Subscribe to RSS
DOI: 10.1055/s-0029-1224118
© Georg Thieme Verlag KG Stuttgart · New York
Biophysikalische Therapieverfahren in der Psychiatrie – Elektrokonvulsionstherapie (EKT) und repetitive transkranielle Magnetstimulation (rTMS)
Transcranial Stimulation Techniques in Psychiatric Disorders: Electroconvulsive Therapy (ECT) and Repetitive Transcranial Magnetic StimulationPublication History
Publication Date:
01 July 2009 (online)
Zusammenfassung
Hirnstimulationsverfahren sind wichtige Behandlungsoptionen bei einer Reihe von psychiatrischen Störungen, die bei richtiger Indikationsstellung zu einer raschen und anhaltenden symptomatischen Verbesserung führen können. Bei der Elektrokonvulsionstherapie (EKT) handelt es sich um das effektivste Therapieverfahren bei Patienten mit schweren depressiven Störungen; die repetitive transkranielle Magnetstimulation (rTMS) ist eine vergleichsweise neue Methode, deren Effektivität in Studien bei Patienten mit depressiven Störungen ebenfalls nachgewiesen wurde, allerdings nicht an die der EKT heranreicht. In kleineren Studien und Fallserien wurden Therapieerfolge auch bei Patienten mit Schizophrenie (Halluzinationen, Negativsyndrom), Zwangs- oder Ticstörungen berichtet. Die optimalen Stimulationsparameter und -orte der rTMS sind weiterhin Gegenstand der Forschung.
Abstract
Non-pharmacological approaches such as transcranial brain stimulation techniques provide important treatment options in patients with drug-resistant psychiatric disorders and can lead to rapid and sustained symptomatic improvements. Among these methods electroconvulsive therapy (ECT) is a long-established approach which has proven efficacy, especially in patients with severe depression. It is safe and well tolerated in general, the most important side effects are cognitive alterations. Novel methods of brain stimulation such as repetitive transcranial magnetic stimulation (rTMS) are currently being investigated as possible alternatives to ECT. Clinical trials in patients with depression have shown that rTMS is clinically effective (though less so than ECT) with good tolerability and a low rate of side effects, which has led to FDA approval for the treatment of patients with depression. Preliminary studies and case series have also reported on rTMS-induced improvements in patients with chronic hallucinations, obsessive-compulsive or tic disorders. The heterogeneity of stimulation parameters throughout studies requires further attention and research.
Schlüsselwörter
Hirnstimulationsverfahren - Elektrokonvulsionstherapie - transkranielle Magnetstimulation
Key words
brain stimulation - electroconvulsive therapy - transcranial magneticstimulation
Literatur
- 1 Bolwig TG. Putative common pathways in therapeutic brain stimulation for affective disorders. CNS Spectr. 2003; 8 490-495
- 2 d’Elia G. Unilateral electroconvulsive therapy. Acta Psychiatr Scand Suppl. 1970; 215 1-98
- 3 d’Elia G, Raotma H. Is unilateral ECT less effective than bilateral ECT?. Br J Psychiatry. 1975; 126 83-89
- 4 Abrams R. Stimulus titration and ECT dosing. J Ect. 2002; 18 ((1)) 3-9 , ; discussion 14–15
-
5 Abrams R.
Electroconvulsive Therapy . Oxford, New York, Oxford University Press 2002 - 6 Baghai TC, Marcuse A, Moller HJ. et al . Electroconvulsive therapy at the Department of Psychiatry and Psychotherapy, University of Munich. Development during the years 1995–2002. Nervenarzt. 2005; 76 ((5)) 597-612
- 7 Scott AI, Dougall N, Ross M. et al . Short-term effects of electroconvulsive treatment on the uptake of 99 mTc-exametazime into brain in major depression shown with single photon emission tomography. J Affect Disord. 1994; 30 ((1)) 27-34
- 8 Mervaala E, Kononen M, Fohr J. et al . SPECT and neuropsychological performance in severe depression treated with ECT. J Affect Disord. 2001; 66 ((1)) 47-58
- 9 Nobler MS, Teneback CC, Nahas Z. et al . Structural and functional neuroimaging of electroconvulsive therapy and transcranial magnetic stimulation. Depress Anxiety. 2000; 12 144-156
- 10 Sackeim HA. The anticonvulsant hypothesis of the mechanism of action of ECT: current status. J ECT. 1999; 15 5-26
- 11 Sanacora G, Mason GF, Rothman DL. et al . Reduced cortical gamma-aminobutyric acid levels in depressed patients determined by proton magnetic resonance spectroscopy. Arch Gen Psychiatry. 1999; 56 ((11)) 1043-1047
- 12 Group . UER. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003; 361 799-808
- 13 Sackeim HA, Prudic J, Devanand DP. et al . Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med. 1993; 328 839-846
- 14 Barker AT, Jalinous R, Freeston IL. Noninvasive magnetic stimulation of human motor cortex. Lancet. 1985; ii 1106-1107
