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DOI: 10.1055/s-2003-814923
Der Fieberkrampf - aktualisierte Gesichtspunkte unter dem Aspekt der evidenzbasierten Medizin
The Febrile Seizure - Updated Aspects in Relation to Evidence Based MedicinePublikationsverlauf
Publikationsdatum:
28. Juli 2004 (online)
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Zusammenfassung
Fieberkrämpfe stellen die häufigste neurologische Störung des Kindesalters dar. Sie betreffen 2 - 4 % aller Kinder, sind in der Regel harmlos, haben keine entwicklungsrelevanten Konsequenzen und bedürfen insbesondere keiner dauerhaften Therapie. Dem akuten Ereignis des Fieberkrampfes liegt nur äußerst selten eine bakterielle Meningitis zu Grunde. Sie kann zudem durch Anamnese und klinische Untersuchung mit hoher Sicherheit ausgeschlossen werden. Für die Indikation einer Lumbalpunktion geben die Leitlinien der Gesellschaft für Neuropädiatrie (http://www.neuropaediatrie.com) einen Handlungsrahmen. Rund ein Drittel der Kinder erleiden assoziiert zu definierten Risikofaktoren weitere Fieberkrämpfe. Das Risiko der Entwicklung einer späteren Epilepsie nach einfachen Fieberkrämpfen ist allerdings nur marginal erhöht. Die Prognose des Patienten nach dem Auftreten eines einfachen Fieberkrampfes ist nicht von derjenigen eines sonst gesunden Kindes zu unterscheiden. Eine antikonvulsive Dauertherapie zur Verhinderung weiterer Fieberkrämpfe ist nicht indiziert. Die intermittierende Therapie mit Benzodiazepinen bei Fieber ist nur in Ausnahmefällen sinnvoll. Das ohnehin nur gering erhöhte Risiko dieser Kinder später eine Epilepsie zu entwickeln wird durch keine der beiden Maßnahmen gesenkt. Die antipyretische Therapie ist zur Fiebersenkung sinnvoll, verhindert aber nicht das Auftreten von Fieberkrampfrezidiven. Wichtigste Maßnahme nach einem Fieberkrampfereignis ist die beruhigende Aufklärung der Eltern hinsichtlich Ursache und Prognose. Auf die Rezidivmöglichkeit sollte hingewiesen werden. Die Eltern müssen aufgeklärt werden, dass weder häufiges Temperaturmessen noch strikte antipyretische Medikation Fieberkrämpfe zuverlässig verhindern können. Hier gilt es falschen medizinpädagogischen Druck von den Eltern zu nehmen. Als akute Interventionsmaßnahme für den seltenen Fall eines länger als drei Minuten dauernden Anfalls sollte ein Benzodiazepin (z. B. Diazepam rektal) empfohlen werden.
Abstract
Febrile seizures are the most common neurological disorder in childhood, occurring in 2 - 4 % of all children. The incidence of bacterial meningitis as a cause of febrile seizures is below 0.5 % and can be excluded by careful history and thorough clinical examination. Guidelines for the indication of a lumbar puncture are found on the website of the Society of Neuropediatrics (http://www.neuropaediatrie.com). One third of children have recurrent febrile seizures. While the risk for recurrence increases with well-defined conditions, the risk to develop a genuine epilepsy is not substantially increased. The prognosis of patients with simple febrile seizures is good and does not differ from healthy children. Continuous antiepileptic medication is not indicated to prevent further febrile seizures. Only on rare occasions an intermittent anticonvulsive therapy could be justified. Furthermore, the risk of subsequent epilepsy cannot be reduced by chronic or intermittent antiepileptic therapy. Antipyretic treatment is indicated to lower body temperature, but there is no substantial evidence that antipyretic drugs significantly prevent further febrile convulsions. The most important action after a febrile seizure is to inform the parents on the possible causes and assure them that the event has a good prognosis. The possibility of recurrent seizures must be explained. Parents should know that they cannot prevent recurrent febrile seizures by frequent measurements of body temperature and subsequent antipyretic treatment.
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Dr. Christian Mühe
Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie · Dr. von Haunersches Kinderspital der Universität München
Lindwurmstraße 4
80337 München
eMail: christian.muehe@med.uni.muenchen.de