – Diagnosis and TherapyC.  Baumgartner1 , P.  Gallmetzer1 , S.  Pirker1
  • 1Karl Landsteiner Institut für Klinische Epilepsieforschung und Kognitive Neurologie, 2. Neurologische Abteilung, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Wien
Further Information

Publication History

Publication Date:
13 September 2010 (online)

Lernziele

Kenntnisse über

Definition, Epidemiologie und Verlauf der Epilepsien wesentliche diagnostische Schritte therapeutische Maßnahmen entsprechend den aktuellen Therapierichtlinien

Literatur

  • 1 Baumgartner C. Handbuch der Epilepsien. Wien, New York; Springer 2001
  • 2 Beghi E, Carpio A, Forsgren L. et al . Recommendation for a definition of acute symptomatic seizure.  Epilepsia. 2010;  51 671-675
  • 3 Hauser W A, Rich S S, Lee J R. et al . Risk of recurrent seizures after two unprovoked seizures.  New Engl J Med. 1998;  338 429-434
  • 4 Berg A T, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review.  Neurology. 1991;  41 965-972
  • 5 Stephen L J, Brodie M J. Management of a first seizure. Special problems: adults and elderly.  Epilepsia. 2008;  49 (Suppl. 1) 45-49
  • 6 Fisher R S, van Emde Boas W, Blume W. et al . Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE).  Epilepsia. 2005;  46 470-472
  • 7 Hauser W A. Incidence and prevalence. In: Engel JJ, Pedley TA, ed Epilepsy: A Comprehensive Textbook. Philadelphia; Lippincott-Raven Publishers 1997: 47-57
  • 8 Elger C E, Beyenburg S, Denning D. et al .Erster epileptischer Anfall und Epilepsien im Erwachsenenalter. In: Diener HC, Putzki N, ed Leitlinien für Diagnostik und Therapie in der Neurologie. Stuttgart, New York; Thieme 2008: 2-16
  • 9 Kwan P, Brodie M J. Early identification of refractory epilepsy.  N Engl J Med. 2000;  342 314-319
  • 10 Kwan P, Arzimanoglou A, Berg A T. et al . Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.  Epilepsia. 2010;  51 1069-1077
  • 11 Sillanpaa M, Schmidt D. Natural history of treated childhood-onset epilepsy: prospective, long-term population-based study.  Brain. 2006;  129 617-624
  • 12 Berg A T, Levy S R, Novotny E J. et al . Predictors of intractable epilepsy in childhood: a case-control study.  Epilepsia. 1996;  37 24-30
  • 13 Sillanpaa M, Schmidt D. Early seizure frequency and aetiology predict long-term medical outcome in childhood-onset epilepsy.  Brain. 2009;  132 989-998
  • 14 Semah F, Picot M C, Adam C. et al . Is the underlying cause of epilepsy a major prognostic factor for recurrence?.  Neurology. 1998;  51 1256-1262
  • 15 Mattson R H, Cramer J A, Collins J F. Prognosis for total control of complex partial and secondarily generalized tonic clonic seizures. Department of Veterans Affairs Epilepsy Cooperative Studies No. 118 and No. 264 Group.  Neurology. 1996;  47 68-76
  • 16 Hitiris N, Mohanraj R, Norrie J. et al . Predictors of pharmacoresistant epilepsy.  Epilepsy Res. 2007;  75 192-196
  • 17 Aikia M, Kalviainen R, Mervaala E. et al . Predictors of seizure outcome in newly diagnosed partial epilepsy: memory performance as a prognostic factor.  Epilepsy Res. 1999;  37 159-167
  • 18 Stefan H. Epilepsien: Diagnose und Behandlung Stuttgart, New York; Thieme 1999
  • 19 Schmidt D, Elger C E. Praktische Epilepsiebehandlung, 2. Auflage. Stuttgart, New York; Georg Thieme Verlag 2002
  • 20 Binnie C D, Stefan H. Modern electroencephalography: its role in epilepsy management.  Clin Neurophysiol. 1999;  110 1671-1697
