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Fortschr Neurol Psychiatr 2022; 90(04): 147-162
DOI: 10.1055/a-1484-0118
Übersichtsarbeit

Selbstinduzierte epileptische Anfälle Prävalenz, Ursachen und Behandlung

Self-induced epileptic seizures: Prevalence, Causes and Treatment
Johannes Rösche
1   Klinik, Hephata Diakonie, Schwalmstadt-Treysa, Germany
2   Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Germany
,
Maria Iracema Rocha Dudek
3   Klinik für Psychiatrie und Psychotherapie/Ludwig-Noll-Krankenhaus Klinikum Kassel GmbH, Kassel, Germany
,
Oona Kohnen
4   Schweizerische Epilepsieklinik, Klinik Lengg AG, Zürich, Switzerland
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Zusammenfassung

Die Erstbeschreibung selbstinduzierter epileptischer Anfälle stammt von 1827. Die Prävalenz wird von der Mehrzahl der Autoren bei 1% unselektierter Patienten mit Epilepsie angege-ben. Dabei machen die Patienten meist etwa ein Viertel der Patienten mit photosensibler Epilepsie aus. Es sind daneben jedoch auch viele nicht-visuelle Auslösemechanismen beschrieben. Die Ursachen können in angenehmen Empfindungen während der ausgelösten Anfälle oder einer spannungslösenden Funktion der Anfälle bestehen. Häufig wird das Selbstinduktionsmanöver als unwillkürlicher Vorgang erlebt. Die Behandlung erweist sich insgesamt als schwierig. Für einzelne Patienten sind positive Effekte einer Verhaltenstherapie beschrieben. Bei photosensiblen Epilepsien wird die Abschottung von den auslösenden Reizen durch Sonnenbrillen empfohlen. Unter pharmakologischen Therapien scheinen Fenfluramin, Clonazepam und Valproat am aussichtsreichsten. Der Erfolg hängt unabhängig von der Methode stark von der Veränderungsbereitschaft der Patienten ab.

Abstract

Self-induced seizures were first described in 1827. A majority of authors found that in unselected patients with epilepsy, the prevalence rate of these seizures was 1%. In patients with photosensitive epilepsy, there was roughly a 25% prevalence. Apart from visual stimulation, many other mechanisms of self-induction have been described. A feeling of pleasure or relaxation during seizures may be a reason for self-inductive behaviour. But often the procedure of self-induction is experienced as involuntary. Treatment is always difficult. Behavioral therapy has been proven effective in some patients. In patients with photosensitive epilepsy, sunglasses are recommended. Fenfluramine, clonazepam and valproate seem to be a bit more effective than other drugs. After all, the treatment effect depends on the motivation of the patient to change the condition.

Schlüsselwörter

Photosensitivität - Heißwasser-Epilepsie - Tic-Störung - Sonnenbrille - Fenfluramin

Keywords

photosensitivity - hot-water-epilepsy - tic disorder - sunglasses - fenfluramine


Publication History

Received: 30 January 2021

Accepted: 08 April 2021

Article published online:
01 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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