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Erschienen in: NeuroTransmitter 2/2018

06.02.2018 | Epilepsie | Zertifizierte Fortbildung

Epilepsie

Was können Labor- und EEG-Diagnostik beim ersten epileptischen Anfall leisten?

verfasst von: PD Dr. med. Jan Rémi, PD Dr. med. Rainer Surges

Erschienen in: NeuroTransmitter | Ausgabe 2/2018

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Zusammenfassung

Bei einem ersten epileptischen Anfall sind neben Anamnese und zerebraler Bildgebung vor allem auch klinische Laboruntersuchungen und das EEG wichtige Informationsquellen in der Diagnostik. Sie können die Diagnose eines epileptischen Anfalls stützen oder zeigen das Vorliegen einer Epilepsie auf. Dabei müssen allerdings Schwellenwerte, Sensitivität und Spezifität richtig eingeschätzt werden.
Literatur
1.
2.
Zurück zum Zitat Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality. Epilepsia 2008;49 Suppl 1:8–12.CrossRefPubMed Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality. Epilepsia 2008;49 Suppl 1:8–12.CrossRefPubMed
3.
Zurück zum Zitat Xu Y, Nguyen D, Mohamed A, Carcel C, Li Q, Kutlubaev MA, et al. Frequency of a false positive diagnosis of epilepsy: A systematic review of observational studies. Seizure 2016;41:167–74.CrossRefPubMed Xu Y, Nguyen D, Mohamed A, Carcel C, Li Q, Kutlubaev MA, et al. Frequency of a false positive diagnosis of epilepsy: A systematic review of observational studies. Seizure 2016;41:167–74.CrossRefPubMed
4.
5.
Zurück zum Zitat Krumholz A, Cole AJ, Shinnar S, French J, Gronseth G, Wiebe S, et al. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy SocietyCommentary Author Response. Neurology 2015;85(17):1526–7.CrossRefPubMed Krumholz A, Cole AJ, Shinnar S, French J, Gronseth G, Wiebe S, et al. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy SocietyCommentary Author Response. Neurology 2015;85(17):1526–7.CrossRefPubMed
6.
Zurück zum Zitat Hopkins A, Garman A, Clarke C. The first seizure in adult life. Value of clinical features, electroencephalography, and computerised tomographic scanning in prediction of seizure recurrence. Lancet. 1988;1(8588):721–6.CrossRefPubMed Hopkins A, Garman A, Clarke C. The first seizure in adult life. Value of clinical features, electroencephalography, and computerised tomographic scanning in prediction of seizure recurrence. Lancet. 1988;1(8588):721–6.CrossRefPubMed
7.
Zurück zum Zitat Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F. Value of tongue biting in the diagnosis of seizures. Arch Intern Med 1995;155(21):2346–9.CrossRefPubMed Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F. Value of tongue biting in the diagnosis of seizures. Arch Intern Med 1995;155(21):2346–9.CrossRefPubMed
8.
Zurück zum Zitat Turnbull TL, Vanden Hoek TL, Howes DS, Eisner RF. Utility of laboratory studies in the emergency department patient with a new-onset seizure. Ann Emerg Med 1990;19(4):373–7.CrossRefPubMed Turnbull TL, Vanden Hoek TL, Howes DS, Eisner RF. Utility of laboratory studies in the emergency department patient with a new-onset seizure. Ann Emerg Med 1990;19(4):373–7.CrossRefPubMed
9.
Zurück zum Zitat Tardy B, Lafond P, Convers P, Page Y, Zeni F, Viallon A, et al. Adult first generalized seizure: etiology, biological tests, EEG, CT scan, in an ED. Am J Emerg Med. 1995;13(1):1–5.CrossRefPubMed Tardy B, Lafond P, Convers P, Page Y, Zeni F, Viallon A, et al. Adult first generalized seizure: etiology, biological tests, EEG, CT scan, in an ED. Am J Emerg Med. 1995;13(1):1–5.CrossRefPubMed
10.
