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In der neuen S2k-Leitlinie „Erster epileptischer Anfall und Epilepsien im Erwachsenenalter“ werden Empfehlungen zu klinisch relevanten Fragestellungen in fünf großen Themenblöcken gegeben: Management erster epileptischer Anfall, Pharmakotherapie, Epilepsiechirurgie, komplementäre und supportive Therapieverfahren und psychosoziale Aspekte.

The new S2k guideline “First epileptic seizure and epilepsies in adulthood” provides recommendations on clinically relevant issues in five major topics: management of first epileptic seizures, pharmacotherapy, epilepsy surgery, complementary and supportive treatment, and psychosocial aspects.

Seit September 2023 liegt die neue S2k-Leitlinie „Erster epileptischer Anfall und Epilepsien im Erwachsenenalter“ vor, die die „alte“ S1-Leitlinie ersetzt. Detaillierte Empfehlungen zu vielfältigen Aspekten der Diagnostik, Therapien und Komorbiditäten sowie zu psychosozialen Aspekten der Epilepsie wurden im Rahmen einer strukturierten Konsensusfindung von einer repräsentativen, multiprofessionellen Leitliniengruppe mit 66 Mitgliedern erarbeitet und abgestimmt. Die methodische Vorgehensweise bei der Entwicklung dieser Leitlinie und deren Dokumentation folgte dem Leitfaden der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) zur „Erstellung des Leitlinienreports für für Autor*innen von S2k, S2e und S3-Leitlinien“ und „AWMF-Regelwerk Leitlinien 2.0“ z. B. hinsichtlich der Graduierung der Empfehlungsstärke und der Konsensstärke. Transparenz hinsichtlich potenzieller Interessenkonflikte ist eine wichtige Voraussetzung für die Vertrauenswürdigkeit von Leitlinien und damit auch für deren Akzeptanz. Potenzielle Interessenkonflikte und dadurch bedingte Einschränkungen in der Mitarbeit an der Leitlinienentwicklung sind im Leitlinienreport detailliert dokumentiert. Die Leitlinie wurde durch die DGN und AWMF begutachtet und durch die Vorstände der beteiligten Fachgesellschaften verabschiedet. Der Anspruch der Leitlinie, die medizinische Versorgung von Menschen mit Epilepsie zu verbessern, setzt voraus, dass diese dem Adressatenkreis bekannt ist. Hierzu wurde bzw. wird die Leitlinie auf den Internetseiten der AWMF, Deutschen Gesellschaft für Epileptologie (DGfE), DGN und anderer Fachgesellschaften veröffentlicht. Von der DGfE wurde die Kampagne „Wegweiser Epilepsie“ mit Videoclips und Textbeiträgen auf der Homepage der Fachgesellschaft umgesetzt, um die Leitlinie gegenüber einer größeren Öffentlichkeit bekannt zu machen.

Following electrode implantation, a subgroup of patients treated with deep brain stimulation (DBS) for focal epilepsy exhibits a reduction of seizure frequency before stimulation is initiated. Microlesioning of the target structure has been postulated to be the cause of this “insertional” effect (IE). We examined the occurrence and duration of this IE in a group of patients with focal epilepsy following electrode implantation in the anterior nuclei of the thalamus (ANT) and/or nucleus accumbens (NAC) for DBS treatment. Changes in monthly seizure frequency compared to preoperative baseline were assessed one month (14 patients) and five months (four patients) after electrode implantation. A group analysis between patients with implantation of bilateral ANT‐electrodes (four patients), NAC‐electrodes (one patient) as well as ANT and NAC‐electrodes (nine patients) was performed. In this cohort, seizure frequency decreased one month after electrode implantation by 57.1 ± 30.1%, p≤ 0.001 (compared to baseline). No significant difference within stimulation target subcohorts was found (p> 0.05). Out of the four patients without stimulation for five months following electrode insertion, three patients showed seizure frequency reduction lasting two to three months, while blinded to their stimulation status. An IE might explain seizure frequency reduction in our cohort. This effect seems to be independent of the number of implanted electrodes and of the target itself. The time course of the blinded subgroup of epilepsy patients suggests a peak of the lesional effect at two to three months after electrode insertion.

