Substanzgebundene Abhängigkeitserkrankungen und bulimische Essstörungen

Zusammenfassung

Einleitung: Es soll ein Überblick über die Studienlage zur repetitiven transkraniellen Magnetstimulation (rTMS) bei substanzgebundene Abhängigkeiten und bulimischen Essstörungen gegeben werden. Material und Methoden: Anhand einer Pubmed-Recherche wurden Studien identifiziert, in denen rTMS zur Behandlung von substanzgebundener Abhängigkeit untersucht wurde. Diese Studien wurden hinsichtlich eingeschlossener Patienten, Stimulationsparameter und Ergebnissen ausgewertet. Darüber hinaus werden je nach Studienlage Empfehlungen zur Verwendung der rTMS bei den verschiedenen Abhängigkeiten gegeben. Ergebnisse: Die Pubmed-Recherche identifizierte 20 Publikationen zur Anwendung der rTMS, davon vier zur “deep” TMS, sieben Studien bei Alkoholabhängigkeit, acht bei Nikotinabhängigkeit, zwei bei Drogenabhängigkeit sowie drei Studien zur Behandlung bulimischer Essstörungen. Außerdem wurden zwölf Review-Artikel identifiziert. Es wurde meist hochfrequent stimuliert (HFrTMS). Zielort war überwiegend der dorsolaterale präfrontale Kortex (DLPFC), vor dem Hintergrund der neuropsychologischen Bedeutung dieser Region bei der Ausbildung von Craving und der Effekte auf die dopaminerge Neurotransmission. Die Ergebnisse der einzelnen Studien sind sehr heterogen und die Fallzahlen der verfügbaren Studien verhältnismäßig gering. Schlussfolgerungen: Nur für die Anwendung bei Nikotinabhängigkeit kann ein möglicher Effekt der HF-rTMS über dem linken DLPFC diskutiert werden. Aufgrund dieser Limitationen und kleinen Fallzahlen kann keine Empfehlung für eine rTMS-Behandlung von Alkohol- oder Drogenabhängigkeit und bulimischen Essstörungen gegeben werden. Die Vorarbeiten rechtfertigen aber weitere klinische Anwendungsstudien an größeren Fallzahlen.

Summary

Objectives: An overview about the current data concerning repetitive transcranial magnetic stimulation (rTMS) in substance use disorders (SUD) and bulimia should be given. Material and methods: Based on a pubmed search, rTMS studies in SUD were compared regarding included patients, stimulation parameters and results. Results: The pubmed search identified a total of 20 articles concerning the use of rTMS, including four manuscripts referring to deep TMS, seven to alcohol dependence, eight to nicotine dependence, two to drug dependence (cocain and metamphetamine) und three to bulimic eating disorders. In addition, twelve reviews were published. Most of the studies applied high frequency rTMS (HF-rTMS). The target region was the dorsolateral prefrontal cortex (DLPFC) in most of the cases, because of its neuropsychological role in craving and because of the well-known effects of DLPFC rTMS on dopaminergic neurotransmission. In summary the study results are very heterogenous and investigated samples are rather small. Conclusions: A possible therapeutic effect of HF-rTMS over the left DLPFC can only be discussed for nicotine dependence. In all other SUDs, rTMS can not be recommended because of methodological limitations. However, the preliminary data justify further clinical studies based on larger sample sizes.

Schlüsselwörter

Substanzabhängigkeit - Alkohol - Nikotin - Bulimie - rTMS

Keywords

Substance use disorders - alcohol - nicotine - bulimic eating disorders - rTMS

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