Tiefe Hirnstimulation bei psychischen Erkrankungen - Indikation in Einzelfällen bei Depressionen, Zwangsstörungen, Tourette-Syndrom und tardiven Dyskinesien

Der Einsatz der tiefen Hirnstimulation bei neurologischen Krankheitsbildern wie M. Parkinson und Dystonie haben die Frage aufgeworfen, welche psychischen Krankheitsbilder als Indikation in Frage kommen. Bis jetzt liegen zu den Krankheitsbildern Depression, Zwangsstörung, Tourette-Syndrom und tardive Dystonien positive Einzelfallberichte oder kleine Fallserien vor. Die Indikation wurde jeweils nach der Ausschöpfung medikamentöser und psychotherapeutischer Therapieoptionen gestellt. Zielgebiete sind bei der Depression ein subgenuales zinguläres Areal oder der Nucleus accumbens. Bei der Zwangsstörung werden Areale im Bereich des vorderen Schenkels der Capsula interna oder des Nucleus accumbens als Zielpunkte stimuliert. Für das Tourette-Syndrom liegen Ergebnisse für die Stimulation in Subarealen des Thalamus, im Globus pallidus internus und im Nucleus accumbens vor. Zur Behandlung der tardiven Dystonien wurde im Globus pallidus internus stimuliert.

The application of deep brain stimulation in neurologic disorders such as dystonia or M. Parkinson raises the question which psychiatric disorder may benefit from deep brain stimulation as well. Until now single case reports or reports summarizing 6 to 10 patients report clinical improvement to a variable degree in patients suffering from depression, obsessive-compulsive disorder, Tourette syndrome or tardive dystonia. The indication for deep brain stimulation was met only after utilised use of medication and psychotherapy. Target regions for depression are a subgenual cingular region, for OCD the anterior part of the internal capsula and the nucleus accumbens. In Tourette syndrome reports mention the subregions of the thalamus , the globus pallidus internus or the nucleus accumbens as target region. In tardive dystonia the globus pallidus internus was stimulated.

Key words

deep brain stimulation - psychiatric disorder - target regions

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