Präfrontale repetitive transkranielle Magnetstimulation in der Therapie depressiver Erkrankungen

Zusammenfassung

Die Möglichkeit einer nicht invasiven, fokalen Stimulation bestimmter Kortexareale zur Therapie neurologischer und psychiatrischer Erkrankungen durch die repetitive transkranielle Magnetstimulation (rTMS) wird derzeit von verschiedenen Arbeitsgruppen in einer Vielzahl offener und kontrollierter klinischer Studien untersucht. Mittels präfrontaler rTMS kann das fronto-limbische System, welches bei depressiven Erkrankungen reversible Funktionsänderungen zeigt, beeinflusst werden. Effekte der rTMS auf verschiedene im Rahmen einer Depression beteiligte Neurotransmittersysteme wurden nachgewiesen, wie beispielsweise eine verstärkte Dopaminausschüttung in mesostriatalen und mesolimbischen Regionen, sowie Effekte auf die serotonerge Neurotransmission. Obwohl meist nur kleine Patientenkollektive untersucht wurden, zeigte die Mehrzahl kontrollierter Studien signifikante antidepressive, der Plazebobehandlung überlegene Effekte für die präfrontale rTMS. Größere Multicenter-Studien zum Beweis der antidepressiven Wirksamkeit sollten durchgeführt und spezifische Indikationen näher untersucht werden.

Summary

The possibility of a non-invasive, focal stimulation of distinct cortical brain regions as treatment of neurological and psychiatric diseases by repetitive transcranial magnetic stimulation (rTMS) is at present investigated in numerous open and controlled clinical trials. Prefrontal rTMS can modulate the function of fronto-limbic circuits, which is reversibly altered in major depression. Effects of rTMS on neurotransmitter systems involved in the pathophysiology of depressive disorders have been shown, e.g. stimulation of subcortical dopamine release. Though conducted with small sample sizes, the majority of controlled trials demonstrated significant antidepressant effects of verum rTMS compared to a sham condition. Larger multicenter-trials should be conducted to investigate the efficacy of rTMS as antidepressant treatment and to test specific applications.

Schlüsselwörter

Depression - repetitiv - transkraniell - Magnetstimulation

Keywords

Depression - repetitive - transcranial - magnetic stimulation

• Literatur

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