Stroke is one of the commonest causes of seizures and epilepsy, mainly among the elderly and adults. This seminar paper aims to provide an updated overview of post‐stroke seizures and post‐stroke epilepsy (PSE) and offers clinical guidance to anyone involved in the treatment of patients with seizures and stroke. The distinction between acute symptomatic seizures occurring within seven days from stroke (early seizures) and unprovoked seizures occurring afterwards (late seizures) is crucial regarding their different risks of recurrence. A single late post‐stroke seizure carries a risk of recurrence as high as 71.5% (95% confidence interval: 59.7–81.9) at ten years and is diagnostic of PSE. Several clinical and stroke characteristics are associated with increased risk of post‐stroke seizures and PSE. So far, there is no evidence supporting the administration of antiepileptic drugs as primary prevention, and evidence regarding their use in PSE is scarce.

Currently, the relevance of EEG measurements in acute stroke patients is considered low in clinical practice. However, recent studies on the predictive value of EEG measurements after stroke for various outcomes may increase the role of EEG in patients with stroke. We aimed to review the current literature on the utility of EEG measurements after stroke as a tool to predict outcome and complications, focusing on studies in which the EEG measurement was performed in the acute phase after the event and in which long-term outcome measures were reported. In our literature review, we identified 4 different outcome measures (functional outcome, mortality, development of post-stroke cognitive decline, and development of post-stroke epilepsy) where studies on the utility of acute EEG measurements exist. There is a large body of evidence for the prediction of functional outcome, in which a multitude of associated quantitative and qualitative EEG parameters are described. In contrast, only few studies focus on mortality as outcome parameter. We found studies of high methodical quality on the prediction of post-stroke cognitive decline, though the number of patients in these studies often was small. The role of EEG as a prediction tool for seizures and epilepsy after stroke could increase after a recently published study, especially if its result can be incorporated into already existing post-stroke epilepsy prediction tools. In summary, EEG is useful for the prediction of functional outcome, mortality, development of post-stroke cognitive decline and epilepsy, even though there is a discrepancy between the large amount of studies on EEG in acute stroke patients and its underuse in clinical practice.

ObjectivesDepending on patient age at onset, absence epilepsy is subdivided into childhood and juvenile forms. Absence seizures can occur several times per day (pyknoleptic course) or less frequently than daily (non-pyknoleptic course). Seizures typically terminate before adulthood, but a quarter of patients need ongoing treatment beyond adolescence. Little is known about their long-term seizure and psychosocial outcome.MethodsFiles of 135 outpatients with absence epilepsy (76 females; 123 had additional generalised tonic–clonic seizures) were retrospectively analysed after a median follow-up of 45.4 years (IQR: 31.9–56.2). Eighty-two subjects completed an additional interview. Patients were dichotomised according to age at epilepsy onset (childhood: n=82; juvenile: n=53) and course of absence seizures (pyknoleptic: n=80; non-pyknoleptic: n=55).ResultsAmong all patients, 53% achieved 5-year terminal seizure remission, 16% without antiepileptic medication. Median age at last seizure was lower in patients with childhood onset of absence epilepsy (37.7 years) versus juvenile onset (44.4 years; P≤0.01). However, rates and duration of terminal seizure remission were similar. Pyknoleptic versus non-pyknoleptic course of absence seizures made no difference for long-term seizure outcome. Multivariate analysis identified only higher age at investigation to be associated with terminal 5-year seizure remission. Regarding aspects of psychosocial outcome, there were no significant differences between the respective subgroups.ConclusionsThese data indicate that if absence epilepsy persists beyond adolescence, long-term seizure and psychosocial outcome do not differ between childhood and juvenile onset or between pyknoleptic and non-pyknoleptic course of absence epilepsy. However, higher patient age increases the chance of terminal seizure remission.

