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Management des refraktären Status epilepticus

Eine Bestandsaufnahme aus neurologischer und neuropädiatrischer Sicht

Management of refractory status epilepticus from a neurologic and neuropediatric perspective

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Zusammenfassung

Der Status epilepticus ist einer der häufigsten neurologischen Notfälle. Bei 60–70% aller Patienten mit Status epilepticus beendet die Gabe von Benzodiazepinen und Phenytoin die epileptische Aktivität. Die eigentliche Herausforderung ergibt sich erst, wenn der Status epilepticus persistiert und damit refraktär ist. Patienten bedürfen dann häufig der Gabe von anästhesierenden Antiepileptika oder anderer eingreifender Maßnahmen, so dass spätestens ab diesem Zeitpunkt das weitere Management auf einer Intensivstation erfolgen muss. Die Empfehlungen in aktuellen Leitlinien gehen in der Regel detailliert auf die Initialtherapie des Status epilepticus ein und können dabei auf Daten randomisierter kontrollierter Studien zurückgreifen. Das weitere Vorgehen beim refraktären Status epilepticus wird dagegen häufig nur kursorisch dargestellt, hier liegen ausschließlich Daten retrospektiver und unkontrollierter prospektiver Untersuchungen vor. Weil der Status epilepticus jedoch in einem Drittel der Fälle refraktär ist, ist eine Bestandsaufnahme hinsichtlich des weiteren Managements dringend erforderlich. Der epileptologisch und neuropädiatrisch besetzte Königsteiner Arbeitskreis hat sich bei seiner 31. Tagung im März 2006 mit dem klinischen und experimentellen Szenario und den impliziten prognostischen Variablen des refraktären Status epilepticus auseinandergesetzt. Wir möchten die Ergebnisse dieser Diskussionen darstellen und aus neurologischer und neuropädiatrischer Sicht Empfehlungen zum aktuellen und zukünftigen Management des refraktären Status epilepticus aussprechen.

Summary

Status epilepticus is a frequent neurologic emergency that is refractory to benzodiazepines and phenytoin in 60% to 70% of cases. Patients commonly require management in an intensive care unit incorporating aggressive treatment with intravenous anaesthetics. Treatment guidelines commonly comment on initial pharmacologic management in detail, as they can refer to data from randomised controlled trials. In contrast, recommendations for the management of refractory status epilepticus often are sparse, as they rely on data from retrospective or uncontrolled prospective studies only. Since status epilepticus is refractory in every third patient, a critical analysis of the available data and a review focussing on the further management of this condition are urgently needed. The Koenigstein Team, a panel of expert epileptologists and neuropediatricians, discussed at its 31st meeting in March 2006 the clinical and experimental aspects and implicit prognostic variables of refractory status epilepticus. Here we present the results of that discussion and state recommendations from a neurologic and neuropediatric perspective for current und future management of refractory status epilepticus.

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Authors and Affiliations

  1. Epilepsie-Zentrum Bethel, Evangelisches Krankenhaus Bielefeld, Bielefeld, Deutschland

    B. Pohlmann-Eden

  2. Klinik für Neuropädiatrie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    U. Stephani

  3. Klinik für Kinderheilkunde und Jugendmedizin, Abt. für Neuropädiatrie, Universitätsklinikum Tübingen, Tübingen, Deutschland

    I. Krägeloh-Mann

  4. Neuropädiatrie, Universitäts-Kinderklinik Zürich, Zürich, Schweiz

    B. Schmitt

  5. Zentrum für Kinder- und Jugendmedizin, Abt. für Neuropädiatrie, Universitätsklinikum Jena, Jena, Deutschland

    U. Brandl

  6. Klinik für Neurologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    M. Holtkamp

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  1. B. Pohlmann-Eden
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Pohlmann-Eden, B., Stephani, U., Krägeloh-Mann, I. et al. Management des refraktären Status epilepticus. Nervenarzt 78, 871–882 (2007). https://doi.org/10.1007/s00115-007-2257-5

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