Subscribe to RSS
DOI: 10.1055/s-0031-1281688
© Georg Thieme Verlag KG Stuttgart · New York
Kommotionelle Konvulsionen: Epileptischer Anfall oder nicht?
Concussive Convulsions: Seizure or no Seizure?Publication History
Publication Date:
14 October 2011 (online)

Zusammenfassung
Konvulsionen nach Schädel-Hirn-Traumata (SHT) stellen eine differenzialdiagnostische und therapeutische Herausforderung dar. Sie können eingeteilt werden in späte (> 7 Tage nach Trauma), frühe (1 – 7 Tage nach Trauma), sofortige (innerhalb der ersten 24 Stunden nach Trauma) oder unmittelbare Konvulsionen („Aufprallanfälle“, innerhalb der ersten Sekunden nach Trauma). Aufprallanfälle sind möglicherweise nicht epileptischer Genese und werden auch als kommotionelle Konvulsion bezeichnet. Während frühe und späte posttraumatische epileptische Anfälle häufig Indikatoren für strukturelle traumatische Hirnschäden darstellen und mit der Entstehung einer posttraumatischen Epilepsie assoziiert sind, ist die Datenlage für sofortige Anfälle und insbesondere für Aufprallanfälle respektive kommotionelle Konvulsionen weniger homogen. Nur ein kleiner Teil sofortiger Anfälle ist mit strukturellen Hirnschäden und der Entwicklung einer symptomatischen Epilepsie verbunden, in der Mehrzahl der Fälle handelt es sich um benigne und prognostisch günstige Ereignisse. Der hier dargestellte Fall dient als Ausgangspunkt für pathophysiologische und klinische Überlegungen bei unmittelbar nach einem SHT auftretenden Konvulsionen.
Abstract
Convulsions following traumatic brain injury (TBI) represent a diagnostic and therapeutic challenge. They can be differentiated into late (> 7 days after TBI), early (1 – 7 days after TBI), immediate (within the first 24 h after TBI), and impact seizures (within seconds after TBI). Some authors suggest that most impact seizures are non-epileptic in origin and hence coined the term “concussive convulsions” for benign impact seizures. Early and late post-traumatic seizures frequently indicate structural brain damage and transition to chronic, post-traumatic epilepsy. The data for impact seizures or concussive convulsions is less clear: only a small percentage of impact seizures is associated with structural brain damage and the development of post-traumatic epilepsy, rather the majority of cases are benign and associated with an excellent prognosis. Here, we present a case report as a starting point for pathophysiological and clinical considerations regarding convulsions that start within seconds after TBI.
Schlüsselwörter
Schädel-Hirn-Trauma - Epilepsie - kommotionelle Konvulsionen - Aufprallanfälle
Keywords
epilepsy - traumatic brain injury - concussive convulsions - impact seizures
Literatur
- 1
Firsching R, Woischneck D.
Present status of neurosurgical trauma in Germany.
World journal of surgery.
2001;
25 (9)
1221-1223
Reference Ris Wihthout Link
- 2
Annegers J F et al.
A population-based study of seizures after traumatic brain injuries.
The New England journal of medicine.
1998;
338 (1)
20-24
Reference Ris Wihthout Link
- 3
Raymont V et al.
Correlates of posttraumatic epilepsy 35 years following combat brain injury.
Neurology.
2010;
75 (3)
224-229
Reference Ris Wihthout Link
- 4
McCrory P R, Bladin P F, Berkovic S F.
Retrospective study of concussive convulsions in elite Australian rules and rugby
league footballers: phenomenology, aetiology, and outcome.
BMJ.
1997;
314 (7075)
171-174
Reference Ris Wihthout Link
- 5
Barry E, Bergey G K, Krumholz A et al.
Post-traumatic seizure types vary with the interval following head injury.
Epilepsia.
1997;
38 (Suppl 8)
49
Reference Ris Wihthout Link
- 6
Frey L C.