  • 21 Blume W T. Current trends in electroencephalography.  Curr Opin Neurol. 2001;  14 193-197
  • 22 Pedley T A, Mendiratta A, Walczak T S. Seizures and epilepsy. In: Ebersole JS, Pedley TA, ed Current Practice of Clinical Electroencephalography. Philadelphia; Lippincott Williams & Wilkins 2003: 506-587
  • 23 Salinsky M, Kanter R, Dasheiff R M. Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve.  Epilepsia. 1987;  28 331-334
  • 24 Von Oertzen J, Urbach H, Jungbluth S. et al . Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy.  J Neurol Neurosurg Psychiatry. 2002;  73 643-647
  • 25 Serles W, Baumgartner C, Feichtinger M. et al . Richtlinien für ein standardisiertes MRT-Protokoll für Patienten mit epileptischen Anfällen in Österreich.  Mitteilungen der Österreichische Sektion der Internationalen Liga gegen Epilepsie. 2003;  3 2-13
  • 26 Commission on Classification and Terminology of the International League against Epilepsy . Proposal for revised clinical and electroencephalographic classification of epileptic seizures.  Epilepsia. 1981;  22 489-501
  • 27 Commission on Classification and Terminology of the International League against Epilepsy . Proposal for revised classification of epilepsies and epileptic syndromes.  Epilepsia. 1989;  30 389-399
  • 28 Berg A T, Berkovic S F, Brodie M J. et al . Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009.  Epilepsia. 2010;  51 676-685
  • 29 Berg A T, Berkovic S F, Brodie M J. et al . Revidierte Terminologie und Konzepte zur Einteilung von epileptischen Anfällen und Epilepsien: Bericht der Klassifikations- und Terminologiekommission der Internationalen Liga gegen Epilepsie, 2005–2009.  Akt Neurol. 2010;  37 120-130
  • 30 Avanzini G. A sound conceptual framework for an epilepsy classification is still lacking.  Epilepsia. 2010;  51 720-722
  • 31 Ferrie C D. Terminology and organization of seizures and epilepsies: radical changes not justified by new evidence.  Epilepsia. 2010;  51 713-714
  • 32 Fisher R S. What is a classification essay?.  Epilepsia. 2010;  51 714-715
  • 33 Guerrini R. Classification concepts and terminology: is clinical description assertive and laboratory testing objective?.  Epilepsia. 2010;  51 718-720
  • 34 Shinnar S. The new ILAE classification.  Epilepsia. 2010;  51 715-717
  • 35 Shorvon S, Guerrini R. Acute symptomatic seizures – should we retain the term?.  Epilepsia. 2010;  51 722-723
  • 36 Krämer G. Schon wieder eine neue Klassifikation und Nomenklatur epileptischer Anfälle und Epilepsien?.  Akt Neurol. 2010;  37 119
  • 37 Leidy N K, Elixhauser A, Vickrey B. et al . Seizure frequency and the health-related quality of life of adults with epilepsy.  Neurology. 1999;  53 162-166
  • 38 Gilliam F G, Fessler A J, Baker G. et al . Systematic screening allows reduction of adverse antiepileptic drug effects: a randomized trial.  Neurology. 2004;  62 23-27
  • 39 French J A, Pedley T A. Clinical practice. Initial management of epilepsy.  N Engl J Med. 2008;  359 166-176
  • 40 Sheth R D. Metabolic concerns associated with antiepileptic medications.  Neurology. 2004;  63 S24-29
  • 41 Israni R K, Kasbekar N, Haynes K. et al . Use of antiepileptic drugs in patients with kidney disease.  Semin Dial. 2006;  19 408-416
  • 42 Saetre E, Abdelnoor M, Amlie J P. et al . Cardiac function and antiepileptic drug treatment in the elderly: a comparison between lamotrigine and sustained-release carbamazepine.  Epilepsia. 2009;  50 1841-1849
