Zur Wertigkeit neuer Antiepileptika in der Behandlung der Altersepilepsie

W. Fröscher

doi:10.1055/s-0038-1626477

Nervenheilkunde, Table of Contents

Nervenheilkunde 2006; 25(05): 380-389
DOI: 10.1055/s-0038-1626477

Originaler Artikel

Schattauer GmbH

Zur Wertigkeit neuer Antiepileptika in der Behandlung der Altersepilepsie

The role of new antiepileptic drugs in elderly patients with epilepsy

Authors

W. Fröscher

¹Epilepsiezentrum Bodensee und Waldburg-Zeil-Kliniken, Neurologische Klinik Wangen

Abstract

Zusammenfassung

Von Altersepilepsie spricht man, wenn epileptische Anfälle nach dem 60. oder 65. Lebensjahr auftreten. Die Wirksamkeit der alten und neuen Antiepileptika ist in diesem Alter mindestens so gut wie im mittleren Lebensalter, jedoch treten Nebenwirkungen häufiger auf. Die neuen Antiepileptika sind auch im höheren Lebensalter nicht wirksamer als die herkömmlichen, jedoch ermöglicht die Verfügbarkeit acht neuer Substanzen eine bessere Anpassung der Therapie an die individuelle Verträglichkeit. Als Standardtherapie kann weiterhin, wie bei jüngeren Patienten mit fokalen Anfällen, Carbamazepin, bei generalisierten Anfällen Valproinsäure eingesetzt werden. Diese Antiepileptika werden den noch älteren Substanzen Phenobarbital/Primidon und Phenytoin wegen des Nebenwirkungsspektrums vorgezogen. Häufiger als bei jüngeren Patienten wird man von diesem Behandlungsschema jedoch abgehen, z.B. wenn es darum geht, risikoreiche Interaktionen zu vermeiden oder das Risiko einer Osteoporose vermieden werden soll. Bezüglich des Auftretens kognitiver Störungen werden Valproinsäure und vor allem Carbamazepin unterschiedlich beurteilt. Falls kognitive Störungen unter Carbamazepin auftreten, stehen mit Lamotrigin, Gabapentin und Levetiracetam gute Behandlungsalternativen zur Verfügung. Mit zunehmender Langzeiterfahrung mit den neuen Antiepileptika und mit sinkenden Kosten dieser Substanzen wird gerade im höheren Lebensalter die Tendenz immer mehr zu den Antiepileptika mit dem geringsten Interaktionspotenzial gehen.

Summary

„Epilepsy in the elderly“ means epilepsy in patients older than 60 or 65 years. The efficacy of older and newer antiepileptic drugs at this age is at least equivalent to the efficacy in middle-aged patients. However, adverse events are more frequent in the elderly. The efficacy of the newer antiepileptic drugs is not superior to the older drugs, neither in the elderly nor in other age-groups. Nevertheless, the availability of eight new drugs allows to tailor the therapy with respect to their individual tolerability. As in younger adult patients carbamazepine is still the first-line drug for the treatment of focal seizures, valproic acid for generalised seizures. Carbamazepine and valproic acid are preferred to the older drugs phenobarbital/primidone and phenytoin with respect to the tolerability. More often than in younger patients one will deviate from this treatment strategy, e.g. to avoid dangerous interactions or the aggravation of an overt osteoporosis. Valproic acid and above all carbamazepine are assessed very differently as regards the influence on cognitive functioning. Valuable options in case of a decline of cognitive functioning caused by carbamazepine are lamotrigine, gabapentin and levetiracetam. With increasing long-time experience and reduced costs of the newer drugs there will be a strong tendency, especially in the elderly, to prefer those drugs with the lowest risk of interactions.

Schlüsselwörter

Altersepilepsie - Pharmakotherapie - neue Antiepileptika

Keywords

Epilepsy in the elderly - pharmacotherapy - new antiepileptic drugs

Full Text

References

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