Biophysikalische Therapieverfahren in der Psychiatrie – Elektrokonvulsionstherapie (EKT) und repetitive transkranielle Magnetstimulation (rTMS)

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

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