  • 43 Nasreddine W, Beydoun A. Valproate-induced thrombocytopenia: a prospective monotherapy study.  Epilepsia. 2008;  49 438-445
  • 44 Bartl R. Antiepileptika-induzierte Osteopathie. Formen, Pathogenese, Prophylaxe, Früherkennung, Therapie.  Dtsch Med Wochenschr. 2007;  132 1475-1479
  • 45 Pack A. Bone health in people with epilepsy: is it impaired and what are the risk factors?.  Seizure. 2008;  17 181-186
  • 46 Vestergaard P. Epilepsy, osteoporosis and fracture risk – a meta-analysis.  Acta Neurol Scand. 2005;  112 277-286
  • 47 Nakken K O, Tauboll E. Bone loss associated with use of antiepileptic drugs.  Expert Opin Drug Saf. 2010;  9 561-571
  • 48 Ben-Menachem E. Weight issues for people with epilepsy – a review.  Epilepsia. 2007;  48 (Suppl. 9) 42-45
  • 49 Perucca E. An introduction to antiepileptic drugs.  Epilepsia. 2005;  46 (Suppl. 4) 31-37
  • 50 Kanner A M. Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment.  Biol Psychiatry. 2003;  54 388-398
  • 51 Barraclough B M. The suicide rate of epilepsy.  Acta Psychiatr Scand. 1987;  76 339-345
  • 52 Jones J E, Hermann B P, Barry J J. et al . Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy.  Epilepsy Behav. 2003;  4 (Suppl. 3) S31-38
  • 53 Forsgren L, Nystrom L. An incident case-referent study of epileptic seizures in adults.  Epilepsy Res. 1990;  6 66-81
  • 54 Hesdorffer D C, Hauser W A, Annegers J F. et al . Major depression is a risk factor for seizures in older adults.  Ann Neurol. 2000;  47 246-249
  • 55 Kanner A M. Depression in epilepsy: a neurobiologic perspective.  Epilepsy Curr. 2005;  5 21-27
  • 56 Gilliam F, Hecimovic H, Sheline Y. Psychiatric comorbidity, health, and function in epilepsy.  Epilepsy Behav. 2003;  4 (Suppl. 4) S26-30
  • 57 Boylan L S, Flint L A, Labovitz D L. et al . Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy.  Neurology. 2004;  62 258-261
  • 58 Lehrner J, Kalchmayr R, Serles W. et al . Health-related quality of life (HRQOL), activity of daily living (ADL) and depressive mood disorder in temporal lobe epilepsy patients.  Seizure. 1999;  8 88-92
  • 59 Kanner A M, Kozak A M, Frey M. The Use of Sertraline in Patients with Epilepsy: Is It Safe?.  Epilepsy Behav. 2000;  1 100-105
  • 60 Jobe P C, Browning R A. The serotonergic and noradrenergic effects of antidepressant drugs are anticonvulsant, not proconvulsant.  Epilepsy Behav. 2005;  7 602-619
  • 61 Schmitz B, Wolf P. Psychosis in epilepsy: frequency and risk factors.  J Epilepsy. 1995;  8 295-305
  • 62 Kanner A M. Psychosis of Epilepsy: A Neurologist’s Perspective.  Epilepsy Behav. 2000;  1 219-227
  • 63 Kanner A M, Palac S. Neuropsychiatric complications of epilepsy.  Curr Neurol Neurosci Rep. 2002;  2 365-372
  • 64 Schmitz B. Depression and mania in patients with epilepsy.  Epilepsia. 2005;  46 (Suppl. 4) 45-49
  • 65 Mensah S A, Beavis J M, Thapar A K. et al . A community study of the presence of anxiety disorder in people with epilepsy.  Epilepsy Behav. 2007;  11 118-124
  • 66 Vazquez B, Devinsky O. Epilepsy and anxiety.  Epilepsy Behav. 2003;  4 (Suppl. 4) S20-25
  • 67 Beyenburg S, Mitchell A J, Schmidt D. et al . Anxiety in patients with epilepsy: Systematic review and suggestions for clinical management.  Epilepsy Behav. 2005;  7 161-171
  • 68 Beyenburg S, Schmidt D. Epilepsiepatienten mit Angsterkrankungen. Erkennen und Behandeln.  Nervenarzt. 2005;  76 1077-1091
