Was tun, wenn das erste medikament versagt? Kurzgefasste expertenempfehlungen zur behandlung von epilepsien bei jugendlichen und erwachsenen

Currently, the best medical treatment of epilepsy results in seizure freedom in 50% of newly treated individuals. If the first antiepileptic drug (AED) has failed to control the seizures, diagnostic and therapeutic re-evaluation involving a change in medication will achieve seizure freedom in further 10 to 20%. Here we offer evidence-based and product-neutral expert recommendations of how to proceed after the first AED has not led to seizure freedom. If the diagnosis of partial epilepsy is certain, a combination of the first AED with lamotrigine, levetiracetam, oxcarbazepine, pregabalin, topiramate or zonisamide is recommended. In individuals with idiopathic generalized epilepsy, lamotrigine and topiramate are available if valproic acid has failed. Many of the modern AEDs are particularly well suited for add-on treatment because they are not involved in interactions with other drugs such as AEDs, oral contraceptives or with hormones. Other advantages of some modern AEDs include absence of weight gain or mood stabilizing effects. These data request a careful evaluation to determine if a modern, interaction-free AED should be preferred over an older AEDs for future treatment, particularly when the individual has side effects with the current treatment. The choice among the new AEDs will be made after careful consideration of all other individual relevant factors including side effects.