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Nervenheilkunde 2014; 33(05): 335-345
DOI: 10.1055/s-0038-1633405
Epilepsie
Schattauer GmbH

Präklinisches Management und Therapie des epileptischen Anfalls und des Status epilepticus

NotfallbehandlungPreclinical management and treatment of seizures and status epilepticus
T. Knieß
1   Neurologische Klinik Rhön-Klinikum GmbH, Bad Neustadt/Saale
,
F. C. Schmitt
2   Universitätsklinik für Neurologie, Otto-von-Guericke-Universität, Magdeburg
› Author Affiliations
Further Information

Publication History

eingegangen am: 15 January 2014

angenommen am: 29 January 2014

Publication Date:
02 February 2018 (online)

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Zusammenfassung

Epilepsie ist eine der häufigsten neurologischen Erkrankungen im Erwachsenenalter und eine der häufigsten Diagnosen in neurologischen Kliniken. Im Rettungswesen werden epileptische Anfälle oder klinisch ähnlich suspekte Ereignisse, die nicht zwingend epileptisch sein müssen, unter der Meldediagnose “Krampfanfall” geführt. Eine sichere diagnostische Einschätzung am Notfallort ist für die Mitarbeiter der Rettungsteams oft erschwert, da Patienten im oder nach einem Anfall oft noch verwirrt sein können, oder zum Ereignis eine Amnesie zeigen. Fehldiagnosen liegen bei ca. 30%. Folge kann eine Überoder Unterversorgung der Betroffenen sein, die im ungünstigsten Fall eine erhöhte Morbidität oder Mortalität nach sich ziehen kann. Eine verbesserte präklinische diagnostische Einschätzung kann das weitere therapeutische Prozedere steuern. Neben einer medikamentösen Notfalltherapie kommt der Ersten Hilfe und den Basismaßnahmen durch Laienhilfe oder Rettungsdienste eine wichtige Rolle zu.

Summary

In adult neurology, epilepsy is one of the most common chronic neurological diseases. Also it is one of the most frequent diagnoses in a neurological hospital unit. Epileptic seizures and paroxysmal events, which have the potential to be categorized as epileptic in the clinical context, are labelled and communicated as “fit” in the emergency service. Making an accurate diagnosis is often difficult for the emergency team, e.g. because the patient is postictally amnesic or confused. The rate of misdiagnosis is estimated up to 30%. Misdiagnosis can results in both overand undertreatment of the patient, which could lead to an increased morbidity and mortality under unfavorable circumstances. An optimized pre-hospital management could modify succeeding therapeutic procedures. Aside possible emergency therapy, first aid and other interventions from lay people or paramedics have considerable importance.

Schlüsselwörter

Prähospitales Management - Notfalltherapie - Anfall - Anfallsserie - Status epilepticus - Epilepsie

