Neurostimulationsverfahren bei therapieresistenten Zwangsstörungen

Zusammenfassung

Gegenstand und Ziel Zwangsstörungen (OCD) zählen zu den häufigsten psychiatrischen Erkrankungen, verlaufen jedoch in einem erheblichen Anteil der Fälle chronisch und therapieresistent. Angesichts der begrenzten Wirksamkeit etablierter Erstlinientherapien rücken Neurostimulationsverfahren zunehmend in den Fokus. Ziel dieser Arbeit ist es, einen systematischen Überblick über internationale Leitlinienempfehlungen zur Anwendung nichtinvasiver und invasiver Neuromodulationsverfahren bei therapieresistenter OCD zu geben.

Material und Methoden Es erfolgte eine systematische Literaturrecherche in PubMed unter Verwendung definierter Suchbegriffe. Ergänzend wurden relevante Positionspapiere gesichtet. Die identifizierten Quellen wurden im Hinblick auf Indikationskriterien, klinische Evidenzlage, Zulassungsstatus und Implementierung in den Versorgungskontext analysiert und vergleichend bewertet.

Ergebnisse Leitlinienübergreifend wird die tiefe Hirnstimulation (THS) bei schwerer, therapieresistenter OCD zunehmend als effektive Behandlungsoption anerkannt, erfordert jedoch eine strenge Indikationsstellung und interdisziplinäre Einbettung. Die Evidenzlage zur transkraniellen Magnetstimulation (TMS) ist inkonsistent, jedoch zunehmend positiv, insbesondere für hochfrequente Stimulation über den dorsomedialen präfrontalen Kortex (dmPFC) bzw. den anterioren zingulären Kortex (ACC). Für Elektrokonvulsionstherapie (EKT) und ablative Verfahren bestehen Einschränkungen hinsichtlich Evidenz und Indikation; andere Verfahren wie transkranielle Direktstromstimulation (tDCS) oder Vagusnervstimulation (VNS) werden derzeit nicht empfohlen.

Schlussfolgerung/klinische Relevanz Neurostimulationsverfahren können bei ausgewählten Patienten mit therapieresistenter OCD eine wirksame Erweiterung des therapeutischen Spektrums darstellen. Voraussetzung ist ein standardisiertes, evidenzbasiertes und partizipativ gestaltetes Vorgehen unter Einbindung spezialisierter, interdisziplinärer Versorgungsstrukturen. Weitere Forschung zur Wirksamkeit, Zielstrukturpräzision und Patientenbeteiligung ist essenziell.

Abstract

Aims Obsessive-compulsive disorder (OCD) is among the most common psychiatric conditions but frequently follows a chronic and treatment-resistant course. Given the limited efficacy of established first-line therapies, neuromodulation techniques are gaining increasing attention. This review aims to provide a systematic overview of international guideline recommendations concerning the use of non-invasive and invasive neuromodulatory interventions in treatment-resistant OCD.

Materials and Methods A systematic literature search was conducted in the PubMed database using predefined search terms. In addition, relevant position papers were reviewed. Identified sources were analyzed and comparatively assessed with regard to indication criteria, clinical evidence, regulatory approval status, and integration into clinical care pathways.

Results Across guidelines, deep brain stimulation (DBS) is increasingly recognized as an effective treatment option for severe, treatment-resistant OCD, although it requires rigorous patient selection and multidisciplinary implementation. The evidence base for transcranial magnetic stimulation (TMS) is inconsistent but increasingly favorable, particularly for high-frequency stimulation targeting the dorsomedial prefrontal cortex (dmPFC) and anterior cingulate cortex (ACC). Electroconvulsive therapy (ECT) and ablative procedures are limited in both evidence and indication. Other modalities, such as transcranial direct current stimulation (tDCS) and vagus nerve stimulation (VNS), are currently not recommended.

Conclusion Neurostimulation techniques may offer a valuable therapeutic extension for selected patients with treatment-resistant OCD. Prerequisites include a standardized, evidence-based, and participatory approach, embedded within specialized interdisciplinary care structures. Further research is essential to refine efficacy, targeting precision, and patient involvement.

Schlüsselwörter

Zwangsstörungen - Therapieresistenz - Neurostimulation - Leitlinien

Keywords

OCD - treatment resistance - neurostimulation - guidelines

Publikationsverlauf

Artikel online veröffentlicht:
14. Oktober 2025

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