Zurück zum Zitat Nass RD, Sassen R, Elger CE, Surges R. The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure 2017;47:51–65.CrossRefPubMed Nass RD, Sassen R, Elger CE, Surges R. The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure 2017;47:51–65.CrossRefPubMed
11.
Zurück zum Zitat Kyriakides T, Angelini C, Schaefer J, Sacconi S, Siciliano G, Vilchez JJ, et al. EFNS guidelines on the diagnostic approach to pauci- or asymptomatic hyperCKemia. Eur J Neurol 2010;17(6):767–73.CrossRefPubMed Kyriakides T, Angelini C, Schaefer J, Sacconi S, Siciliano G, Vilchez JJ, et al. EFNS guidelines on the diagnostic approach to pauci- or asymptomatic hyperCKemia. Eur J Neurol 2010;17(6):767–73.CrossRefPubMed
12.
Zurück zum Zitat Wyllie E, Lueders H, Pippenger C, VanLente F. Postictal serum creatine kinase in the diagnosis of seizure disorders. Arch Neurol 1985;42(2):123–6.CrossRefPubMed Wyllie E, Lueders H, Pippenger C, VanLente F. Postictal serum creatine kinase in the diagnosis of seizure disorders. Arch Neurol 1985;42(2):123–6.CrossRefPubMed
13.
Zurück zum Zitat Brigo F, Igwe SC, Erro R, Bongiovanni LG, Marangi A, Nardone R, et al. Postictal serum creatine kinase for the differential diagnosis of epileptic seizures and psychogenic non-epileptic seizures: a systematic review. J Neurol 2015;262(2):251–7.CrossRefPubMed Brigo F, Igwe SC, Erro R, Bongiovanni LG, Marangi A, Nardone R, et al. Postictal serum creatine kinase for the differential diagnosis of epileptic seizures and psychogenic non-epileptic seizures: a systematic review. J Neurol 2015;262(2):251–7.CrossRefPubMed
14.
Zurück zum Zitat Brewster LM, Mairuhu G, Sturk A, van Montfrans GA. Distribution of creatine kinase in the general population: Implications for statin therapy. Am Heart J 2007 O;154(4):655–61.CrossRefPubMed Brewster LM, Mairuhu G, Sturk A, van Montfrans GA. Distribution of creatine kinase in the general population: Implications for statin therapy. Am Heart J 2007 O;154(4):655–61.CrossRefPubMed
15.
Zurück zum Zitat Goksu E, Oktay C, Kilicaslan I, Kartal M. Seizure or syncope: the diagnostic value of serum creatine kinase and myoglobin levels. Eur J Emerg Med 2009;16(2):84–6.CrossRefPubMed Goksu E, Oktay C, Kilicaslan I, Kartal M. Seizure or syncope: the diagnostic value of serum creatine kinase and myoglobin levels. Eur J Emerg Med 2009;16(2):84–6.CrossRefPubMed
16.
Zurück zum Zitat Petramfar P, Yaghoobi E, Nemati R, Asadi-Pooya AA. Serum creatine phosphokinase is helpful in distinguishing generalized tonic-clonic seizures from psychogenic nonepileptic seizures and vasovagal syncope. Epilepsy Behav 2009;15(3):330–2.CrossRefPubMed Petramfar P, Yaghoobi E, Nemati R, Asadi-Pooya AA. Serum creatine phosphokinase is helpful in distinguishing generalized tonic-clonic seizures from psychogenic nonepileptic seizures and vasovagal syncope. Epilepsy Behav 2009;15(3):330–2.CrossRefPubMed
17.
Zurück zum Zitat Molaie M, Culebras A, Miller M. Nocturnal plasma prolactin and cortisol levels in epileptics with complex partial seizures and primary generalized seizures. Arch Neurol 1987;44(7):699–702.CrossRefPubMed Molaie M, Culebras A, Miller M. Nocturnal plasma prolactin and cortisol levels in epileptics with complex partial seizures and primary generalized seizures. Arch Neurol 1987;44(7):699–702.CrossRefPubMed
18.