Epidemiology of posttraumatic epilepsy: a critical review.
Epilepsia.
2003;
44 (Suppl 10)
11-17
Reference Ris Wihthout Link
- 7
Parko K L, Abrams G M, Campbell J S, Glass G A.
Epilepsy, Sleep Disturbances and psychiatric consequences. Continuum: Lifelong Learning
in Neurology.
Traumatic Brain Injury.
2010;
16 (6)
110-127
Reference Ris Wihthout Link
- 8 Jennet B. Character of early epilepsy. Epilepsy After Non-Missile Head Injuries. 1 London: William Heinemann Medical Books LTD; 1975: 179
Reference Ris Wihthout Link
- 9
D’Ambrosio R, Perucca E.
Epilepsy after head injury.
Current opinion in neurology.
2004;
17 (6)
731-735
Reference Ris Wihthout Link
- 10
Dias M S, Carnevale F, Li V.
Immediate posttraumatic seizures: is routine hospitalization necessary?.
Pediatric neurosurgery.
1999;
30 (5)
232-238
Reference Ris Wihthout Link
- 11
Holmes J F et al.
Do children require hospitalization after immediate posttraumatic seizures?.
Annals of emergency medicine.
2004;
43 (6)
706-710
Reference Ris Wihthout Link
- 12
Emanuelson I, Uvebrant P.
Occurrence of epilepsy during the first 10 years after traumatic brain injury acquired
in childhood up to the age of 18 years in the south western Swedish population-based
series.
Brain injury.
2009;
23 (7)
612-616
Reference Ris Wihthout Link
- 13
Liesemer K et al.
Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury:
rates, risk factors, and clinical features.
Journal of neurotrauma.
2011;
28 (5)
755-762
Reference Ris Wihthout Link
- 14
Clear D, Chadwick D W.
Seizures provoked by blows to the head.
Epilepsia.
2000;
41 (2)
5243-244
Reference Ris Wihthout Link
- 15
Hallen O.
Über „die organische pathologische Rektion des bereits (wenn auch nur im Verborgenen)
kranken“ Gehirns.
Der Nervenarzt.
1969;
40 (10)
460-462
Reference Ris Wihthout Link
- 16
Krayenbuhl H et al.
Pseudo-traumatic epilepsy.
Epilepsia.
1970;
11 (1)
59-71
Reference Ris Wihthout Link
- 17
Wolf P.
Minor head trauma unmasking asymptomatic lesions.
Epilepsia.
2001;
42 (4)
573
Reference Ris Wihthout Link
- 18
Barry E et al.
Nonepileptic posttraumatic seizures.
Epilepsia.
1998;
39 (4)
427-431
Reference Ris Wihthout Link
- 19
Westbrook L E, Devinsky O, Geocadin R.
Nonepileptic seizures after head injury.
Epilepsia.
1998;
39 (9)
978-982
Reference Ris Wihthout Link
- 20
McCrory P R, Berkovic S F.
Concussive convulsions. Incidence in sport and treatment recommendations.
Sports medicine.
1998;
25 (2)
131-136
Reference Ris Wihthout Link
- 21
McCrory P R, Berkovic S F.
Video analysis of acute motor and convulsive manifestations in sport-related concussion.
Neurology.
2000;
54 (7)
1488-1491
Reference Ris Wihthout Link
- 22
Perron A D, Brady W J, Huff J S.
Concussive convulsions: emergency department assessment and management of a frequently
misunderstood entity. Academic emergency medicine.
official journal of the Society for Academic Emergency Medicine.
2001;
8 (3)
296-298
Reference Ris Wihthout Link
- 23
Ropper A H, GorsonKC.
Clinical practice. Concussion.
The New England journal of medicine.
2007;
356 (2)
166-172
Reference Ris Wihthout Link
- 24
Sander J W, O’Donoghue M F.
Epilepsy: getting the diagnosis right.