Keywords

Prehospital - emergency care - management - seizure - epilepsy - treatment
 

  • Literatur

  • 1 Martindale JL, Goldstein JN, Pallin DJ. Emergency department seizure epidemiology. Emerg Med Clin North Am 2011; 29 (01) 15-27.
    CrossrefPubMedGoogle Scholar
  • 2 Huff JS, Morris DL, Kothari RU, Gibbs MA. Emergency Medicine Seizure Study Group. Emergency department management of patients with seizures: a multicenter study. Acad Emerg Med Off J Soc Acad Emerg Med 2010; 08 (06) 622-8.
    Google Scholar
  • 3 Krumholz A, Grufferman S, Orr ST, Stern BJ. Seizures and seizure care in an emergency department. Epilepsia 1989; 30 (02) 175-81.
    CrossrefPubMedGoogle Scholar
  • 4 Martin-Gill C, Hostler D, Callaway CW, Prunty H, Roth RN. Management of prehospital seizure patients by paramedics. Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir 2009; 13 (02) 179-84.
    Google Scholar
  • 5 Heuer JF. et al. Accuracy of prehospital diagnoses by emergency physicians: comparison with discharge diagnosis. Eur J Emerg Med Off J Eur Soc Emerg Med 2012; 19 (05) 292-6.
    Google Scholar
  • 6 Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last? A systematic comparison of seizures recorded in the epilepsy monitoring unit. Epilepsia 2009; 47 (09) 1499-503.
    Google Scholar
  • 7 Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia 1999; 40 (01) 120-2.
    CrossrefPubMedGoogle Scholar
  • 8 Theodore WH. et al. The secondarily generalized tonic-clonic seizure: a videotape analysis. Neurology 1994; 44 (08) 1403-7.
    CrossrefPubMedGoogle Scholar
  • 9 Hoppe C, Poepel A, Elger CE. Epilepsy: Accuracy of patient seizure counts. Arch Neurol 2007; 64 (11) 1595-9.
    CrossrefPubMedGoogle Scholar
  • 10 Scheepers B, Clough P, Pickles C. The misdiagnosis of epilepsy: findings of a population study. Seizure J Br Epilepsy Assoc 1998; 07 (05) 403-6.
    CrossrefPubMedGoogle Scholar
  • 11 Zaidi A, Clough P, Cooper P, Scheepers B, Fitzpatrick AP. Misdiagnosis of epilepsy: many seizurelike attacks have a cardiovascular cause. J Am Coll Cardiol 2000; 36 (01) 181-4.
    CrossrefPubMedGoogle Scholar
  • 12 Josephson C, Rahey S, Sadler R. Neurocardiogenic Syncope: Frequency and Consequences of its Misdiagnosis as Epilepsy. Can J Neurol Sci 2007; 34 (02) 221-4.
    CrossrefPubMedGoogle Scholar
  • 13 Sigurdardottir KR, Olafsson E. Incidence of psychogenic seizures in adults: a population-based study in Iceland. Epilepsia 1998; 39 (07) 749-52.
    CrossrefPubMedGoogle Scholar
  • 14 Lesser RP. Psychogenic Seizures. Neurology 1996; 46 (06) 1499-507.
    CrossrefPubMedGoogle Scholar
  • 15 Hovorka J, Nezádal T, Herman E, Nemcová I, Bajacek M. Psychogenic non-epileptic seizures, prospective clinical experience: diagnosis, clinical features, risk factors, psychiatric comorbidity, treatment outcome. Epileptic Disord Int Epilepsy J Videotape 2007; 09 (Suppl. 01) S52-58.
    Google Scholar
  • 16 Niedermeyer E, Blumer D, Holscher E, Walker BA. Classical hysterical seizures facilitated by anticonvulsant toxicity. Psychiatr Clin (Basel) 1970; 03 (02) 71-84.
    Google Scholar
  • 17 Reuber M, Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav 2003; 04 (03) 205-16.
    CrossrefPubMedGoogle Scholar
  • 18 Reuber M, Baker GA, Gill R, Smith DF, Chadwick DW. Failure to recognize psychogenic nonepileptic seizures may cause death. Neurology 2004; 62 (05) 834-5.
    CrossrefPubMedGoogle Scholar
  • 19 Benbadis SR. How many patients with pseudoseizures receive antiepileptic drugs prior to diagnosis?. Eur Neurol 1999; 41 (02) 114-5.
    CrossrefPubMedGoogle Scholar
  • 20 Holtkamp M, Othman J, Buchheim K, Meierkord H. Diagnosis of psychogenic nonepileptic status epilepticus in the emergency setting. Neurology 2006; 66 (11) 1727-9.
    CrossrefPubMedGoogle Scholar
  • 21 Burneo JG. et al. Teddy bears: an observational finding in patients with non-epileptic events. Neurology 2003; 61 (05) 714-5.
    PubMedGoogle Scholar
  • 22 Cervenka MC, Lesser R, Tran TT, Fortuné T, Muthugovindan D, Miglioretti DL. Does the teddy bear sign predict psychogenic nonepileptic seizures?. Epilepsy Behav 2013; 28 (02) 217-20.
    CrossrefPubMedGoogle Scholar
  • 23 Galustyan SG, Walsh-Kelly CM, Szewczuga D, Bergholte J, Hennes H. The short-term outcome of seizure management by prehospital personnel: a comparison of two protocols. Pediatr Emerg Care 2003; 19 (04) 221-5.
    CrossrefPubMedGoogle Scholar
  • 24 Lühr A. Abstract. Abstr Neurowoche 2010 Arbeitsgemeinschaft Klin Neurowissenschaften Mannheim. 2010
    PubMedGoogle Scholar
  • 25 Stefan H. Epilepsien. Stuttgart: Thieme; 1999
    Google Scholar
  • 26 Trollmann R. Leitlinien der Intensivmedizin – Bewusst seins störung jenseits der Neugeborenen-periode. AWMF Leitlinien. 2012 22. 16
    PubMedGoogle Scholar
  • 27 Räsänen J, Martin DJ, Downs JB, Hodges MR. Oxygen supplementation during electroconvulsive therapy. Br J Anaesth 1988; 61 (05) 593-7.
    CrossrefPubMedGoogle Scholar