Zurück zum Zitat Parra A, Velasco M, Cervantes C, Muñoz H, Cerbón MA, Velasco F. Plasma prolactin increase following electric stimulation of the amygdala in humans. Neuroendocrinology 1980;31(1):60–5.CrossRefPubMed Parra A, Velasco M, Cervantes C, Muñoz H, Cerbón MA, Velasco F. Plasma prolactin increase following electric stimulation of the amygdala in humans. Neuroendocrinology 1980;31(1):60–5.CrossRefPubMed
19.
Zurück zum Zitat Chen DK, So YT, Fisher RS, Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Use of serum prolactin in diagnosing epileptic seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2005;65(5):668–75.CrossRefPubMed Chen DK, So YT, Fisher RS, Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Use of serum prolactin in diagnosing epileptic seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2005;65(5):668–75.CrossRefPubMed
20.
Zurück zum Zitat Oribe E, Amini R, Nissenbaum E, Boal B. Serum prolactin concentrations are elevated after syncope. Neurology 1996;47(1):60–2.CrossRefPubMed Oribe E, Amini R, Nissenbaum E, Boal B. Serum prolactin concentrations are elevated after syncope. Neurology 1996;47(1):60–2.CrossRefPubMed
21.
Zurück zum Zitat Bazil CW, Short D, Crispin D, Zheng W. Patients with intractable epilepsy have low melatonin, which increases following seizures. Neurology 2000;55(11):1746–8.CrossRefPubMedPubMedCentral Bazil CW, Short D, Crispin D, Zheng W. Patients with intractable epilepsy have low melatonin, which increases following seizures. Neurology 2000;55(11):1746–8.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Hazouard E, Dequin PF, Lanotte R, Legras A, Ferrandière M, Perrotin D. [Losing consciousness: role of the venous lactate levels in the diagnosis of convulsive crises]. Presse Med. 1998;27(13):604–7.PubMed Hazouard E, Dequin PF, Lanotte R, Legras A, Ferrandière M, Perrotin D. [Losing consciousness: role of the venous lactate levels in the diagnosis of convulsive crises]. Presse Med. 1998;27(13):604–7.PubMed
23.
Zurück zum Zitat Matz O, Zdebik C, Zechbauer S, Bündgens L, Litmathe J, Willmes K, et al. Lactate as a diagnostic marker in transient loss of consciousness. Seizure 2016;40:71–5.CrossRefPubMed Matz O, Zdebik C, Zechbauer S, Bündgens L, Litmathe J, Willmes K, et al. Lactate as a diagnostic marker in transient loss of consciousness. Seizure 2016;40:71–5.CrossRefPubMed
24.
Zurück zum Zitat Zisimopoulou V, Mamali M, Katsavos S, Siatouni A, Tavernarakis A, Gatzonis S. Cerebrospinal fluid analysis after unprovoked first seizure. Funct Neurol 2016;31(2):101–7.PubMedPubMedCentral Zisimopoulou V, Mamali M, Katsavos S, Siatouni A, Tavernarakis A, Gatzonis S. Cerebrospinal fluid analysis after unprovoked first seizure. Funct Neurol 2016;31(2):101–7.PubMedPubMedCentral
25.
Zurück zum Zitat Noachtar S, Rémi J. The role of EEG in epilepsy: a critical review. Epilepsy Behav 2009;15(1):22–33.CrossRefPubMed Noachtar S, Rémi J. The role of EEG in epilepsy: a critical review. Epilepsy Behav 2009;15(1):22–33.CrossRefPubMed
26.
Zurück zum Zitat Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014;55(4):475–82.CrossRefPubMed Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014;55(4):475–82.CrossRefPubMed
27.
Zurück zum Zitat Noachtar S, Borggraefe I. Epilepsy surgery: a critical review. Epilepsy Behav 2009;15(1):66–72.CrossRefPubMed Noachtar S, Borggraefe I. Epilepsy surgery: a critical review. Epilepsy Behav 2009;15(1):66–72.CrossRefPubMed
28.