BMJ.
1997;
314 (7075)
158-159
Reference Ris Wihthout Link
- 25 Evans R W. Post-traumatic seizures and epilepsy. In: Basow D S UpToDate.. Waltham: MA: UpToDate; 2011
Reference Ris Wihthout Link
- 26
Anderson-Barnes V CW, Sharon R, Tsao J W.
Mild Traumatic Brain Injury Update. Continuum: Lifelong Learning in Neurology.
Traumatic Brain Injury.
2010;
16 (6)
17-26
Reference Ris Wihthout Link
- 27
Denny-Brown D, Russell W R.
Experimental cerebral concussion.
The Journal of physiology.
1940;
99 (1)
153
Reference Ris Wihthout Link
- 28
Walker A E, Kollros J J, Case T J.
The physiological basis of concussion.
J Neurosurg.
1944;
1
103-116
Reference Ris Wihthout Link
- 29
Foltz E L, Jenkner F L, Ward jr A A.
Experimental cerebral concussion.
Journal of neurosurgery.
1953;
10 (4)
342-352
Reference Ris Wihthout Link
- 30
Ommaya A K, Gennarelli T A.
Cerebral concussion and traumatic unconsciousness. Correlation of experimental and
clinical observations of blunt head injuries.
Brain – a journal of neurology.
1974;
97 (4)
633-654
Reference Ris Wihthout Link
- 31
Hayes R L et al.
Activation of pontine cholinergic sites implicated in unconsciousness following cerebral
concussion in the cat.
Science.
1984;
223
301-303
Reference Ris Wihthout Link
- 32
McCrory P.
The nature of concussion: a speculative hypothesis.
British journal of sports medicine.
2001;
35 (3)
146-147
Reference Ris Wihthout Link
- 33
Shaw N A.
The neurophysiology of concussion.
Progress in neurobiology.
2002;
67 (4)
281-344
Reference Ris Wihthout Link
- 34
D’Ambrosio R, Miller JW.
What is an epileptic seizure? Unifying definitions in clinical practice and animal
research to develop novel treatments.
Epilepsy currents/ American Epilepsy Society.
2010;
10 (3)
61-66
Reference Ris Wihthout Link
- 35
Dudek F E, Bertram E H.
Counterpoint to “what is an epileptic seizure”? by D’ambrosio and Miller.
Epilepsy currents/American Epilepsy Society.
2010;
10 (4)
91-94
Reference Ris Wihthout Link
- 36 Beer R, Ettlin T, Kampfl A. et al .Leichtes Schädel-Hirn-Trauma. In: Diener H C, Putzki N, [Hrsg.] Leitlinien für Diagnostik und Therapie in der Neurologie.. Stuttgart: Thieme; 2008
Reference Ris Wihthout Link
- 37
Chadwick D.
Concussive convulsions. Wrong diagnosis may deprive people of their livelihood.
BMJ.
1997;
314
1283
Reference Ris Wihthout Link
- 38
McCrory P et al.
Consensus statement on concussion in sport – the Third International Conference on
Concussion in Sport held in Zurich, November 2008.
The Physician and sportsmedicine.
2009;
37 (2)
141-159
Reference Ris Wihthout Link
- 39
Temkin N R.
Preventing and treating posttraumatic seizures: the human experience.
Epilepsia.
2009;
50 (Suppl 2)
10-13
Reference Ris Wihthout Link
- 40 Lewrenz H. Krankheit und Kraftverkehr. Begutachtungs-Leitlinien des Gemeinsamen Beirats für Verkehrsmedizin beim Bundesminister
für Verkehrsmedizin. In: Schriftenreihe des Bundesministers für Verkehr. 5. Aufl. Bonn; 1996
Reference Ris Wihthout Link
Dr. Lothar Burghaus
Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln
Kerpener Str. 62
50924 Köln
Email: lothar.burghaus@uk-koeln.de