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Nervenheilkunde 2015; 34(12): 1016-1025
DOI: 10.1055/s-0038-1627659
Hirnstimulation
Schattauer GmbH

Transkranielle Gleichstromstimulation in der Psychiatrie

Update 2015Transcranial direct current stimulation in psychiatryUpdate 2015
U. Palm
1   Klinik für Psychiatrie, Ludwig-Maximilians-Universität München
2   Munich Center for Brain Stimulation
,
W. Strube
1   Klinik für Psychiatrie, Ludwig-Maximilians-Universität München
,
T. Bunse
1   Klinik für Psychiatrie, Ludwig-Maximilians-Universität München
,
I. Bauer
1   Klinik für Psychiatrie, Ludwig-Maximilians-Universität München
3   Klinik für Psychiatrie, Technische Universität München
,
G. Dunkel
1   Klinik für Psychiatrie, Ludwig-Maximilians-Universität München
,
A. Hasan
1   Klinik für Psychiatrie, Ludwig-Maximilians-Universität München
2   Munich Center for Brain Stimulation
,
A. Pfeiffer
1   Klinik für Psychiatrie, Ludwig-Maximilians-Universität München
2   Munich Center for Brain Stimulation
,
F. Padberg
1   Klinik für Psychiatrie, Ludwig-Maximilians-Universität München
2   Munich Center for Brain Stimulation
› Author Affiliations
Further Information

Publication History

eingegangen am: 01 October 2015

angenommen am: 01 October 2015

Publication Date:
22 January 2018 (online)

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Zusammenfassung

Ziel: Die transkranielle Gleichstromstimulation ist ein nicht invasives Verfahren zur Neuromodulation, das seit etwa zehn Jahren intensiv in der Behandlung von neuropsychia trischen Erkrankungen erforscht wird. Es wird ein Überblick über Einsatz und Entwicklung des Verfahrens bei psychiatrischen Erkrankungen gegeben. Material und Methoden: Eine Literaturrecherche wurde über die Literaturdatenbank des US-amerikanischen National Institute of Mental Health (Pubmed) durchgeführt mit den Stichworten “tDCS” bzw. “transcranial direct current stimulation” und dem jeweiligen gesuchten Krankheitsbild. Ergebnisse: Vor allem in der Behandlung der Depression liegen doppelblinde randomisierte klinische Studien vor, die eine Wirksamkeit der tDCS belegen konnten, wobei diese mit steigender Therapieresistenz abnimmt. In der Behandlung der Schizophrenie liegen wenige Studien zur Verbesserung von klinischer Symptomatik oder Kognition vor. Relativ gut erforscht ist der Einsatz der tDCS bei der Behandlung der Tabakabhängigkeit bezüglich Reduktion des Rauchverlangens, ebenso bei der Alkoholabhängigkeit. Die Modulation des Essverlangens konnte in mehreren Studien nachgewiesen werden. Für die Behandlung der Alzheimer Demenz liegen gemischte Resultate aus Studien vor. Die Behandlung sonstiger psychiatrischer Erkrankungen, ebenso wie die Behandlung psychiatrischer Komorbidität bei neurologischen Erkrankungen, ist meist nur auf Ebene von Fallberichten beschrieben. Schlussfolgerung: Nur für wenige Krankheitsbilder besteht eine ausreichend gute Datenlage, um die tDCS als Zusatztherapie empfehlen zu können. Für eine Zulassung der tDCS als etablierte Therapie sind noch umfassende systematische Untersuchungen bei den meisten psychiatrischen Erkrankungen nötig. Insgesamt gilt die Anwendung als sicher und nebenwirkungsarm, selbst bei intensivierter Anwendung. Dennoch bedarf es weiterer Standardisierung des Verfahrens bezüglich Elektrodenpositionierung, Stromstärke, Dauer und Frequenz der Anwendung sowie Gesamtzahl der Anwendungen.

Summary

Objective: Transcranial direct current stimulation is a non-invasive tool for neuromodulation and has been investigated in neuro - psychiatric disorders over the last 10 years. In this review, we provide an overview of application and evolvement of this therapeutic tool in psychiatric disorders over the last years. Regarding depressive disorders and schizophrenia, this review follows up directly on two publications (2013 and 2014) on the respective disorders. Regarding other psychiatric disorders, an overview over studies mostly published in recent years is given. Materials and methods: A literature search was performed using the database of the National Institute of Health (Pubmed) with the terms “tDCS”, “transcranial direct current stimulation”, and the respective disorder searched. Results: For the treatment of depression, a couple of double-blind randomized controlled trials were found that show efficacy of tDCS as an adjunct to psychopharmacologic treatment. Efficacy of treatment is declining with increasing treatment resistance. For the treatment of schizophrenia, only a few clinical trials report improvement of psychopathologic symptoms or cognition. There is relatively good data for the use of tDCS in the treatment of tobacco addiction and the reduction of nicotine craving, as well as for the treatment of alcohol addiction. There is also some data on modulation of food craving by tDCS. The treatment of dementia (i.e. Alzheimer) is evaluated in several studies and brought diverging results. The improvement of other psychiatric disorders such as general anxiety disorder, obsessive- compulsive disorder, Tourette’s syndrome, or psychiatric symptoms in neurologic disorders is reported in case reports only. Application of tDCS during pregnancy is discussed. Safety aspects were evaluated and brought no additional information to the sound knowledge of a safe and well tolerable use of tDCS. Conclusions: For only a few psychiatric disorders, i.e. depressive disorders, and to some extent schizophrenia and addiction disorders, there is enough data available to suggest tDCS as an adjunct treatment to psychopharmacologic therapy. There is a lack of sufficient and reliable data to establish tDCS as a regular treatment tool in most psychiatric disorders. Application of tDCS is safe and well tolerable even when using intensive stimulation protocols. However there is a need for standardization of electrode positioning, current strength, duration and frequency of application and total number of applications. Finally, regulatory authorities in most countries are not able to suggest tDCS due to lacking evidence of efficacy.

Schlüsselwörter

Transkranielle Gleichstromstimulation - tDCS - Depression - Schizophrenie - Demenz - Sucht - psychiatrische Erkrankung

Keywords

Transcranial direct current stimulation - tDCS - depression - schizophrenia - dementia - addiction - psychiatric disorder
 

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