  • 69 Baumgartner C, Lehner-Baumgartner E. The functional deficit zone – general principles. In: Lüders HO, ed Textbook of Epilepsy Surgery. London; Informa Healthcare 2008: 781-791
  • 70 Elger C E, Helmstaedter C, Kurthen M. Chronic epilepsy and cognition.  Lancet Neurol. 2004;  3 663-672
  • 71 Helmstaedter C. Neuropsychologie bei Epilepsie. In: Sturm W, Herrmann M, Wallesch CW, eds Lehrbuch der Klinischen Neuropsychologie. Lisse, NL; Swets & Zeitlinger Publishers 2000: 571-580
  • 72 Helmstaedter C, Kurthen M. Memory and epilepsy: characteristics, course, and influence of drugs and surgery.  Curr Opin Neurol. 2001;  14 211-216
  • 73 Jokeit H, Schacher M. Neuropsychological aspects of type of epilepsy and etiological factors in adults.  Epilepsy Behav. 2004;  5 (Suppl. 1) S14-20
  • 74 Lehner-Baumgartner E, Baumgartner C. Epilepsien. In: Lehrner J, Pusswald G, Fertl E, Strubreither W, Kryspin-Exner I, eds Klinische Neuropsychologie: Grundlagen-Diagnostik-Rehabilitation. Wien; Springer 2006: 315-326
  • 75 Hermann B, Seidenberg M. Epilepsy and cognition.  Epilepsy Curr. 2007;  7 1-6
  • 76 Hermann B, Seidenberg M, Jones J. The neurobehavioural comorbidities of epilepsy: can a natural history be developed?.  Lancet Neurol. 2008;  7 151-160
  • 77 Loring D W, Marino S, Meador K J. Neuropsychological and behavioral effects of antiepilepsy drugs.  Neuropsychol Rev. 2007;  17 413-425
  • 78 Meador K J. Cognitive and memory effects of the new antiepileptic drugs.  Epilepsy Res. 2006;  68 63-67
  • 79 Runbech L, Sabers A. Effect of antiepileptic drugs on cognitive function in individuals with epilepsy: a comparative review of newer versus older agents.  Drugs. 2002;  62 593-604
  • 80 Kockelmann E, Elger C E, Helmstaedter C. Significant improvement in frontal lobe associated neuropsychological functions after withdrawal of topiramate in epilepsy patients.  Epilepsy Res. 2003;  54 171-178
  • 81 Ortinski P, Meador K J. Cognitive side effects of antiepileptic drugs.  Epilepsy Behav. 2004;  5 (Suppl. 1) S60-65
  • 82 Park S P, Hwang Y H, Lee H W. et al . Long-term cognitive and mood effects of zonisamide monotherapy in epilepsy patients.  Epilepsy Behav. 2008;  12 102-108
  • 83 Baumgartner C, Gallmetzer P, Zeitlhofer J. Schlafstörungen bei Epilepsie.  Klin Neurophysiol. 2008;  39 230-236
  • 84 Kwan P, Brodie M J. Effectiveness of first antiepileptic drug.  Epilepsia. 2001;  42 1255-1260
  • 85 Brodie M J, Perucca E, Ryvlin P. et al . Comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy.  Neurology. 2007;  68 402-408
  • 86 Glauser T, Ben-Menachem E, Bourgeois B. et al . ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes.  Epilepsia. 2006;  47 1094-1120
  • 87 Marson A G, Al-Kharusi A M, Alwaidh M. et al . The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial.  Lancet. 2007;  369 1000-1015
  • 88 Wheless J W, Clarke D F, Arzimanoglou A. et al . Treatment of pediatric epilepsy: European expert opinion, 2007.  Epileptic Disord. 2007;  9 353-412
  • 89 Glauser T A, Cnaan A, Shinnar S. et al . Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy.  N Engl J Med. 2010;  362 790-799
  • 90 French J A, Kanner A M, Bautista J. et al . Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society.  Neurology. 2004;  62 1252-1260
  • 91 Bergey G K. Evidence-based treatment of idiopathic generalized epilepsies with new antiepileptic drugs.  Epilepsia. 2005;  46 (Suppl. 9) 161-168
