Neuroendokrine Effekte der repetitiven transkraniellen Magnetstimulation

Zusammenfassung

Seit Anfang der neunziger Jahre des vergangenen Jahrhunderts wird die repetitive transkranielle Magnetstimulation (rTMS) als mögliches Therapieverfahren bei verschiedenen psychiatrischen Krankheitsbildern diskutiert. Nach dem Faradayschen Prinzip kann über die Induktion eines Magnetfeldes im Schädelinneren ein schmerzloser elektrischer Stromfluss erzeugt werden. Hervorzuheben ist, dass die während und nach Magnetstimulation gemessenen neurobiologischen Effekte nicht durch das Magnetfeld selbst, sondern durch den hierüber intrazerebral induzierten elektrischen Strom, welcher zu neuronaler Depolarisation führt, verursacht werden. Dies wiederum beeinflusst neuronale Netzwerke, welche bei psychiatrischen Erkrankungen möglicherweise dysfunktional sind. Erst in letzter Zeit wurden in der Grundlagenforschung Kenntnisse über die durch rTMS induzierten neurobiologischen Veränderungen gewonnen, die den beschriebenen klinischen Effekten zugrunde liegen und zu einer Optimierung der bislang eher unspezifischen klinischen Anwendung von rTMS führen könnten. Diese zeigen sich tierexperimentell unter anderem in spezifischen Änderungen der Freisetzungsmuster von Neuromodulatoren und Neurotransmittern in psychopathologisch relevanten Hirnregionen. Von besonderem Interesse sind hierbei als klassischer Neurotransmitter das Monoamin Dopamin sowie das Neuropeptid Vasopressin. Letzteres weist vielfältige neuromodulatorische Eigenschaften auf, seine Bedeutung für die Pathogenese der Depression wird zunehmend erkannt.

Summary

The potential therapeutic properties of repetitive transcranial magnetic stimulation (rTMS) in the treatment of various psychiatric disorders are under discussion since the early nineties of the last century. According to Faraday’s law, the induction of a magnetic field evokes intracerebral electric currents. It is important to note that the effects obtained by use of rTMS do not occur on the basis of the magnetic field applied but are achieved by the electric field induced that ultimately leads to neuronal depolarization. This, in turn, influences neuronal networks thought to be dysfunctional in psychiatric disorders. In recent years, increasing knowledge concerning the rTMS-induced neurobiological changes could be accumulated in basic science. The mechanisms observed could underly the clinical effects reported and may finally help to optimize the clinical efficacy of rTMS. rTMS can induce specific alterations in neuronal networks as reflected by changes in neurotransmitter/neuromodulator release in psychopathologically relevant brain regions. The classical neurotransmitter dopamine and the neuropeptide vasopressin hereby are of particular interest. The latter exerts a multitude of neuromodulatory functions and its role in the pathogenesis of depressive disorder is increasingly recognized.

Schlüsselwörter

Repetitive transkranielle Magnetstimulation - Depression - Stress - Neurobiologie - Dopamin - Vasopressin

Keywords

Repetitive transcranial magnetic stimulation - depression - dopamine - vasopressin - stress

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