Neue Hirnstimulationsverfahren bei Neue Hirnstimulationsverfahren

Zusammenfassung

Im Bereich nicht-pharmakologischer Ansätze zur Depressionsbehandlung findet die Elektrokrampftherapie (EKT) in den letzten Jahren aufgrund ihrer Wirksamkeit bei pharmakotherapieresistenten Depressionen wieder ein zunehmendes Interesse. Daneben werden gegenwärtig verschiedene neue Hirnstimulationsverfahren als Alternativen untersucht, die an die hohe Effektivität der EKT anknüpfen sollen und gleichzeitig eine Verringerung unerwünschter Nebenwirkungen erwarten lassen: die präfrontale repetitive transkranielle Magnetstimulation (rTMS), die Vagusnervstimulation (VNS) und die Magnetkonvulsionstherapie (MKT). Alle drei Methoden befinden sich derzeit in der klinischen Erprobungsphase. Die umfangreichsten Befunde liegen bislang zur rTMS vor. Zur VNS, die aufgrund der Applikationsart besonders als Langzeittherapie geeignet erscheint, wurden bislang nur Ergebnisse offener Studien veröffentlicht, die jedoch therapeutische Effekte in der Langzeitbeobachtung nahe legen. Die MKT ist eine der EKT nahestehende Behandlungsmethode, die im Vergleich die Möglichkeit einer besser lokalisier- und dosierbaren Anfallsprovokation bietet. Daraus könnte eine Verringerung unerwünschter Wirkungen im Vergleich zur EKT resultieren.

Summary

In the area of non-pharmacological approaches for the treatment of depression, electroconvulsive therapy (ECT) gains increasing interest, because of its effectiveness in pharmacotherapy-resistant depressions. Beside ECT, new methods of brain stimulation are currently investigated that could theoretically have similar effectiveness as ECT with the advantage of fewer side effects: Prefrontal repetitive Transcranial Magnetic Stimulation (rTMS), Vagus Nerve Stimulation (VNS), and Magnetic Seizure Therapy (MST). All mentioned methods are being tested in clinical studies. The largest body of evidence has been published in the field of rTMS. VNS is theoretically an interesting long-term intervention, e.g. in case of high rates of relapses. Promising long-term data from an open study are available, however, results of a first placebo-controlled study have not been published yet. MST is methodologically similar to ECT, but is probably able to locate and dose the seizure stimulation more precisely. Hence it might show reduced side effects compared with ECT.

Schlüsselwörter

Major Depression - TMS - rTMS - biophysikalische Verfahren

Keywords

Major Depression - TMS - rTMS - biophysical methods

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