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Aktuelle Neurologie 2018; 45(10): 737-748
DOI: 10.1055/a-0591-2214
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Erster epileptischer Anfall im erwerbsfähigen Alter: Prognose-adaptiertes Management

First Epileptic Seizure During Working Age: Prognosis-Adapted Management
Ulrich Specht
Epilepsie-Zentrum Bethel, Krankenhaus Mara, Bielefeld
,
Christian G. Bien
Epilepsie-Zentrum Bethel, Krankenhaus Mara, Bielefeld
› Author Affiliations
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Publication History

Publication Date:
25 April 2018 (online)

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Zusammenfassung

Hintergrund Die Frage des angemessenen Managements nach einem ersten epileptischen Anfall verursacht nicht selten Unsicherheit. Dies betrifft vier Themenbereiche: die Diagnostik; die Einschätzung des Rezidivrisikos; die Beratung des Patienten bezüglich einer antiepileptischen Pharmakotherapie sowie deren weiterer ärztlicher Begleitung; und die sozialmedizinische Bewertung (Fahreignung, berufliche Eignung).

Methodik Zusammenfassung der relevanten Datenlage zu diesen Themenfeldern und daraus abgeleitete Empfehlungen zum praktischen Umgang mit ersten epileptischen Anfällen im erwerbsfähigen Alter.

Ergebnis Nach der Klärung, ob es sich um einen epileptischen Anfall gehandelt hat, dient die Diagnostik einerseits dazu, akut-symptomatische und potenziell behandlungsbedürftige Ursachen zu erkennen, andererseits zur Abschätzung des Rezidivrisikos. Dieses hängt weniger davon ab, ob eine Epilepsie diagnostiziert werden kann. Risikoerhöhend sind vielmehr – auch additiv – das Vorliegen folgender Merkmale: epilepsietypische Aktivität im EEG, bildgebender Nachweis einer Hirnläsion, zerebrale Vorerkrankung oder Auftreten des Anfalls aus dem Schlaf. Je höher das Rezidivrisiko, desto stärker scheint der rezidivprophylaktische Effekt einer antiepileptischen Pharmakotherapie zu sein und desto eher wird man dafür optieren. Die Entscheidung hierüber wird gemeinsam mit dem Patienten getroffen unter Berücksichtigung seiner Präferenzen und seiner sozialen Situation (z. B. Angewiesensein auf die Fahreignung, berufliche Besonderheiten). In der weiteren Begleitung kommt der Sicherung der Adhärenz eine entscheidende Rolle zu. Für die Frist bis zur Wiedererlangung der Fahreignung und der Eignung, bestimmte berufliche Tätigkeiten (wieder) auszuüben, gibt es verbindliche Regelungen.

Abstract

Background Appropriate management after the first epileptic seizure often causes uncertainty in diagnostics, the assessment of the risk of recurrence, patient counselling on antiepileptic pharmacotherapy as well as further medical supervision and the assessment of driving ability and job suitability.

Methodology Summary of the relevant data on these topics and recommendations derived therefrom for the practical handling of first epileptic seizures at working age.

Results After identifying the epileptic nature of the seizure, diagnostics aims at identifying acute-symptomatic and potential treatment-requiring causes; in addition, it enables estimation of risk of seizure recurrence. This risk depends less on whether “epilepsy” can be diagnosed; rather, the following points indicate an increased recurrence risk: epileptiform activity in the EEG, imaging evidence of a potentially epileptogenic brain lesion, existing cerebral neurological disease, or onset of seizure from sleep. The higher the risk of recurrence, the stronger seems the prophylactic effect so that earlier antiepileptic pharmacotherapy will be considered. The decision on this is taken together with the patient, taking into account his preferences and his social situation (driving license, job characteristics). With subsequent medical supervision, the assurance of adherence plays a crucial role. There are regulations regarding the seizure-free period before reapplying for a driverʼs license and carrying out certain occupational activities.

Schlüsselwörter

erster epileptischer Anfall - Epilepsie - EEG - Prognose - Fahreignung

Keywords

first epileptic seizure - epilepsy - EEG - prognosis - driving ability
 

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