Repetitive transkranielle Magnetstimulation bei Schizophrenie

Zusammenfassung

Während zur antidepressiven Wirkung der repetitiven transkraniellen Magnetstimulation (rTMS) eine große Zahl an Studien vorliegt, ist der Einsatz dieser Methode in der Behandlung der Schizophrenie bisher wenig untersucht. Es finden sich jedoch zunehmend Hinweise für die Wirksamkeit der rTMS bei Schizophrenie. Besonders beeindruckend ist dabei, dass die Negativsymptomatik durch rTMS beeinflussbar scheint. In diesem Zusammenhang ist zum Verständnis der rTMS-Wirkung bei Schizophrenie die Differenzierung zwischen Negativsymptomatik und depressiver Symptomatik von besonderer Bedeutung.

Unter Verwendung eines plazebokontrollierten Paralleldesigns wurden 10 Patienten mit Schizophrenie in die Studie eingeschlossen. Die Stimulation erfolgte hochfrequent (10 Hz) über dem linken dorsolateralen praefrontalen Kortex (DLPFC) an 10 Tagen. Bei der Evaluation der rTMS-Wirkung wurde durch Auswahl geeigneter Ratingskalen auf die Diskriminierung von Negativ- und depressiver Symptomatik Wert gelegt.

Es zeigte sich, dass die aktive hochfrequente rTMS verglichen mit Plazebostimulation zu einer grenzwertig signifikanten Verminderung der Negativsymptomatik führt. Weiter fand sich ein Trend bezüglich der Verminderung depressiver Symptomatik.

Die selektive Modulation mesolimbischer und mesostriataler dopaminerger Systeme, die in mehreren Untersuchungen im Zusammenhang mit hochfrequenter rTMS demonstriert wurde, könnte die therapeutischen Effekte auf Negativsymptomatik und depressive Symptomatik erklären.

Summary

Compared with depression there are only few studies investigating the beneficial effects of repetitive transcranial magnetic stimulation (rTMS) in schizophrenia. Recent studies provide increasing evidence that rTMS may be useful in treating schizophrenia. Most intriguing are results, demonstrating a reduction of negative symptoms following high frequency rTMS. In this context, disentangling of negative and depressive symptoms is of utmost importance when understanding rTMS effects on schizophrenic symptoms.

Using a sham-controlled parallel-design, 20 patients with schizophrenia were included in the study. Patients were treated with high-frequency 10 Hz rTMS over 10 days. Evaluating the therapeutic response to rTMS, clinical ratings focused on discriminating negative from depressive symptoms.

High frequency rTMS led to a significant reduction of negative symptoms combined with a trend for improvement of depressive symptoms in the active stimulated group as compared to the sham stimulated group.

Beneficial effects of high-frequency rTMS on negative and depressive symptoms may be due to a selective modulation of dopaminergic mesolimbic and mesostriatal systems as has been postulated in recent studies.

Schlüsselwörter

Repetitive transkranielle Magnetstimulation (rTMS) - Schizophrenie - Negativsymptomatik - depressive Symptomatik

Keywords

Repetitive transcranial magnetic stimulation - schizophrenia - negative symptoms - depressive symptoms

• Literatur

• 1 Addington D, Addington J, Maticka-Tyndale E. Specificity of the Calgary Depression Scale for schizophrenics. Schizophr Res 1994; 11 (03) 239-44.
• 2 Bowden C, Cheetham SC, Lowther S, Katona CL, Crompton MR, Horton RW. Reduced dopamine turnover in the basal ganglia of depressed suicides. Brain Res 1997; 769 (01) 135-40.
• 3 Burt T, Lisanby SH, Sackeim HA. Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis. Int J Neuropsychopharmacol 2002; 05 (01) 73-103.
• 4 Cohen E, Bernardo M, Masana J, Arrufat FJ, Navarro V, Valls S. et al. Repetitive transcranial magnetic stimulation in the treatment of chronic negative schizophrenia: a pilot study. J Neurol Neurosurg Psychiatry 1999; 67 (01) 129-30.
• 5 Feinsod M, Kreinin B, Chistyakov A, Klein E. Preliminary evidence for a beneficial effect of low-frequency, repetitive transcranial magnetic stimulation in patients with major depression and schizophrenia. Depress Anxiety 1998; 07 (02) 65-8.
• 6 Geller V, Grisaru N, Abarbanel JM, Lemberg T, Belmaker RH. Slow magnetic stimulation of prefrontal cortex in depression and schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 1997; 21 (01) 105-10.
• 7 Hausmann A, Fleischhacker WW. Differential diagnosis of depressed mood in patients with schizophrenia: a diagnostic algorithm based on a review. Acta Psychiatr Scand 2002; 106 (02) 83-96.
• 8 Heimer L, Harlan RE, Alheid GF, Garcia MM, de Olmos J. Substantia innominata: a notion which impedes clinical-anatomical correlations in neuropsychiatric disorders. Neuroscience 1997; 76 (04) 957-1006.
• 9 Hoffman RE, Boutros NN, Hu S, Berman RM, Krystal JH, Charney DS. Transcranial magnetic stimulation and auditory hallucinations in schizophrenia. Lancet 2000; 355 (9209): 1073-5.
• 10 Hoffman RE, Boutros NN. Transcranial magnetic stimulation studies of schizophrenia. Epilepsy & Behavior 2001; 02: S30-S35.
• 11 Keck M, Welt T, Muller M, Erhardt A, Ohl F, Toschi N. et al. Repetitive transcranial magnetic stimulation increases the release of dopamine in the mesolimbic and mesostriatal system. Neuropharmacology 2002; 43 (01) 101.
• 12 Klein E, Kolsky Y, Puyerovsky M, Koren D, Chistyakov A, Feinsod M. Right prefrontal slow repetitive transcranial magnetic stimulation in schizophrenia: a double-blind sham-controlled pilot study. Biol Psychiatry 1999; 46 (10) 1451-4.
• 13 McNamara B, Ray JL, Arthurs OJ, Boniface S. Transcranial magnetic stimulation for depression and other psychiatric disorders. Psychol Med 2001; 31 (07) 1141-6.
• 14 Nahas Z, Molloy M, Risch SC, George MS. TMS in schizophrenia. In: George MS, Belmaker RH. (eds) Transcranial magnetic stimulation in neuropsychiatry. Washington, DC: American Psychiatric Press; 2000: 237-52.
• 15 Rollnik JD, Huber TJ, Mogk H, Siggelkow S, Kropp S, Dengler R. et al. High frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex in schizophrenic patients. Neuroreport 2000; 11 (18) 4013-5.
• 16 Rosenberg PB, Mehndiratta RB, Mehndiratta YP, Wamer A, Rosse RB, Balish M. Repetitive transcranial magnetic stimulation treatment of comorbid posttraumatic stress disorder and major depression. J Neuropsychiatry Clin Neurosci 2002; 14 (03) 270-6.
• 17 Schultz SK, Andreasen NC. Schizophrenia. Lancet 1999; 353 (9162): 1425-30.
• 18 Strafella AP, Paus T, Barrett J, Dagher A. Repetitive transcranial magnetic stimulation of the human prefrontal cortex induces dopamine release in the caudate nucleus. J Neurosci 2001; 21 (15) RC157.
• 19 Yu HC, Liao KK, Chang TJ, Tsai SJ. Transcranial magnetic stimulation in schizophrenia. Am J Psychiatry 2002; 159 (03) 494-5.