Kognitive Defizite und psychiatrische Störungen in Frühstadien epileptischer Erkrankungen

 

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Zusammenfassung

Hinweise auf das Vorliegen kognitiver Störungen bereits am Beginn epileptischer Erkrankungen lassen sich bereits aus theoretischen Erwägungen (Vorhandensein einer zugrunde liegenden Hirnläsion, genetische Determination, Auswirkung interiktaler epileptischer Aktivität im EEG) gewinnen. Für die vorliegende Arbeit wurde die Literatur zu kognitiven Defiziten bei genetisch determinierten Epilepsiesyndromen und dem Vorliegen kognitiver oder psychischer Störungen am Beginn einer Epilepsie sowohl im Erwachsenenalter als auch im Kindesalter durchgesehen. In mehreren Tiermodellen wurden Hinweise auf das Auftreten von Gedächtnisstörungen oder Lernbehinderungen vor der Manifestation epileptischer Anfälle, die teilweise auch als Äquivalent eines Aufmerksamkeitsdefizits-Hyperaktivitäts-Syndroms angesehen werden können, gefunden. Bei den familiären Frontallappenepilepsien sind spezifische Verbindungen einzelner Mutationen mit Mustern kognitiver, aber auch psychischer Störungen beschrieben. Kognitive Defizite am Beginn einer Epilepsie im Erwachsenenalter sind insbesondere im Bereich des verzögerten Abrufs im Verbalgedächtnis sowie für die selektive Aufmerksamkeit und die psychomotorische Geschwindigkeit wiederholt beschrieben. Depressionen bzw. Suizidversuche treten bereits im Vorfeld gehäuft auf. Im Kindesalter werden Hinweise auf kognitive Defizite auch in Form von Verhaltensauffälligkeiten gesehen und teilweise ebenfalls retrospektiv im Vorfeld der Manifestation einer Epilepsie beschrieben. Obwohl Hinweise für die Bedeutung verbaler Gedächtnisstörungen am Beginn einer Epilepsie als Risikofaktor für die Entwicklung eines therapierefraktären Verlaufs vorliegen, kann aufgrund der vorliegenden Studien noch nichts über die Bedeutung kognitiver Defizite oder psychiatrischer Störungen im Umfeld eines ersten unprovozierten Anfalls für die Entwicklung einer Epilepsie ausgesagt werden.

Abstract

From a theoretical point of view it may be hypothezised that cognitive deficits are not uncommon in patients with new-onset epilepsy since causative brain lesions, genetic influences and interictal epileptic activity are likely to exist even before the first unprovoked seizure. We reviewed the literature concerning cognitive deficits in genetically determined epilepsy-syndromes and studies on cognitive and psychiatric deficits in patients with new-onset epilepsy. In several animal models hints of memory deficits or learning disorders even before the manifestation of epileptic seizures were found. Some learning disorders showed characteristics of the human attention-deficit-hyperactivity-disorder. In familial frontal epilepsies specific associations between cognitive deficits as well as psychiatric syndromes and certain mutations were described. Cognitive deficits in adult patients with new-onset epilepsy were described several times with regard to delayed recall in verbal memory, selective attention and psychomotor performance. Depression and suicide attempts were increased before the first seizure. In childhood cognitive deficits were regarded as causative factors for behavioral problems, which sometimes were even found before the first recognized seizure. Verbal memory deficits at the onset of epilepsy seemed to be a risk factor for the development of a therapy refractory course. But on the basis of the published data it is impossible to state whether cognitive deficits after a first unprovoked seizure in adulthood indicate an increased risk of recurrent seizures apart from the results of MRI and EEG studies.

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Dr. med. Dr. phil. Johannes Rösche, MA

Klinik und Poliklinik für Neurologie, Universität Rostock

Gehlsheimer Str. 20

18147 Rostock

Email: johannes.roesche@med.uni-rostock.de