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PSYCH up2date 2021; 15(03): 219-235
DOI: 10.1055/a-1186-7030
Schizophrenien und andere psychotische Störungen

Nichtinvasive Hirnstimulationsverfahren in der Psychiatrie

Tobias Schwippel
,
Christian Plewnia
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Das pharmakologische Instrumentarium zur Behandlung psychischer Erkrankungen hat sich seit der Entdeckung des Chlorpromazin als Antipsychotikum 1952 und der Entwicklung und Vermarktung der SSRI in den 1970er- und 1980er-Jahren nicht mehr fundamental erweitert. Mit dem zunehmenden Wissen um die hirnphysiologischen Prozesse psychischer Erkrankung bieten Methoden der nichtinvasiven Hirnstimulation hingegen neue und sichere Behandlungsoptionen.
Kernaussagen

  • Die repetitive transkranielle Magnetstimulation (rTMS) kann die Aktivität kortikaler Areale gezielt modulieren und adaptive neuroplastische Prozesse fördern.

  • Die rTMS ist nebenwirkungsarm und sehr gut verträglich.

  • Die rTMS Therapiedauer liegt bei 3–6 Wochen und kann mit Pharmako- und Psychotherapie kombiniert werden.

  • Die Wirksamkeit von hochfrequenter rTMS (hf-rTMS) des linken dorsolateralen Präfrontalkortex bei Depression ist durch mehrere multizentrische klinische Studien nachgewiesen.

  • Die Wirksamkeit der niederfrequenten rTMS (lf-rTMS) des linken temporo-parietalen Kortex bei auditorischen Halluzinationen ist bisher in kleineren kontrollierten Studien gezeigt. Laut aktueller S3-Leitlinie Schizophrenie sollte Patienten bei Therapieresistenz eine Behandlung angeboten werden.

  • Die transkranielle Gleichstromstimulation (tDCS) wurde bisher in einigen klinischen Studien zur Behandlung von Depression und Schizophrenie erfolgreich eingesetzt.

  • tDCS ist einfach zu applizieren und sehr gut verträglich, jedoch aufgrund noch fehlender Ergebnisse multizentrischer Studien außerhalb von Studien aktuell nicht zu empfehlen.



Publication History

Article published online:
10 May 2021

© 2021. Thieme. All rights reserved.

