Nicht invasive kortikale Stimulation als adjuvante Therapie zur Unterstützung der funktionellen Erholung nach Schlaganfall

Zusammenfassung

Hintergrund: Über 60 % der Schlaganfallpatienten behalten bleibende funktionelle Defizite, die das berufliche und soziale Leben erheblich einschränken. Die Entwicklung wirksamer neurorehabilitativer Therapiestrategien zielt darauf ab, die funktionelle Erholung zu verbessern und damit die Lebensqualität nachhaltig zu steigern. Aus wissenschaftlichen Untersuchungen bei gesunden Probanden ergeben sich zunehmend Hinweise darauf, dass die nicht invasive kortikale Stimulation kognitive Leistungen steigern kann.

Ziel: Die Arbeit gibt einen Überblick über das Konzept der nicht invasiven kortikalen Stimulation und die Darstellung der Methoden und deren Anwendung im Hinblick auf die Bedeutung für die Schlaganfallrehabilitation.

Methode: Eine systematische Literaturrecherche wurde durchgeführt.

Ergebnisse: Erste Ergebnisse aus Studien mit kleiner Stichprobengröße sprechen dafür, dass eine Kombination aus gezieltem motorischen Training und nicht invasiver kortikaler Stimulation bei Schlaganfallpatienten zu vorübergehenden funktionellen Verbesserungen führen kann.

Schlussfolgerungen: Die nicht invasive kortikale Stimulation scheint eine Möglichkeit zu bieten, die funktionelle Erholung zu verbessern. Sie könnte sich in naher Zukunft zu einer adjuvanten Maßnahme in der neurologischen Rehabilitation entwickeln. Um diese innovative Strategie in eine tägliche klinische Anwendung zu übersetzen, sind ein besseres Verständnis der ihr zugrunde liegenden Mechanismen und ihre Evaluation in kontrollierten, multizentrischen Studien notwendig.

Abstract

Background: Over 60 % of the stroke patients show persistent functional impairments that considerably limit their occupational and social life. The development of effective therapeutic strategies for neurorehabilitation aims at increasing functional recovery and subsequently promoting quality of life in the long run. Recent studies in healthy subjects have provided increasing evidence for non-invasive cortical stimulation to enhance cognitive function.

Objective: This article gives an overview of the concept of non-invasive cortical stimulation and outlines the methods and their application with regard to their relevance in stroke rehabilitation.

Method: A systematic literature review was performed.

Results: First results of studies with stroke patients suggest that combining a specific motor training with non-invasive cortical stimulation might transiently improve functional outcome.

Conclusions: Non-invasive cortical stimulation appears to offer a promising option to enhance functional recovery. It might provide an adjuvant intervention in neurorehabilitation in the near future. For translation of this innovative strategy into routine clinical practice it is necessary to get better insight into the underlying mechanisms and to evaluate this therapeutic strategy with controlled multi-centre trials.

transkranielle Gleichstromstimulation - repetitive Transkranielle Magnetstimulation - Schlaganfall - Rehabilitation

transcranial direct current stimulation - repetitive transcranial magnetic stimulation - stroke - rehabilitation

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