Nervenheilkunde 2009; 28(07): 476-480
DOI: 10.1055/s-0038-1628662
Update Neurologie
Schattauer GmbH

Update Epileptologie

Update epileptology
A. Hufnagel
1   Neuro-Consil GmbH, Düsseldorf
› Author Affiliations
Further Information

Publication History

Eingegangen am: 03 March 2009

angenommen am: 09 March 2009

Publication Date:
24 January 2018 (online)

Zusammenfassung

Während der vergangenen beiden Jahre konnten entscheidende Verbesserung in der Diagnostik und Therapie der Epilepsien erzielt werden. Die wesentlichen Innovationen sind: Die Verbesserung der MR-Diagnostik epileptogener Läsionen durch 7-Tesla-Gerät (experimentell). MR-Traktografie, Propeller-MRT (Bewegungsartefakte-Unterdrückung) und funktionalisierte Magneto-Nano-Partikel verbessern die Darstellung des epileptischen Herdes sowie funktionell wichtiger Hirnareale. Lacosamid wurde als Zusatztherapie bei fokalen Epilepsien neu zugelassen. Rufinamid wurde bei therapieresistentem Lennox-Gastaut-Syndrom ab vier Jahren neu zugelassen. Die SANAD-Studien zeigten, dass Lamotrigin Vorteile bei der Behandlung fokaler Epilepsien und Valproinsäure Vorteile bei der Behandlung idiopathisch generalisierter Epilepsien hat. Langzeitergebnisse fünf Jahre nach Durchführung eines Epilepsiechirurgischen Eingriffs zeigen eine Wiederverschlechterung der Anfallssituation. Interstitielle Bestrahlung und Gamma-knife-Bestrahlung sind eventuelle Alternativen zur Resektion bei Patienten mit medialer Temporallappenepilepsie.

Summary

MR-Imaging of epileptogenic lesions and depiction of the epileptic focus was improved by 7-Tesla-MRI as well as MR-tractography, propeller-MRI technique which suppresses motion artifacts and application of magnetonano-particles. Lacosamid was licensed in Germany for add-on treatment of focal epilepsies. Rufinamide was licensed in Germany for add-on treatment of intractable Lennox-Gastaut-Syndrome. The SANAD-studies show advantages of lamotrigine for treatment of focal epilepsies and of valproate for treatment of generalized epilepsies. Long-term outcome of epilepsy surgery demonstrate increasing fraction of patients with relapse of seizures. Interstitial radiation and gamma-knife-surgery increasingly appears to be an alternative treatment for patients with medial temporal lobe epilepsy.

