Epilepsiechirurgie

A. Schulze-Bonhage

doi:10.1055/s-0038-1626954

Nervenheilkunde, Inhaltsverzeichnis

Nervenheilkunde 2007; 26(11): 1006-1012
DOI: 10.1055/s-0038-1626954

Arbeiten zum Schwerpunkt - Theme Articles

Schattauer GmbH

Epilepsiechirurgie

Welche Patienten profitieren am meisten?Epilepsy surgeryWhich patients gain most?

Authors

A. Schulze-Bonhage

¹Sektion Epileptologie, Neurozentrum, Universitätsklinikum Freiburg

Abstract

Zusammenfassung

Die Epilepsiechirurgie kann bei einem erheblichen Teil der Patienten mit unzureichender Anfallskontrolle unter medikamentöser antiepileptischer Therapie Anfallsfreiheit erzielen. Günstige Faktoren für das Erzielen einer vollständigen Anfallskontrolle sind Patienten, bei denen Lage und Größe des Fokus eine vollständige Resektion ermöglichen, bei denen der kernspintomografische Nachweis– auch unter Einsatz neuer hochauflösender Bildgebungsmethoden– Hinweise auf das epileptogene Areal gibt, bei denen die Ergebnisse der multimodalen prächirurgischen Diagnostik konkordant auf ein epileptogenes Areal hinweisen, die nicht an sekundär generalisierten tonisch-klonischen Anfällen leiden und frühzeitig operiert werden. Operierte Patienten haben gute Chancen, auch psychosoziale Ziele zu verwirklichen: Sie haben insbesondere bei einem Erzielen von Anfallsfreiheit verbesserte berufliche und soziale Chancen, gewinnen an Mobilität und bewerten insgesamt ihre Lebensqualität besser als Patienten, bei denen trotz Pharmakoresistenz medikamentöse Therapieversuche fortgesetzt werden. Wahrscheinlich ist auch das Risiko unerwarteter Todesfälle (SUDEP) vermindert. Die Realisierbarkeit eines Lebens ohne Medikamenteneinnahme wird derzeit noch kontrovers bewertet, und es besteht kein Konsens über Absetzstrategien nach einem epilepsiechirurgischen Eingriff. Hingegen besteht gute Evidenz dafür, dass die Erhaltung guter kognitiver Leistungen durch entsprechende Patientenauswahl und Operationsplanung von hohem Wert für die Patienten ist.

Summary

Epilepsy surgery can lead to seizure freedom also in a considerable percentage of patients with insufficient seizure control under phamacotherapy. Positive predictors for complete seizure control are localization and extension of the focus allowing for a complete removal, evidence for a structural lesion using– advanced–imaging, absence of generalized tonic-clonic seizures, and early surgical therapy. Patients havea good chance to achieve also psychosocial aims: particularly in case of seizure freedom they have better vocational chances and interpersonal relationships, they gain in mobility and rate their quality of life as higher compared to patients continuing medical treatment. The risk of sudden unexpected deaths may be reduced after successful epilepsy surgery. There is an ongoing debate on how many patients can live postoperatively without medication, and regarding the way antiepileptic drugs should be tapered. The preservation of cognitive capabilities by patient selection and optimal planning of surgery has significant impact on postoperative living.

Schlüsselworte

Epilepsiechirurgie - Outcome - Anfallsfreiheit - Prädiktoren - Ziele - Psychosoziale Faktoren - Antiepileptika-Kognition

Keywords

Epilepsy surgery - outcome - seizure freedom - predictors - aims - psychosocial factors - antiepileptica-cognition

Volltext

Referenzen

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