  • 92 Camfield C, Camfield P. Management guidelines for children with idiopathic generalized epilepsy.  Epilepsia. 2005;  46 (Suppl. 9) 112-116
  • 93 Hitiris N, Brodie M J. Evidence-based treatment of idiopathic generalized epilepsies with older antiepileptic drugs.  Epilepsia. 2005;  46 (Suppl. 9) 149-153
  • 94 Marson A G, Al-Kharusi A M, Alwaidh M. et al . The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial.  Lancet. 2007;  369 1016-1026
  • 95 French J A, Kanner A M, Bautista J. et al . Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society.  Neurology. 2004;  62 1261-1273
  • 96 Beyenburg S, Stavem K, Schmidt D. Placebo-corrected efficacy of modern antiepileptic drugs for refractory epilepsy: systematic review and meta-analysis.  Epilepsia. 2010;  51 7-26
  • 97 Labiner D M, Paradis P E, Manjunath R. et al . Generic antiepileptic drugs and associated medical resource utilization in the United States.  Neurology. 2010;  74 1566-1574
  • 98 Helmers S L, Paradis P E, Manjunath R. et al . Economic burden associated with the use of generic antiepileptic drugs in the United States.  Epilepsy Behav. 2010 Jun 25 [Epub ahead of print]; 
  • 99 Harden C L, Hopp J, Ting T Y. et al . Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society.  Neurology. 2009;  73 126-132
  • 100 Harden C L, Meador K J, Pennell P B. et al . Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society.  Neurology. 2009;  73 133-141
  • 101 Harden C L, Pennell P B, Koppel B S. et al . Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society.  Neurology. 2009;  73 142-149
  • 102 Meador K J, Baker G A, Browning N. et al . Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs.  N Engl J Med. 2009;  360 1597-1605
  • 103 Bromley R L, Baker G A, Meador K J. Cognitive abilities and behaviour of children exposed to antiepileptic drugs in utero.  Curr Opin Neurol. 2009;  22 162-166
  • 104 Brodie M J, Elder A T, Kwan P. Epilepsy in later life.  Lancet Neurol. 2009;  8 1019-1030
  • 105 Brodie M J, Kwan P. Epilepsy in elderly people.  BMJ. 2005;  331 1317-1322
  • 106 Krämer G. Epilepsien im höheren Lebensalter. Stuttgart; Thieme 1998
  • 107 Engel Jr J, Wiebe S, French J. et al . Practice parameter: Temporal lobe and localized neocortical resections for epilepsy: Report of the Quality Standards Subcommittee of the American Academy of Neurology, in Association with the American Epilepsy Society and the American Association of Neurological Surgeons.  Neurology. 2003;  60 538-547
  • 108 Wiebe S, Blume W T, Girvin J P. et al . A randomized, controlled trial of surgery for temporal-lobe epilepsy.  N Engl J Med. 2001;  345 311-318
  • 109 Tellez-Zenteno J F, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis.  Brain. 2005;  128 1188-1198
  • 110 Baumgartner C. Epilepsiechirurgie und Neurostimulation.  J Neuol Neurochir Psychiat. 2009;  10 40-54
  • 111 Baumgartner C. Neurostimulation zur Behandlung von Epilepsien – Eine kritische Bilanz.  Nervenheilkunde. 2007;  26 999-1005

Univ.-Prof. DI Dr. Christoph Baumgartner

Karl Landsteiner Institut für Klinische Epilepsieforschung und Kognitive Neurologie
2. Neurologische Abteilung
Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Wien

Riedelgasse 5

1130 Wien, Österreich

Email: christoph.baumgartner@wienkav.at

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