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Therapierefraktärer Status epilepticus

Diagnostik, Therapie, Verlauf und Prognose

Refractory status epilepticus

Diagnosis, therapy, course, and prognosis

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Zusammenfassung

Der Status epilepticus (SE) gehört mit einer jährlichen Inzidenz von 10–20/100.000 Einwohnern zu den häufigsten Notfällen in der Neurologie. Die Gesamtmortalität liegt abhängig von einer Reihe klinischer Parameter zwischen 10% und 20%. Die Patienten zeigen lang andauernde oder in Serie auftretende motorische Anfälle oder prolongierte Bewusstseinsstörungen bis hin zum Koma. Darüber hinaus können eine Reihe systemischer Komplikationen auftreten, die auch als Folge einer aggressiven medikamentösen Therapie möglich sind. Während sich der überwiegende Teil der SE durch standardisierte Behandlungsalgorithmen unterbrechen lässt, erweisen sich einige SE als refraktär gegen diese Initialtherapie und bedürfen einer intensivmedizinischen Intervention. Hier kommen vornehmlich nicht sedierende Antikonvulsiva und bei Bedarf zusätzlich Injektionsnarkotika zum Einsatz. In Einzelfällen stellen nichtmedikamentöse Therapieansätze (z. B. die Epilepsiechirurgie) eine zusätzliche Behandlungsalternative dar. Die vorliegende Arbeit präsentiert einen Überblick über die Studienlage zu Verlauf, Diagnostik und Therapie des refraktären SE einschließlich nichtmedikamentöser Behandlungsstrategien.

Summary

Status epilepticus (SE) is a frequent neurological emergency with an annual incidence of 10–20/100,000 individuals. The overall mortality is about 10–20%. Patients present with long-lasting fits or series of epileptic seizures or extended stupor and coma. Furthermore, patients with SE can suffer from a number of systemic complications possibly also due to side effects of the medical treatment. In the beginning, standardized treatment algorithms can successfully stop most SE. A minority of SE cases prove however to be refractory against the initial treatment and require intensified pharmacologic intervention with nonsedating anticonvulsive drugs or anesthetics. In some partial SE, nonpharmacological approaches (e.g., epilepsy surgery) have been used successfully. This paper reviews scientific evidence of the diagnostic approach, therapeutic options, and course of refractory SE, including nonpharmacological treatment.

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Notes

  1. Die Angabe der wissenschaftlichen begründeten Evidenz der vorgeschlagenen Therapieprinzipien erfolgt über die in der Legende der Tab. 2 näher erklärten Symbole (⇑⇑, ⇑, ⇔).

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    F. Bösebeck, G. Möddel, K. Anneken, M. Fischera, S. Evers, E. B. Ringelstein & C. Kellinghaus

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Bösebeck, F., Möddel, G., Anneken, K. et al. Therapierefraktärer Status epilepticus. Nervenarzt 77, 1159–1175 (2006). https://doi.org/10.1007/s00115-006-2125-8

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