 
  • Literatur

  • 1 Akhtari M, Bragin A, Cohen M, Moats R, Brenker F, Lynch MD, Vinters HV, Engel Jr. J. Functionalized magnetonanoparticles for MRI diagnosis and localization in epilepsy. Epilepsia 2008; 08: 1419-1430.
  • 2 Alper K, Kuzniecky R, Carlson C, Barr WB, Vorkas CK, Patel JG, Carrelli AL, Starner K, Flom PL, Devinsky O. Postictal psychosis in partial epilepsy: A case-control study. Annals of Neurology 2008; 63: 602-610.
  • 3 Bartolomei F, Hayashi M, Tamura M, Rey M, Fischer C, Chauvel P, Régis J. Long-term efficacy of gamma knife radiosurgery in mesial temporal lobe epilepsy. Neurology 2008; 70: 1658-1663.
  • 4 Berg MJ, Gross RA, Tomaszewski KJ, Zingaro WM, Haskins LS. Generic substitution in the treatment of epilepsy. Neurology 2008; 71: 525-530.
  • 5 Biton V, Rosenfeld WE, Whitesides J, Fountain NB, Vaiciene N, Rudd GD. Intravenous lacosamide as replacement for oral lacosamide in patients with partial-onset seizures. Epilepsia 2008; 03: 418-424.
  • 6 Castro LH, Serpa MH, Valério RM, Jorge CL, Ono CR, Arantes PR, Rosemberg S, Wen HT. Good surgical outcome in discordant ictal EEG-MRI unilateral mesial temporal sclerosis patients. Epilepsia 2008; 08: 1324-1332.
  • 7 Ensrud KE, Walczak TS, Blackwell TL, Ensrud ER, Barrett-Connor E, Orwoll ES. Antiepileptic drug use and rates of hip bone loss in older men. Neurology 2008; 71: 723-730.
  • 8 Eriksson SH, Thom M, Bartlett PA, Symms MR, McEvoy AW, Sisodiva SM, Duncan JS. Propeller MRI visualizes detailed pathology of hippocampal sclerosis. Epilepsia 2008; 49 (01) 33-9.
  • 9 Fedi M, Berkovic SF, Scheffer IE, O`Keefe G, Marini C, Mulligan R, Gong S, Tochon-Danguy H, Reutens DC. Reduced striatal D1 receptor binding in autosomal dominant nocturnal frontal lobe epilepsy. Neurology 2008; 71: 795-798.
  • 10 Glauser T, Kluger G, Sachdeo R, Krauss G, Perdomo C, Arroyo S. Rufinamide for generalized seizures associated with Lennox-Gastaut syndrome. Neurology 2008; 70: 1950-1958.
  • 11 Kossoff EH, Rowley H, Sinha SR, Vining EPG. A Prospective Study of the Modified Atkins Diet for Intractable Epilepsy in Adults. Epilepsia 2008; 02: 316-319.
  • 12 Koubeissi MZ, Amina S, Pita I, Bergey GK, Werz MA. Tolerability and efficacy of oral loading of levetiracetam. Neurology 2008; 70: 2166-2170.
  • 13 Kretz R, Coban I, Gaus V, Schmitz B. EURAP: the European registry of antiepileptic drugs and pregnancy. Nervenarzt 2006; 77: 724-8.
  • 14 LeLorier J, Duh MS, Paradis PE, Dess MA, Lefebvre P, Weiner J, Manjunath R, Sheehy O. Clinical consequences of generic substitution of lamotrigine for patients with epilepsy. Neurology 2008; 70: 2179-2186.
  • 15 Marson AG, Al-Kharusi AM, Alwaidh M. et al. The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial. Lancet 2007; 369 (9566): 1016-26.
  • 16 Marson AG, Al-Kharusi AM, Alwaidh M. et al. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. Lancet 2007; 369 (9566): 1000-15.
  • 17 Moshe S, Shilo M, Chodick G, Yagev Y, Blatt I, Korczyn AD, Neufeld MY. Occurrence of seizures in association with work-related stress in young male army recruits. Epilepsia 2008; 08: 1451-1456.
  • 18 Noachtar S, Andermann E, Meyvisch P, Andermann F, Gough WB, Schiemann-Delgado J. Levetiracetam fort he treatment of idiopathic generalized epilepsy with myoclonic seizures. Neurology 2008; 70: 607-616.
  • 19 Pack AM, Morrell MJ, Randall A, McMahon DJ, Shane E. Bone health in young women with epilepsy after one year of antiepileptic drug monotherapy. Neurology 2008; 70: 1586-1593.
  • 20 Rodrigo S, Oppenheim C, Chassoux F, Hodel J, de Vanssay A, Baudoin-Chial S, Devaux B, Meder J-F. Language lateralization in temporal lobe epilepsy using functional MRI and probabilistic tractography. Epilepsia 2008; 08: 1367-1376.
  • 21 Schulze-Bonhage A, Trippel M, Wagner K, Bast T, Deimling FV, Ebner A, Elger C, Mayer T, Keimer R, Steinhoff BJ, Spreer J, Fauser S, Ostertag C. Outcome and predictors of interstitial radiosurgery in the treatment of gelastic epilepsy. Neurology 2008; 71: 277-282.
  • 22 Sheth RD, Binkley N, Hermann BP. Progressive bone deficit in epilepsy. Neurology 2008; 70: 170-176.