Zurück zum Zitat Gelisse P, Genton P, Kuate C, Pesenti A, Baldy-Moulinier M, Crespel A. Worsening of Seizures by Oxcarbazepine in Juvenile Idiopathic Generalized Epilepsies. Epilepsia 2004;45(10):1282–6.CrossRefPubMed Gelisse P, Genton P, Kuate C, Pesenti A, Baldy-Moulinier M, Crespel A. Worsening of Seizures by Oxcarbazepine in Juvenile Idiopathic Generalized Epilepsies. Epilepsia 2004;45(10):1282–6.CrossRefPubMed
29.
Zurück zum Zitat Rémi J, Stoyke C, Noachtar S. Juvenile myoclonic epilepsy is often treated inadequately. Zeitschrift fur Epileptol. 2008;21(1). Rémi J, Stoyke C, Noachtar S. Juvenile myoclonic epilepsy is often treated inadequately. Zeitschrift fur Epileptol. 2008;21(1).
30.
Zurück zum Zitat Benbadis SR, LaFrance WC, Papandonatos GD, Korabathina K, Lin K, Kraemer HC. Interrater reliability of EEG-video monitoring. Neurology 2009;73(11):843–6.CrossRefPubMedPubMedCentral Benbadis SR, LaFrance WC, Papandonatos GD, Korabathina K, Lin K, Kraemer HC. Interrater reliability of EEG-video monitoring. Neurology 2009;73(11):843–6.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat van Donselaar CA, Schimsheimer RJ, Geerts AT, Declerck AC. Value of the electroencephalogram in adult patients with untreated idiopathic first seizures. Arch Neurol 1992;49(3):231–7.CrossRefPubMed van Donselaar CA, Schimsheimer RJ, Geerts AT, Declerck AC. Value of the electroencephalogram in adult patients with untreated idiopathic first seizures. Arch Neurol 1992;49(3):231–7.CrossRefPubMed
32.
Zurück zum Zitat Benbadis SR. Errors in EEGs and the misdiagnosis of epilepsy: Importance, causes, consequences, and proposed remedies. Epilepsy Behav 2007;11(3):257–62.CrossRefPubMed Benbadis SR. Errors in EEGs and the misdiagnosis of epilepsy: Importance, causes, consequences, and proposed remedies. Epilepsy Behav 2007;11(3):257–62.CrossRefPubMed
33.
Zurück zum Zitat Rémi J, Vollmar C, de Marinis A, Heinlin J, Peraud A, Noachtar S. Congruence and discrepancy of interictal and ictal EEG with MRI lesions in focal epilepsies. Neurology 2011;77(14):1383–90.CrossRefPubMed Rémi J, Vollmar C, de Marinis A, Heinlin J, Peraud A, Noachtar S. Congruence and discrepancy of interictal and ictal EEG with MRI lesions in focal epilepsies. Neurology 2011;77(14):1383–90.CrossRefPubMed
34.
Zurück zum Zitat Goodin DS, Aminoff MJ. Does the interictal EEG have a role in the diagnosis of epilepsy? Lancet 1984;1(8381):837–9.CrossRefPubMed Goodin DS, Aminoff MJ. Does the interictal EEG have a role in the diagnosis of epilepsy? Lancet 1984;1(8381):837–9.CrossRefPubMed
35.
Zurück zum Zitat Salinsky M, Kanter R, Dasheiff RM. Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve. Epilepsia 1987;28(4):331–4.CrossRefPubMed Salinsky M, Kanter R, Dasheiff RM. Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve. Epilepsia 1987;28(4):331–4.CrossRefPubMed
36.
Zurück zum Zitat Sofat P, Teter B, Kavak KS, Gupta R, Li P. Time interval providing highest yield for initial EEG in patients with new onset seizures. Epilepsy Res 2016;127:229–32.CrossRefPubMed Sofat P, Teter B, Kavak KS, Gupta R, Li P. Time interval providing highest yield for initial EEG in patients with new onset seizures. Epilepsy Res 2016;127:229–32.CrossRefPubMed
37.
