Schlaganfall: Epilepsie und Rolle des EEG

Zusammenfassung

Zerebrovaskuläre Erkrankungen sind die bedeutendste Ursache von epileptischen Anfällen und einer symptomatischen fokalen Epilepsie im höheren Lebensalter. Etwa 10 % der Patienten erleiden innerhalb der ersten fünf Jahre nach einem akuten Insult zumindest einen symptomatischen epileptischen Anfall. In ungefähr der Hälfte der Fälle handelt es sich um Frühanfälle innerhalb der ersten zwei Wochen. Das Risiko der Entwicklung einer Epilepsie ist besonders nach Spätanfällen erhöht und beträgt ca. 3 - 5 %. Schlaganfalltyp, -lokalisation und -ätiologie, die Schwere des initialen neurologischen Defizits, eine Kortexbeteiligung, erhaltene Kortexinseln im Infarktareal sowie die Menge des zisternalen Blutes bei Patienten mit Subarachnoidalblutungen beeinflussen in unterschiedlichem Maße die Wahrscheinlichkeit des Auftretens epileptischer Anfälle oder einer Epilepsie. Patienten, bei denen in der Akutphase mittels EEG periodische lateralisierte epileptiforme Entladungen (PLEDs) abgeleitet werden können, entwickeln in einem hohen Prozentsatz eine symptomatische fokale Epilepsie, häufig auch einen Status epilepticus. Die in der Literatur berichtete Mortalität beträgt 30 - 50 %. Das EEG ist ferner wegweisend bezüglich der Identifizierung eines fokalen oder komplex-fokalen Status epilepticus infolge des Insultes. Prospektive randomisierte Studien über den Nutzen einer antikonvulsiven Therapie bei Risikopatienten hinsichtlich des Auftretens von Frühanfällen oder der späteren Entwicklung einer Epilepsie liegen nicht vor. Trotzdem ist in bestimmten Situationen ein frühzeitiger Einsatz von Antikonvulsiva gerechtfertigt.

Abstract

Cerebrovascular diseases are the main cause of symptomatic partial epilepsy in elderly patients. In the first five years, about 10 % of stroke patients suffer at least one epileptic seizure. In approximately half of these patients seizures occur during the first two weeks following the acute insult (early seizures). Particularly after late onset seizures the risk of epilepsy is increased. Stroke subtype, localisation, severity, preserved cortical islands within the infarction, cortical involvement and amount of cisternal blood in patients with subarachnoid haemorrhage influence the probability of epileptic seizures or epilepsy. A high proportion of patients with periodic lateralised epileptiform discharges (PLEDs) develop a chronic seizure disorder, and status epilepticus is common in those patients. Mortality rates of 30 - 50 % are reported in the literature. EEG is also a guide in diagnosing a non-convulsive status epilepticus due to stroke. Prospective randomised studies on the efficacy of anticonvulsant prophylaxis or treatment of early seizures are lacking. Nevertheless, early initiation of anticonvulsant therapy is justified in certain situations.

Key words

Stroke - epilepsy - EEG

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