Vagusnervstimulation: Derzeitiger Stellenwert in der Epilepsietherapie

Zusammenfassung

Die Vagusnervstimulation (VNS) ist eine palliative Behandlungsmethode pharmakoresistenter Epilepsien, mit der bei ca. 30 - 40 % der Patienten eine Reduktion der Anfallsfrequenz um mehr als 50 % erreicht werden kann. Die häufigsten Nebenwirkungen dieser im Allgemeinen gut tolerierten Methode sind Heiserkeit, laryngeale Missempfindungen, Husten oder Dyspnoe während der Stimulation. Ihr Einsatz sollte ernsthaft erwogen werden, wenn eine nachgewiesene Pharmakoresistenz besteht und ein resektiver epilepsiechirurgischer Eingriff nicht oder nur mit relativ hohem Risiko möglich ist. Nach der Implantation ist eine medikamentöse Behandlung weiterhin zwingend notwendig. Sie kann zum Teil jedoch vereinfacht werden und somit besser verträglich sein. Die Nachsorge ist teilweise aufwändig, weshalb die VNS an spezialisierten Zentren durchgeführt werden sollte.

Abstract

Vagus nerve stimulation (VNS) is a palliative method for treatment of medically refractory epilepsies and can result in a reduction of seizure frequency of more than 50 % in approximately 30 - 40 % of the patients. Most commonly reported side effects of this usually well tolerated method are hoarseness, laryngeal dysaesthesia, cough or dyspnea. Implantation of a vagus nerve stimulator should be considered in pharmacoresistant epilepsies in which resective epilepsy surgery is not possible or would bear a high risk. After implantation, further medical therapy is still mandatory. However, it may be possible to reduce co-medications thus improving tolerability. Follow-up is essential and in some patients time-consuming. VNS should be performed at specialised epilepsy centers.

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