Nichtinvasive Hirnstimulationsverfahren in der Psychiatrie

In der Behandlung psychischer Erkrankungen bietet die Gruppe der nichtinvasiven Hirnstimulationsverfahren einen auf neurophysiologischen Erkenntnissen basierenden und integrativen Ansatz. Einige der Stimulationsverfahren sind für spezifische psychiatrische Indikationen bereits wissenschaftlich sehr gut untersucht und haben sich weltweit in der Therapie etabliert. So hat die transkranielle Magnetstimulation (TMS) zur Behandlung der therapierefraktären Depression in den USA bereits seit 2008 eine Zulassung der Food and Drug Administration (FDA). In Europa und speziell in Deutschland wird TMS jedoch selbst im universitären Rahmen nicht flächendeckend angeboten. Der nachfolgende Artikel beschreibt die zur Verfügung stehenden Technologien und deren biologische Wirkmechanismen, skizziert die klinische Indikationsstellung und Anwendung der TMS und fasst die klinische Evidenz zusammen. Er orientiert sich an den kürzlich veröffentlichen Leitlinien zur therapeutischen Nutzung nichtinvasiver Hirnstimulation [1] [2] [3].

Abstract

Based on neurophysiological findings, non-invasive brain stimulation methods offer an integrative treatment approach for mental disorders. Some of the stimulation methods have already been extensively studied for specific psychiatric indications and have become established as reasonable treatment option. For example, transcranial magnetic stimulation (TMS) for the treatment of refractory depression received approval from the Food and Drug Administration (FDA) in the United States in 2008. However, in Europe and especially in Germany, TMS is not widely offered even in a university setting. The following article describes the available technologies and their biological mechanisms of action, outlines the clinical indication and application of TMS, and summarizes the clinical evidence. The article is based on recently published guidelines for the therapeutic use of non-invasive brain stimulation [1] [2] [3].

Schlüsselwörter

Nichtinvasive Hirnstimulation - transkranielle Magnetstimulation - transkranielle Gleichstromstimulation - Depression - Schizophrenie

Key words

Non-invasive brain stimulation - transcranial magnetic stimulation - transcranial direct current stimulation - depression - schizophrenia

Publication History

Article published online:
26 January 2022

• 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
• 2 Fregni F, El-Hagrassy MM, Pacheco-Barrios K. et al. Evidencebased 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.
• 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.
• 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
• 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
• 6 Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet 1985; 325: 1106-1107
• 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
• 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
• 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
• 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
• 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
• 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.
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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, placebocontrolled, multicenter trial. Eur Arch Psychiatry Clin Neurosci 2018; 268: 663-673
• 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
• 22 Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 2000; 527: 633
• 23 Reinhart RM, Nguyen JA. Working memory revived in older adults by synchronizing rhythmic brain circuits. Nature Neurosci 2019; 22: 820-827
• 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
• 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
• 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
• 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