Impfung zur Vorbeugung der COVID-19-Erkrankung sowie Impfpriorisierung bei Epilepsie

Der Vorstand der Deutschen Gesellschaft für Epileptologie und die Kommission „Epilepsie und Synkopen“ der Deutschen Gesellschaft für Neurologie haben die aktuelle Datenlage zur Impfung zur Vorbeugung der Corona-Virus-Krankheit 2019 (COVID-19) sowie zur Impfpriorisierung bei Menschen mit Epilepsie gesichtet, diese zusammengefasst und geben die unten genannten Empfehlungen ab.The Board of Directors of the German Society of Epileptology and the committee on epilepsy and syncope of the German Society of Neurology have reviewed the current data on vaccination to prevent coronavirus disease 2019 (COVID-19) and vaccination prioritization in people with epilepsy and provide a summary and recommendations

First Epileptic Seizure and Epilepsy in Adulthood

Background The manuscript is a current and significantly expanded version of the 2012 German Society of Neurology (DGN) Guidelines for the First Epileptic Seizure and Epilepsy in Adulthood. The goal of these guidelines is to summarize the present situation with regard to diagnostics and therapy along with the available scientific literature and thereby improve the diagnostic and therapeutic procedures and contribute towards their standardization. The guidelines pertain exclusively to those epilepsies in adulthood. Children's epilepsies will not be included, nor will status epilepticus or seizures resulting from an immune-mediated disease of the brain as these types of epilepsies already have their own set of DGN guidelines. Methodology The guideline committee is comprised of neurology experts possessing special expertise in the area of epilepsy, as well as clinicians and independent physicians. In addition to the German Society of Neurology (DGN), the German Society of Neurosurgery (DGNC), the Austrian Chapter of the International League Against Epilepsy, the Swiss League Against Epilepsy as well as the Luxemburg Society of Neurology also participated. Special care was taken to also include younger members on the editorial board. Literature that has been published since the 2012 edition was issued has been examined and incorporated in the current edition. The methodology utilized for guideline development is in accordance with standardized consensus techniques like a modified Delphi process (submission of previously produced text or tables, multi-step written questioning techniques, feedback process, participant information about the group responses, discussion of all comments and, if appropriate, the subsequent revisions; group members are able to examine a comparison of their statements). The consensus process corresponds to the rules of the Association of the Scientific Medical Societies in Germany (AWMF) and the DGN in order to address conflicts of interests. Results The most important new feature is the development of a new epilepsy definition. A substantially new aspect of this definition is the question of whether or not epilepsy can be resolved. Also included is a new version of the classification for seizures and epilepsies which essentially corresponds to the 1989 version. The most important therapeutic development since the 2012 edition has been the significant expansion of the anticonvulsive medication spectrum. New medications have been approved (Perampanel, Brivaracetam) or have extended their approval (Zonisamide, Lacosamide, Eslicarbazepine acetate). The administration of Valproic Acid to women and children is being viewed ever more critically. The guidelines explain, in detail, the problems related to treating women with epilepsy. In addition to drug therapy, operative therapies and stimulation procedures are also covered. Psycho-social aspects, driving ability, education, vocation as well as the problems that arise when discontinuing medication after years of seizure freedom are more extensively discussed. Also, new sections on mortality, first-aid measures, and acute symptomatic seizures have been added. A single chapter has been devoted to pharmacokinetics and addresses the interactive potential of anti-epileptic drugs with other medications as well as the possible influence on vitamin and hormone levels. In particular, therapies for malignant diseases can be critically influenced by interactions

Dll4 and Notch signalling couples sprouting angiogenesis and artery formation.

Endothelial sprouting and proliferation are tightly coordinated processes mediating the formation of new blood vessels during physiological and pathological angiogenesis. Endothelial tip cells lead sprouts and are thought to suppress tip-like behaviour in adjacent stalk endothelial cells by activating Notch. Here, we show with genetic experiments in postnatal mice that the level of active Notch signalling is more important than the direct Dll4-mediated cell-cell communication between endothelial cells. We identify endothelial expression of VEGF-A and of the chemokine receptor CXCR4 as key processes controlling Notch-dependent vessel growth. Surprisingly, genetic experiments targeting endothelial tip cells in vivo reveal that they retain their function without Dll4 and are also not replaced by adjacent, Dll4-positive cells. Instead, activation of Notch directs tip-derived endothelial cells into developing arteries and thereby establishes that Dll4-Notch signalling couples sprouting angiogenesis and artery formation

Dll4 and Notch signalling couples sprouting angiogenesis and artery formation.

Endothelial sprouting and proliferation are tightly coordinated processes mediating the formation of new blood vessels during physiological and pathological angiogenesis. Endothelial tip cells lead sprouts and are thought to suppress tip-like behaviour in adjacent stalk endothelial cells by activating Notch. Here, we show with genetic experiments in postnatal mice that the level of active Notch signalling is more important than the direct Dll4-mediated cell-cell communication between endothelial cells. We identify endothelial expression of VEGF-A and of the chemokine receptor CXCR4 as key processes controlling Notch-dependent vessel growth. Surprisingly, genetic experiments targeting endothelial tip cells in vivo reveal that they retain their function without Dll4 and are also not replaced by adjacent, Dll4-positive cells. Instead, activation of Notch directs tip-derived endothelial cells into developing arteries and thereby establishes that Dll4-Notch signalling couples sprouting angiogenesis and artery formation

First epileptic seizure and epilepsies in adulthood. Abridged version ofthe S2k guideline of the German Society for Neurology in cooperationwith the German Society for Epileptology

Holtkamp M, May T, Berkenfeld R, et al. Erster epileptischer Anfall und Epilepsien im Erwachsenenalter. Kurzfassung S2k-Leitlinie der Deutschen Gesellschaft für Neurologie in Zusammenarbeit mit der Deutschen Gesellschaft für Epileptologie. Clinical Epileptology. 2024.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. For the topic management of first epileptic seizures, the guideline provides recommendations on identifying the two major differential diagnoses, syncope and psychogenic non-epileptic seizure. The importance of additional examinations such as EEG, MRI and cerebrospinal fluid for syndromic classification and etiological allocation is discussed. Recommendations on neuropsychological and psychiatric screening tests are also given. The topic pharmacotherapy issues recommendations on antiseizure medication in monotherapy for focal, generalized and unclassified epilepsies; patient groups with special challenges such as the aged, women of childbearing potential and people with mental retardation are emphasized. Further issues are indications for measuring serum concentrations of antiseizure medication and possible risks of switching manufacturers. In the topic epilepsy surgery, indications for presurgical assessment and the multiple therapeutic approaches, such as resection, laser ablation, and neurostimulation are presented. Recommendations on postoperative management of patients, including rehabilitation and psychosocial counselling, are given. The topic complementary and supportive therapeutic approaches comprises recommendations on the diagnostics and treatment of common psychiatric comorbidities of epilepsy, such as anxiety disorder, depression and psychosis. Another important issue is the management of psychogenic non-epileptic seizures as a neuropsychiatric differential diagnosis or comorbidity of epileptic seizures. Furthermore, recommendations on the potential role of ketogenic diet and on acupuncture, homeopathy and other complementary approaches are made. The recommendations on psychosocial aspects comprise practical issues, such as fitness to drive a car, training and occupation, medical rehabilitation, sport, transition, patients' self-help, education programs for patients and next of kin, adherence, advise on SUDEP