Langzeitverläufe schwierig behandelbarer Epilepsiesyndrome im Kindesalter

Zusammenfassung

Obwohl ca. 50% aller Epilepsien im Kindesund Jugendalter manifest werden und die prognostische Beratung von Patienten und Angehörigen besonders große Bedeutung haben, ist erstaunlich wenig über die tatsächliche Langzeitprognose von Epilepsien im Kindesalter bekannt. Die wichtigste Faustregel scheint zu sein, dass ein therapeutisch schwieriger Verlauf in der Kindheit auch hinsichtlich der Langzeitprognose ungünstig ist. Frühes Erkrankungsalter, symptomatische Ätiologie und zusätzliche Auffälligkeiten im psychopathologischen und neurologischen Bereich sind wichtige prognostisch ungünstige Variablen. Die einzige prospektive, populationsbasierte Langzeitstudie bei Patienten mit symptomatischen generalisierten Epilepsien, denen üblicherweise eine schlechte Prognose zugesprochen wird, ergab nach 20 Jahren eine Mortalität von 24%, immerhin aber auch bei 26% der Patienten eine Remission. 9% hatten bei unauffälligem neurologischem Befund letztlich eine normale Entwicklung durchlaufen. Insofern sollte man nicht übersehen, dass trotz ungünstiger prognostischer Variablen bei einigen Kindern immer noch ein günstiger Epilepsie- und Entwicklungsverlauf möglich ist.

Summary

Although about 50% of all epilepsies start during childhood and adolescence, relatively little is known about the spontaneous course and the prognosis. The crucial rule of the thumb is that difficult-to-treat epilepsies of childhood usually have a bad long-term prognosis. Unfavourable factors are early age of onset, symptomatic etiology and additional psychopathological or neurological symptoms. The only prospective, population-based long-term study in patients with symptomatic generalized epilepsy syndromes that are usually associated with a bad prognosis, reported a mortality of 24%, but also a remission rate of 26% after 20 years. 9% even had a normal development and neurological findings. Thus one should not overlook that in spite of prognostically unfavourable variables at least some children still may have an encouraging spontaneous course of epilepsy and development.

Schlüsselwörter

Epilepsie - Kinder - Prognose

Keywords

Epilepsy - children - prognosis

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