Autonome Funktionsstörungen und Epilepsie

Zusammenfassung

Der plötzliche unerwartete Tod bei Epilepsie (SUDEP) ist definiert als plötzliches unerwartetes Ereignis, das nicht durch andere Ursachen erklärt werden kann und wohl im Zusammenhang mit einem Anfall – nicht jedoch mit einem Status epilepticus – steht. SUDEP ist die häufigste krankheitsbedingte Todesursache bei Patienten mit schwer behandelbarer Epilepsie. Epidemiologische Studien konnten Risikofaktoren für das Auftreten von SUDEP identifizieren. Hierzu zählen z. B. männliches Geschlecht, hohe Anfallsfrequenz, medikamentöse Polytherapie und junges Alter bei Epilepsiebeginn. Als hauptsächliche Pathomechanismen werden eine zentrale Apnoe, kardiale Arrhythmien oder Fehlregulationen im autonomen Nervensystem vermutet. Die einzige wirksam belegte Prophylaxe bei SUDEP ist eine Optimierung der Epilepsietherapie.

Summary

Sudden unexpected death in epilepsy (SUDEP) is defined as a sudden unexpected event which can not be explained by other causes included status epilepticus but may be associated with a seizure. SUDEP is the most frequent disease related cause in patients with refractory epilepsy with incidence rates up to 9 per 1 000 patient-years in pharmaco-resistant epilepsy. Several studies aimed to find risk factors for the appearance of SUDEP. Among others male sex, a high seizure frequency, tonic clonic seizures and polytherapy were identified as risk factors. Potential mechanisms in SUDEP include depressed autonomic function, seizure-related apnoea, cardiac arrhythmia and postictal cardiomyopathy. The only successful prevention of SUDEP is efficacious antiepileptic drug therapy. Further studies have to prove the use of other strategies like cardiac devices and pharmacological modulation of apnoea.

Schlüsselwörter

SUDEP - autonomes Nervensystem - zentrale Apnoe - kardiale Arrhythmie - chronische Epilepsie

Keywords

SUDEP - cardiac arrhythmia - central apnoea - chronic epilepsy

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