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  • Literatur

  • 1 Lefaucheur J-P, Aleman A, Baeken C. et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014–2018). Clin Neurophysiol 2020; 131: 474-528
    CrossrefPubMedGoogle Scholar
  • 2 Fregni F, El-Hagrassy MM, Pacheco-Barrios K. et al. Evidence-based guidelines and secondary meta-analysis for the use of transcranial direct current stimulation (tDCS) in neurological and psychiatric disorders. Int J Neuropsychopharmacol 2020; DOI: 10.1093/ijnp/pyaa051.
    CrossrefPubMedGoogle Scholar
  • 3 McClintock SM, Reti IM, Carpenter LL. et al. Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. J Clin Psychiatry 2018; 79 DOI: 10.4088/JCP.16cs10905.
    CrossrefPubMedGoogle Scholar
  • 4 THE UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799-808
    CrossrefPubMedGoogle Scholar
  • 5 Thielscher A, Antunes A, Saturnino GB. Field modeling for transcranial magnetic stimulation: a useful tool to understand the physiological effects of TMS?. Milano, Italy: IEEE EMBS; 2015
    Google Scholar
  • 6 Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet 1985; 325: 1106-1107
    CrossrefPubMedGoogle Scholar
  • 7 Schwippel T, Schroeder PA, Fallgatter AJ. et al. Clinical review: The therapeutic use of theta-burst stimulation in mental disorders and tinnitus. Prog Neuro-Psychopharmacol Biol Psychiatry 2019; 92: 285-300
    CrossrefPubMedGoogle Scholar
  • 8 Lerner AJ, Wassermann EM, Tamir DI. Seizures from transcranial magnetic stimulation 2012–2016: Results of a survey of active laboratories and clinics. Clin Neurophysiol 2019; 130: 1409-1416
    CrossrefPubMedGoogle Scholar
  • 9 Vigod SN, Murphy KE, Dennis C-L. et al. Transcranial direct current stimulation (tDCS) for depression in pregnancy: A pilot randomized controlled trial. Brain Stimulation 2019; 12: 1475-1483
    CrossrefPubMedGoogle Scholar
  • 10 Plewnia C, Schroeder PA, Wolkenstein L. Targeting the biased brain: non-invasive brain stimulation to ameliorate cognitive control. Lancet Psychiatry 2015; 2: 351-356
    CrossrefPubMedGoogle Scholar
  • 11 Brunoni AR, Chaimani A, Moffa AH. et al. Repetitive transcranial magnetic stimulation for the acute treatment of major depressive episodes: a systematic review with network meta-analysis. JAMA Psychiatry 2017; 74: 143-152
    CrossrefPubMedGoogle Scholar
  • 12 Mutz J, Vipulananthan V, Carter B. et al. Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis. Br Med J 2019; 364 DOI: 10.1136/bmj.l1079.
    CrossrefPubMedGoogle Scholar
  • 13 Cipriani A, Furukawa TA, Salanti G. et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Focus 2018; 16: 420-429
    CrossrefPubMedGoogle Scholar
  • 14 Chen J, Zhou C, Wu B. et al. Left versus right repetitive transcranial magnetic stimulation in treating major depression: a meta-analysis of randomised controlled trials. Psychiatry Res 2013; 210: 1260-1264
    CrossrefPubMedGoogle Scholar
  • 15 Blumberger DM, Vila-Rodriguez F, Thorpe KE. et al. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet 2018; 391: 1683-1692
    CrossrefPubMedGoogle Scholar
  • 16 Kozel FA, Motes MA, Didehbani N. et al. Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: a randomized clinical trial. J Affect Disorders 2018; 229: 506-514
    CrossrefPubMedGoogle Scholar
  • 17 Jardri R, Pouchet A, Pins D. et al. Cortical activations during auditory verbal hallucinations in schizophrenia: a coordinate-based meta-analysis. Am J Psychiatry 2011; 168: 73-81
    CrossrefPubMedGoogle Scholar
  • 18 Li J, Cao X, Liu S. et al. Efficacy of repetitive transcranial magnetic stimulation on auditory hallucinations in schizophrenia: a meta-analysis. Psychiatry Res 2020; 113141
    CrossrefPubMedGoogle Scholar
  • 19 Plewnia C, Zwissler B, Wasserka B. et al. Treatment of auditory hallucinations with bilateral theta burst stimulation: a randomized controlled pilot trial. Brain Stimul 2014; 7: 340-341
    CrossrefPubMedGoogle Scholar
  • 20 Plewnia C, Brendel B, Schwippel T. et al. Treatment of auditory hallucinations with bilateral theta burst stimulation (cTBS): protocol of a randomized, double-blind, placebo-controlled, multicenter trial. Eur Arch Psychiatry Clin Neurosci 2018; 268: 663-673
    CrossrefPubMedGoogle Scholar
  • 21 Wobrock T, Guse B, Cordes J. et al. Left prefrontal high-frequency repetitive transcranial magnetic stimulation for the treatment of schizophrenia with predominant negative symptoms: a sham-controlled, randomized multicenter trial. Biol Psychiatry 2015; 77: 979-988
    CrossrefPubMedGoogle Scholar
  • 22 Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 2000; 527: 633
    CrossrefPubMedGoogle Scholar
  • 23 Reinhart RM, Nguyen JA. Working memory revived in older adults by synchronizing rhythmic brain circuits. Nature Neurosci 2019; 22: 820-827
    CrossrefPubMedGoogle Scholar
  • 24 Brunoni AR, Valiengo L, Baccaro A. et al. The sertraline vs electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry 2013; 70: 383-391
    CrossrefPubMedGoogle Scholar
  • 25 Brunoni AR, Moffa AH, Sampaio-Junior B. et al. Trial of electrical direct-current therapy versus escitalopram for depression. N Engl J Med 2017; 376: 2523-2533
    CrossrefPubMedGoogle Scholar
  • 26 Razza LB, Palumbo P, Moffa AH. et al. A systematic review and meta‐analysis on the effects of transcranial direct current stimulation in depressive episodes. Depression and Anxiety 2020; 594-608
    CrossrefPubMedGoogle Scholar
  • 27 Valiengo LDCL, Goerigk S, Gordon PC. et al. Efficacy and Safety of Transcranial Direct Current Stimulation for Treating Negative Symptoms in Schizophrenia: A Randomized Clinical Trial. Jama Psychiatry 2020; 77: 121-129
    CrossrefPubMedGoogle Scholar