Neurobiologische Grundlagen des therapeutischen Einsatzes der repetitiven transkraniellen Magnetstimulation (rTMS) in der Psychiatrie

Zusammenfassung

Die therapeutische Anwendung der repetitiven transkraniellen Magnetstimulation (rTMS) wurde in den vergangenen Jahren bei unterschiedlichen psychiatrischen Erkrankungen, wie beispielsweise den unipolaren und bipolaren affektiven Störungen sowie der Schizophrenie, diskutiert. Nach dem Faradayschen Prinzip wird über die Induktion eines Magnetfeldes intrakraniell ein elektrischer Stromfluss erzeugt. Dieser wiederum beeinflusst neuronale Netzwerke in psychopathologisch relevanten Hirnarealen, welche bei psychiatrischen Erkrankungen möglicherweise dysfunktional sind. Conditio sine qua non des gezielten therapeutischen Einsatzes der rTMS sind jedoch Kenntnisse über die zugrunde liegenden, durch rTMS induzierten neurobiologischen Veränderungen. Obgleich der therapeutische Einsatz der rTMS derzeit nur im Rahmen wissenschaftlicher Studien empfohlen werden kann, gibt es ausreichende grundlagenwissenschaftliche Hinweise darauf, dass über rTMS spezifische Veränderungen in neuronalen Schaltkreisen hervorgerufen werden können. Diese zeigen sich tierexperimentell in charakteristischen Verhaltensänderungen sowie in Veränderungen der Aktivität des Stresshormonsystems. Zudem konnten spezifische Änderungen in der Freisetzung von Neuromodulatoren und Neurotransmittern sowie der Genexpression in psychopathologisch relevanten Hirnregionen beschrieben werden. Die bislang untersuchten, durch rTMS induzierten neurobiologischen Mechanismen sind teilweise mit den durch antidepressiv wirksame Substanzen tierexperimentell ausgelösten Effekten

identisch.

Summary

In recent years, the therapeutic properties of repetitive transcranial magnetic stimulation (rTMS) have been investigated for the treatment of various psychiatric disorders such as unipolar and bipolar disorders and schizophrenia. According to Faraday´s law the induction of a magnetic field evokes intracerebral electric currents. This, in turn, influences neuronal networks in psychopathologically relevant brain regions thought to be dysfunctional in psychiatric disorders. In order to optimize rTMS for therapeutic use, however, it is indispensable to understand the neurobiological mechanisms involved. So far, the use of rTMS in the treatment of psychiatric disorders can be recommended only in the context of scientific studies. There is compelling evidence resulting from basic science that rTMS can induce specific alterations in neuronal networks. In animal models, these changes are reflected by characteristic behavioural changes and decreases in the activity of the stress hormone system. In addition, regional changes in neurotransmitter/neuromodulator release and in gene transcription could be demonstrated in relevant brain regions. Together, the mechanisms investigated so far are, in part, reminiscent of those accompanying antidepressant drugs.

Schlüsselwörter

Repetitive transkranielle Magnetstimulation - Depression - Stress - Neurobiologie

Keywords

Repetitive transcranial magnetic stimulation - depression - stress - neurobiology

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