  • 28 Baumgartner C. Deutsche Gesellschaft für Neurologie, Kommission Leitlinien. Leitlinie Erster epileptischer Anfall und Epilepsien im Erwachsenenalter. Stuttgart: Thieme; 2012
    Google Scholar
  • 29 Strzelczyk A. et al. Postictal increase in T-wave alternans after generalized tonic-clonic seizures. Epilepsia 2011; 52 (11) 2112-7.
    CrossrefPubMedGoogle Scholar
  • 30 Lempert T. [Syncope. Phenomenology and differentiation from epileptic seizures]. Nervenarzt 1997; 68 (08) 620-4.
    PubMedGoogle Scholar
  • 31 Rosenow F, Knake S. Status epilepticus in adults. Handb Clin Neurol 2012; 108: 813-9.
    PubMedGoogle Scholar
  • 32 Holtkamp M. Status Epilepticus. Aktuel Neurol 2012; 39 (08) 429-36.
    Article in Thieme ConnectGoogle Scholar
  • 33 Holtkamp M. The anaesthetic and intensive care of status epilepticus. Curr Opin Neurol 2007; 20 (02) 188-93.
    CrossrefPubMedGoogle Scholar
  • 34 Walton NY. Systemic effects of generalized convulsive status epilepticus. Epilepsia 1993; 34 (Suppl. 01) S54-58.
    CrossrefPubMedGoogle Scholar
  • 35 Wasterlain CG, Fujikawa DG, Penix L, Sankar R. Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia 1993; 34 (Suppl. 01) S37-53.
    CrossrefPubMedGoogle Scholar
  • 36 Walker MT, Lee SY. Profound neocortical atrophy after prolonged, continuous status epilepticus. AJR Am J Roentgenol 1999; 173 (06) 1712-3.
    CrossrefPubMedGoogle Scholar
  • 37 Meierkord H. The risk of epilepsy after status epilepticus in children and adults. Epilepsia 2007; 48 (Suppl. 08) 94-5.
    CrossrefPubMedGoogle Scholar
  • 38 Haut SR. Seizure clustering. Epilepsy Behav EB 2006; 08 (01) 50-5.
    Google Scholar
  • 39 Rose AB. et al. Occurrence of seizure clusters and status epilepticus during inpatient video-EEG monitoring. Neurology 2003; 60 (06) 975-8.
    CrossrefPubMedGoogle Scholar
  • 40 Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 1989; 30 (04) 389-99.
    CrossrefPubMedGoogle Scholar
  • 41 Rosenow F. et al. Leitlinie Status epilepticus im Erwachsenenalter. Leitlinien für Diagnostik und Therapie in der Neurologie: Herausgegeben von der Kommission Leitlinien der DGN. Stuttgart: Thieme; 2012
    Google Scholar
  • 42 Schmitt FC, Dehnicke C, Merschhemke M, Meencke H-J. Verapamil attenuates the malignant treatment course in recurrent status epilepticus. Epilepsy Behav EB 2010; 17 (04) 565-8.
    Google Scholar
  • 43 Humphries LK, Eiland LS. Treatment of acute seizures: is intranasal midazolam a viable option?. J Pediatr Pharmacol Ther JPPT 2013; 18 (02) 79-87.
    PubMedGoogle Scholar
  • 44 Holsti M. et al. Prehospital intranasal midazolam for the treatment of pediatric seizures. Pediatr Emerg Care 2007; 23 (03) 148-53.
    CrossrefPubMedGoogle Scholar
  • 45 Mahmoudian T, Zadeh MM. Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children. Epilepsy Behav EB 2004; 05 (02) 253-5.
    Google Scholar
  • 46 Vilke GM. et al. Midazolam for the treatment of out-of-hospital pediatric seizures. Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir 2002; 06 (02) 215-7.
    Google Scholar
  • 47 Rosenow F, Hamer HM, Knake S. Therapie des beginnenden und etablierten Status epilepticus. Z für Epileptol 2013; 26 (02) 75-8.
    Google Scholar
  • 48 Brodie MJ, Kwan P. Current position of phenobarbital in epilepsy and its future. Epilepsia 2012; 53 (Suppl. 08) 40-6.
    CrossrefPubMedGoogle Scholar
  • 49 Li W. et al. Rapid loading of intravenous lacosamide: efficacy and practicability during presurgical video-EEG monitoring. Epilepsia 2013; 54 (01) 75-80.
    PubMedGoogle Scholar
  • 50 Kellinghaus C. Lacosamide as treatment for partial epilepsy: mechanisms of action, pharmacology, effects, and safety. Ther Clin Risk Manag 2009; 05: 757-66.
    Google Scholar
  • 51 Meierkord H. et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol Off J Eur Fed Neurol Soc 2010; 17 (03) 348-55.
    Google Scholar
  • 52 Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T. et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17 (01) 3-23.
    CrossrefPubMedGoogle Scholar
  • 53 Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain J Neurol 2012; 135 (Pt 8): 2314-28.
    CrossrefPubMedGoogle Scholar
  • 54 Shorvon S, Trinka E. The London-Innsbruck Status Epilepticus Colloquia 2007-2011, and the main advances in the topic of status epilepticus over this period. Epilepsia 2013; 54 (Suppl. 06) 11-3.
    CrossrefPubMedGoogle Scholar
  • 55 Knieß T, Ziegler V, Kippnich U, Griewing B, Hermann S. Prehospital Epilepsy Emergency Score (PEES) for differential diagnosis in Emergency care. Epilepsia 2013; 54 (Suppl. 03) 277.
    Google Scholar
  • 56 Grübler B. [Stroke management. With the “stroke angel” faster into the clinic]. MMW Fortschr Med 2007; 149 49-50 61.
    PubMedGoogle Scholar
  • 57 Ziegler V. et al. [Mobile computing systems in preclinical care of stroke. Results of the Stroke Angel initiative within the BMBF project PerCoMed]. Anaesthesist 2008; 57 (07) 677-85.
    CrossrefPubMedGoogle Scholar