- 15 George MS, Lisanby SH, Sackeim HA. Transcranial magnetic stimulation: applications in neuropsychiatry. Arch Gen Psychiatry. 1999; 56 ((4)) 300-311
- 16 George MS, Lisanby SH, Sackeim HA. Transcranial magnetic stimulation. Arch Gen Psychiatry. 1999; 56 300-311
- 17 Rau A, Grossheinrich N, Palm U. et al . Transcranial and deep brain stimulation approaches as treatment for depression. Clin EEG Neurosci. 2007; 38 ((2)) 105-115
- 18 Padberg F, Grossheinrich N, Zwanzger P. et al . Neue Hirnstimulationsverfahren bei Depression. Nervenheilkunde. 2005; 5 369-380
- 19 Gershon AA, Dannon PN, Grunhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry. 2003; 160 835-845
- 20 Wassermann EM, Lisanby SH. Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol. 2001; 112 1367-1377
- 21 Hallett M. Transcranial magnetic stimulation: a tool for mapping the central nervous system. Electroencephalogr clin Neurophysiol Suppl. 1996; 46 43-51
- 22 Hallett M. Transcranial magnetic stimulation and the human brain. Nature. 2000; 406 147-150
- 23 Pogarell O, Koch W, Popperl G, Tatsch K. et al . Striatal dopamine release after prefrontal repetitive transcranial magnetic stimulation in major depression: preliminary results of a dynamic [123I] IBZM SPECT study. J Psychiatr Res. 2006; 40 ((4)) 307-314
- 24 Wang H, Wang X, Scheich H. LTD and LTP induced by transcranial magnetic stimulation on cortico-spinal and cortico-cortical excitability [abstract]. Neuroreport. 1996; 7 521-525
- 25 Post A, Keck ME. Transcranial magnetic stimulation as a therapeutic tool in psychiatry: what do we know about the neurobiological mechanisms?. J Psychiatr Res. 2001; 35 193-215
- 26 Nahas Z, DeBrux C, Chandler V. et al . Lack of significant changes on magnetic resonance scans before and after 2 weeks of daily left prefrontal repetitive transcranial magnetic stimulation for depression. J ECT. 2000; 16 380-390
- 27 Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5–7, 1996. Electroenceph clin Neurophysiol. 1998; 1998 1-16
- 28 Ella R, Zwanzger P, Stampfer R. et al . Switch to mania after slow rTMS of the right prefrontal cortex. J Clin Psychiatry. 2002; 63 249
- 29 Pascual-Leone A, Rubio B, Pallardó F. et al . Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. Lancet. 1996; 348 233-237
- 30 Fitzgerald PB, Brown TL, Marston NA. et al . Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Arch Gen Psychiatry. 2003; 60 1002-1008
- 31 O’Reardon JP, Solvason HB, Janicak PG. et al . Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007; 62 ((11)) 1208-1216
- 32 Burt T, Lisanby SH, Sackeim HA. Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis. Int J Neuropsychopharmacol. 2002; 5 73-103
- 33 Kozel FA, George MS. Meta-Analysis of left prefrontal repetitive transcranial magnetic stimulation (rTMS) to treat depression. J Psychiatric Pract. 2002; 8 270-275
- 34 Martin JL, Barbanoj MJ, Schlaepfer TE. et al . Repetitive transcranial magnetic stimulation for the treatment of depression. Systematic review and meta-analysis. Br J Psychiatry. 2003; 182 480-491
- 35 Padberg F, Zwanzger P, Keck ME. et al . Repetitive transcranial mag-netic stimulation (rTMS) in major depression: Relation between efficacy and stimulation intensity. Neuropsychopharmacology. 2002; 27 638-645
- 36 Padberg F, Goldstein-Muller B, Zwanzger P. et al . Prefrontal cortex stimulation as antidepressant treatment: mode of action and clinical effectiveness of rTMS. Suppl Clin Neurophysiol. 2003; 56 406-432
- 37 Lisanby SH, Gutman D, Luber B. et al . Sham TMS: intracerebral measurement of the induced electrical field and the induction of motor-evoked potentials. Biol Psychiatry. 2001; 49 460-463
- 38 Dwork AJ, Arango V, Underwood M. et al . Absence of histological lesions in primate models of ECT and magnetic seizure therapy. Am J Psychiatry. 2004; 161 ((3)) 576-578
- 39 Kosel M, Frick C, Lisanby SH. et al . Magnetic seizure therapy improves mood in refractory major depression. Neuropsychopharmacology. 2003; 28 2045-2048
- 40 Lisanby S, Morales O, Payne N. et al . New developments in electroconvulsive therapy and magnetic seizure therapy. CNS Spectr. 2003; 8 529-536
- 41 White PF, Amos Q, Zhang Y. et al . Anesthetic considerations for magnetic seizure therapy: a novel therapy for severe depression. Anesth Analg. 2006; 103 ((1)) 76-80 , table of contents
- 42 Lisanby S. Update on Magnetic Seizure Therapy: A Novel Form of Convulsive Therapy. J ECT. 2002; 18 ((4)) 182-188
- 43 Lisanby SH, Luber B, Sackeim HA. et al . Deliberate seizure induction with repetitive transcranial magnetic stimulation in nonhuman primates. Arch Gen Psychiatry. 2001; 58 199-200
Korrespondenzadresse
PD Dr. O. Pogarell
Klinik für Psychiatrie und Psychotherapie der
Ludwig-Maximilians-Universität München
Nußbaumstraße 7
80336 München
Email: oliver.pogarell@med.uni-muenchen.de