Komplikationen einer ADS-Behandlung im Erwachsenenalter

Zusammenfassung

Aufmerksamkeitsdefizit-/-Hyperaktivitäts-Störungen (ADS/ADHS) im Erwachsenenalter können medikamentös mit Stimulanzien oder mit noradrenerg-/dopaminerg wirksamen Nichtstimulanzien behandelt werden. Wir berichten den Fall eines 22-jährigen Patienten mit einer ADS, der mit Bupropion behandelt worden war. Hierunter hatte der Patient einen komplex-fokalen Anfall erlitten, woraufhin die Therapie abgebrochen worden war. Auslösende Faktoren des Anfalls waren am ehesten eine nicht beabsichtigte Bupropionüberdosierung sowie möglicherweise eine links-temporal gelegene Arachnoidalzyste. Nach sorgfältiger Nutzen-Risiko-Bewertung wurde eine Behandlung mit Methylphenidat begonnen, von welcher der Patient deutlich profitierte. Weitere unerwünschte therapieassoziierte Ereignisse blieben aus. Der Fall verdeutlicht die Bedeutung der hirnorganischen Diagnostik bei ADS/ADHS im Erwachsenenalter sowie die Effizienz der Therapie mit Methylphenidat im Vergleich zu Nichtstimulanzien, auch in Risikokonstellationen.

Summary

Methylphenidate as well as noradrenergic/ dopaminergic non-stimulants can be used to treat Attention-deficit-/-hyperactivity-disorders (ADD/ADHD) in adults. We here report the case of a 22 year-old patient who suffered from ADD and had been treated with bupropion before admission to our hospital. He had unintentionally overdosed bupropion and had suffered a seizure probably due to bupropion overdose and possibly also due to a left-temporal arachnoid cyst, which was detected by MRI after the first-time seizure. Bupropion-therapy was stopped and the patient was later admitted to our hospital. We carefully weighed possible risks and benefits of a treatment with stimulants. Finally the patient started therapy with methylphenidate under careful observation and showed a significant clinical improvement concerning ADD-symptoms. There were no further adverse drug effects. The case demonstrates the importance of a careful diagnostic workup in ADD/ADHD including MRI. Second important issue highlighted here is the efficiency of a therapy with methylphenidate compared to non-stimulants even in delicate situations.

Schlüsselwörter

ADS - ADHS - Erwachsenenalter - epileptischer Anfall - Epilepsie - Arachnoidalzyste - Bupropion - Methylphenidat

Keywords

ADD - ADHD - adult - seizure - epilepsy - arachnoid cyst - bupropion - methylphenidate

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