Zurück zum Zitat Burkholder DB, Britton JW, Rajasekaran V, Fabris RR, Cherian PJ, Kelly-Williams KM, et al. Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges. Neurology 2016;86(16):1524–30.CrossRefPubMedPubMedCentral Burkholder DB, Britton JW, Rajasekaran V, Fabris RR, Cherian PJ, Kelly-Williams KM, et al. Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges. Neurology 2016;86(16):1524–30.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Werhahn KJ, Hartl E, Hamann K, Breimhorst M, Noachtar S. Latency of interictal epileptiform discharges in long-term EEG recordings in epilepsy patients. Seizure 2015;29:20–5.CrossRefPubMed Werhahn KJ, Hartl E, Hamann K, Breimhorst M, Noachtar S. Latency of interictal epileptiform discharges in long-term EEG recordings in epilepsy patients. Seizure 2015;29:20–5.CrossRefPubMed
39.
Zurück zum Zitat Faulkner HJ, Arima H, Mohamed A. Latency to first interictal epileptiform discharge in epilepsy with outpatient ambulatory EEG. Clin Neurophysiol 2012;123(9):1732–5.CrossRefPubMed Faulkner HJ, Arima H, Mohamed A. Latency to first interictal epileptiform discharge in epilepsy with outpatient ambulatory EEG. Clin Neurophysiol 2012;123(9):1732–5.CrossRefPubMed
40.
Zurück zum Zitat Verrotti A, Beccaria F, Fiori F, Montagnini A, Capovilla G. Photosensitivity: epidemiology, genetics, clinical manifestations, assessment, and management. 2012;14(4):349–62. Verrotti A, Beccaria F, Fiori F, Montagnini A, Capovilla G. Photosensitivity: epidemiology, genetics, clinical manifestations, assessment, and management. 2012;14(4):349–62.
41.
Zurück zum Zitat Kasteleijn-Nolst Trenité D, Rubboli G, Hirsch E, Martins da Silva A, Seri S, Wilkins A, et al. Methodology of photic stimulation revisited: updated European algorithm for visual stimulation in the EEG laboratory. Epilepsia 2012;53(1):16–24.CrossRefPubMed Kasteleijn-Nolst Trenité D, Rubboli G, Hirsch E, Martins da Silva A, Seri S, Wilkins A, et al. Methodology of photic stimulation revisited: updated European algorithm for visual stimulation in the EEG laboratory. Epilepsia 2012;53(1):16–24.CrossRefPubMed
42.
Zurück zum Zitat Dalby MA. Epilepsy and 3 per second spike and wave rhythms. A clinical, electroencephalographic and prognostic analysis of 346 patients. Acta Neurol Scand 1969;Suppl 40:3. Dalby MA. Epilepsy and 3 per second spike and wave rhythms. A clinical, electroencephalographic and prognostic analysis of 346 patients. Acta Neurol Scand 1969;Suppl 40:3.
43.
Zurück zum Zitat Malow Ba, Selwa LM, Ross D, Aldrich MS. Lateralizing value of interictal spikes on overnight sleep-EEG studies in temporal lobe epilepsy. Epilepsia 1999;40(11):1587–92.CrossRefPubMed Malow Ba, Selwa LM, Ross D, Aldrich MS. Lateralizing value of interictal spikes on overnight sleep-EEG studies in temporal lobe epilepsy. Epilepsia 1999;40(11):1587–92.CrossRefPubMed
44.
Zurück zum Zitat Fountain NB, Kim JS, Lee SI. Sleep deprivation activates epileptiform discharges independent of the activating effects of sleep. J Clin Neurophysiol 1998;15(1):69–75.CrossRefPubMed Fountain NB, Kim JS, Lee SI. Sleep deprivation activates epileptiform discharges independent of the activating effects of sleep. J Clin Neurophysiol 1998;15(1):69–75.CrossRefPubMed
Metadaten
Titel
Epilepsie
Was können Labor- und EEG-Diagnostik beim ersten epileptischen Anfall leisten?
verfasst von
PD Dr. med. Jan Rémi
PD Dr. med. Rainer Surges
Publikationsdatum
06.02.2018
Verlag
Springer Medizin
Erschienen in
NeuroTransmitter / Ausgabe 2/2018
Print ISSN: 1436-123X
Elektronische ISSN: 2196-6397
DOI
https://doi.org/10.1007/s15016-018-6209-z

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