Background Following stroke, acute symptomatic seizures (manifestation within seven days) and epilepsy, i.e. occurrence of at least one unprovoked seizure (manifestation after more than seven days), are reported in 3–6% and up to 12% of patients, respectively. Incidence of acute symptomatic seizures is higher in intracranial haemorrhage (10–16%) than in ischaemic stroke (2–4%). Acute symptomatic seizures and unprovoked seizure may be associated with unfavourable functional outcome and increased mortality. In view of the clinical relevance, the European Stroke Organisation has issued evidence-based guidelines on the management of post-stroke seizures and epilepsy.Method A writing committee of six clinicians and researchers from five European countries and Israel identified seven questions relating to prevention of (further) post-stroke seizures and epilepsy and to amelioration of functional outcome and prevention of mortality. Recommendations are based on findings in randomised controlled trials and observational studies using the grading of recommendations assessment, development and evaluation approach.Results In the absence of adequately powered randomised controlled trials, evidence for all recommendations is very low. Based on findings in observational studies, some weak recommendations have been made. In most instances, we suggest not to administer antiepileptic drugs. Due to high incidence of seizure recurrence after one post-stroke unprovoked seizure, secondary antiepileptic drugs prophylaxis needs to be considered.Conclusion Due to very low evidence, these guidelines only give some weak recommendations on prevention of occurrence and recurrence of post-stroke acute symptomatic seizures and unprovoked seizure. Adequately powered randomised controlled trials are required to assess interventions for post-stroke seizure management.

We investigated whether a critical rise of intracranial pressure (ICP) leading to a loss of cerebral perfusion pressure (CPP) could serve as a surrogate marker of brain death (BD).

Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized epilepsy subsyndrome, contributing to approximately 3 to 11 of adolescent and adult cases of epilepsy. However, little is known about the long-term medical evolution of this clinical entity. The aim of this study was to analyze long-term outcome in a clinically well-defined series of patients with JME for seizure evolution and predictors of seizure outcome.

Die Epilepsie ist nach dem Schlaganfall die zweithäufigste neurologische Krankheit. Damit ist die Wahrscheinlichkeit, im Pflegealltag einen epileptischen Anfall zu sehen, hoch. Es gibt aber keinen Grund, Angst vor einem epileptischen Anfall zu haben. Der folgende Beitrag zeigt auf, wie unter- schiedlich sich epileptische Anfälle äußern können, welche Behandlungsmöglichkeiten es gibt und wie Sie damit richtig umgehen.

Status epilepticus is one of the most common emergencies in neurology, and every third patient does not respond to adequate first-line treatment. Refractory status epilepticus may be associated with increased morbidity and mortality, and new treatment options are urgently required. This review critically discusses recently published data regarding the role of ‘new’ antiepileptic drugs, the efficacy and safety of anesthetic agents, and the overall clinical outcome that is an integral part of treatment decisions.

Status epilepticus refractory to first and second-line anticonvulsants represents an outstanding challenge to the medical team. This review covers new insights into the anaesthetic and intensive care of status epilepticus.

Status epilepticus is commonly refractory to first‐line therapy, and thus better treatments are needed. We have investigated an experimental model of drug‐resistant self‐sustaining status epilepticus (SSSE) induced by 2 hours of perforant path stimulation. Propofol in subanesthetic doses administered shortly after the end of stimulation and also after a further 3 hours of SSSE terminated the SSSE without recurrence. This finding calls for a trial of propofol in refractory status epilepticus and also raises the possibility of using it as first‐line therapy. Ann Neurol 2001;49:260–263

Episodes of psychogenic nonepileptic status epilepticus (PNESE) characterized by pronounced generalized motor features were compared with those of refractory generalized convulsive status epilepticus. Patients with PNESE were younger, had port systems implanted more frequently, received higher doses of benzodiazepines until seizure termination or respiratory failure, and had lower serum creatine kinase levels.