Prognose der Umstellung einer antikonvulsiven Medikation

Zusammenfassung

Gegenstand und Ziel

Da wenigstens 25% aller Menschen mit Epilepsie auf eine erste Antiepileptikatherapie nicht anfallsfrei werden, sollen die Erfolgsaussichten weiterer Pharmakotherapien bezüglich mindestens einjähriger Anfallsfreiheit oder zumindest mehr als 50%iger Reduktion der Anfallsfrequenz anhand publizierter Kohortenstudien herausgearbeitet werden.

Methoden

In einer PubMed Recherche gefundene Kohortenstudien an Menschen mit Epilepsie, aus denen der Prozentsatz der Behandlungserfolge bezüglich mindestens einjähriger Anfallsfreiheit oder zumindest mehr als 50%iger Reduktion der Anfallsfrequenz, nach erfolgloser Vorbehandlung mit mindestens einem Antiepileptikum ablesbar war, wurden ausgewertet.

Ergebnisse

Auch nach mehrjährigem therapierefraktärem Verlauf kann noch bei 20% bis 30% der Patienten eine mindestens einjährige Anfallsfreiheit durch Medikamentenumstellungen erzielt werden. Bei vermutlich weiteren 30% lassen sich Reduktionen der Anfallsfrequenz von mehr als 50% erreichen.

Schlussfolgerungen

Es gibt bei Patienten mit therapierefraktärer Epilepsie keine Situation, in welcher der Versuch der weiteren Optimierung der antiepileptischen Medikation grundsätzlich zwecklos wäre.

Klinische Relevanz

Entsprechend internationaler Empfehlungen sollten Patienten mit Epilepsie, bei denen zwei adäquate medikamentöse Therapieversuche nicht zu Anfallsfreiheit geführt haben, einer prächirurgischen Epilepsiediagnostik zugeführt werden. Führt dies nicht zu einem epilepsiechirurgischen Eingriff, sind weitere Medikamentenumstellungen erfolgversprechend.

Summary

Objective

Since at least 25% of patients with epilepsy are not becoming seizure free on a first antiepileptic treatment the efficacy of further pharmacologic treatment concerning seizure freedom for at least one year or reduction of seizure frequency of more than 50% was evaluated according to the cohort studies on patients with epilepsy published so far.

Methods

We evaluated all studies found in PubMed presenting data from which the percentage of patients who achieved seizure freedom for more than one year or the percentage of patients who achieved a reduction in seizure frequency of more than 50% after at least one unsuccessful antiepileptic treatment could be obtained.

Results

Even after a long term refractory course of epilepsy 20% to 30% of the patients can achieve seizure freedom for more than one year by changes in their antiepileptic medication. In probably another 30% of the patients a reduction in seizure frequency of at least 50% can be achieved.

Conclusions

In patients with refractory epilepsy there is always a chance to reduce the seizure frequency by changing the antiepileptic medication.

Clinical relevance

According to international recommendations patients with epilepsy, who are not seizure free despite treatment with two appropriate medical regimens should be transferred to presurgical evaluation. If this does not result in surgical treatment further medical treatment attempts by changing and combining the antiepileptic drugs should be performed.

Schlüsselwörter

Therapierefraktäre Epilepsie - Anfallsfreiheit - Anfallsrezidive - Reduktion der Anfallsfrequenz

Keywords

Refractory epilepsy - seizure freedom - seizure relapse - reduction of seizure frequency

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