Transkranielle Gleichstromstimulation in der Psychiatrie

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

• Literatur

• 1 Nitsche MA, Liebetanz D, Tergau F, Paulus W. Modulation kortikaler Erregbarkeit beim Menschen durch transkranielle Gleichstromstimulation. Nervenarzt 2002; 73: 332-5.
• 2 Mondino M, Bennabi D, Poulet E, Galvao F, Brunelin J, Haffen E. Can transcranial direct current stimulation (tDCS) alleviate symptoms and improve cognition in psychiatric disorders?. World J Biol Psychiatry 2014; 15: 261-75.
• 3 Palm U, Hasan A, Keeser D, Bunse T, Padberg F. Neue Hirnstimulationsverfahren in der Psychiatrie: Die transkranielle Gleichstromstimulation (tDCS) zur Behandlung der Depression. Nervenheilkunde 2013; 32: 866-76.
• 4 Palm U, Hasan A, Dehning S. et al. Bifrontale transkranielle Gleichstromstimulation zur Behandlung der Schizophrenie. Nervenheilkunde 2014; 05: 382-86.
• 5 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: 383-91.
• 6 Bennabi D, Nicolier M, Monnin J. et al. Pilot study of feasibility of the effect of treatment with tDCS in patients suffering from treatment-resistant depression treated with escitalopram. Clin Neurophysiol 2015; 126: 1185-9.
• 7 Loo CK, Sachdev P, Martin D. et al. A doubleblind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. Int J Neuropsychopharmacol 2010; 13: 61-9.
• 8 Loo CK, Alonzo A, Martin D, Mitchell PB, Galvez V, Sachdev P. Transcranial direct current stimulation for depression: 3-week, randomised, shamcontrolled trial. Br J Psychiatry 2012; 200: 52-9.
• 9 Palm U, Schiller C, Fintescu Z. et al. Transcranial direct current stimulation in treatment resistant depression: A randomized double-blind, placebocontrolled study. Brain Stimul 2012; 05: 242-51.
• 10 Blumberger DM, Tran LC, Fitzgerald PB, Hoy KE, Daskalakis ZJ. A randomized double-blind shamcontrolled study of transcranial direct current stimulation for treatment-resistant major depression. Front Psychiatry 2012; 03: 74.
• 11 Brunoni AR, Moffa A, Fregni F. et al. Transcranial direct current stimulation for major depression: a meta-analysis of individual patient data. Br J Psychiatry. 2015 [Epub ahead of print].
• 12 Dell’Osso B, Dobrea C, Arici C. et al. Augmentative transcranial direct current stimulation (tDCS) in poor responder depressed patients: a follow-up study. CNS Spectr 2014; 19: 347-54.
• 13 Shiozawa P, da Silva ME, Dias DR, Chaves AC, de Oliveira Diniz BS, Cordeiro Q. Transcranial direct current stimulation for depression in a 92-year-old patient: a case study. Psychogeriatrics 2014; 14: 269-70.
• 14 Shiozawa P, da Silva ME, Cordeiro Q. Transcranial direct current stimulation for treating depression in a patient with right hemispheric dominance: A Case Study. J ECT 2015; 31: 201-2.
• 15 Ho KA, Bai S, Martin D. et al. A pilot study of alternative transcranial direct current stimulation electrode montages for the treatment of major depression. J Affect Disord 2014; 167: 251-8.
• 16 Ho KA, Bai S, Martin D, Alonzo A, Dokos S, Loo CK. Clinical pilot study and computational modeling of bitemporal transcranial direct current stimulation, and safety of repeated courses of treatment, in major depression. J ECT. 2015 [Epub ahead of print].
• 17 Kuo MF, Nitsche MA. Effects of transcranial electrical stimulation on cognition. Clin EEG Neurosci 2012; 43: 192-9.
• 18 Brunoni AR, Zanao TA, Vanderhasselt MA. et al. Enhancement of affective processing induced by bifrontal transcranial direct current stimulation in patients with major depression. Neuromodulation 2014; 17: 138-42.
• 19 Moreno ML, Vanderhasselt MA, Carvalho AF. et al. Effects of acute transcranial direct current stimulation in hot and cold working memory tasks in healthy and depressed subjects. Neurosci Lett 2015; 591: 126-31.
• 20 Vanderhasselt MA, De Raedt R, Namur V. et al. Transcranial electric stimulation and neurocognitive training in clinically depressed patients: a pilot study of the effects on rumination. Prog Neuropsychopharmacol Biol Psychiatry 2014; 57: 93-9.
• 21 Plewnia C, Schroeder PA, Kunze R, Faehling F, Wolkenstein L. Keep calm and carry on: Improvised frustration tolerance and processing speed by transcranial direct current stimulation (tDCS). PLoS ONE 2015; 10: e0122578.
• 22 Brunoni AR, Boggio PS, De Raedt R. et al. Cognitive control therapy and transcranial direct current stimulation for depression: a randomized, doubleblinded, controlled trial. J Affect Disord 2014; 162: 43-9.
• 23 Hoy KE, Emonson MR, Arnold SL, Thomson RH, Daskalakis ZJ, Fitzgerald PB. Testing the limits: Investigating the effect of tDCS dose on working memory enhancement in healthy controls. Neuropsychologia 2013; 51: 1777-84.
• 24 Teo F, Hoy KE, Daskalakis ZJ, Fitzgerald PB. Investigating the role of current strength in tDCS modulation of working memory performance in healthy controls. Front Psychiatry 2011; 02: 45.
• 25 Brunelin J, Mondino M, Gassab L. et al. Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia. Am J Psychiatry 2012; 169: 719-24.
• 26 Fitzgerald PB, McQueen S, Daskalakis ZJ, Hoy KE. A negative pilot study of daily bimodal transcranial direct current stimulation in schizophrenia. Brain Stimul 2014; 07: 813-6.
• 27 Palm U, Keeser D, Kaymakanova F. et al. EPA-1749 – Transcranial direct current stimulation (TDCS) improves negative symptoms in schizophrenia: a double-blind, randomized, clinical trial. Eur Psychiatry 2014; 29 Suppl (Suppl. 01) 1.
• 28 Nawani H, Bose A, Agarwal SM. et al. Modulation of corollary discharge dysfunction in schizophrenia by tDCS: preliminary evidence. Brain Stimul 2014; 07: 486-8.
• 29 Ferrucci R, Bortolomasi M, Tessari E. et al. EPA-1392 – Transcranial direct-current stimulation (tDCS) in patients with schizophrenia. Eur Psychiatry 2014 29 Suppl (Suppl. 01) 1.
• 30 Bose A, Shivakumar V, Narayanaswamy JC. et al. Insight facilitation with add-on tDCS in schizophrenia. Schizophr Res 2014; 156: 63-5.
• 31 Kurimori M, Shiozawa P, Bikson M, Aboseria M, Cordeiro Q. Targeting negative symptoms in schizophrenia: Results from a proof-of-concept trial assessing prefrontal anodic tDCS protocol. Schizophr Res 2015; 166: 362-3.
• 32 Vercammen A, Rushby JA, Loo C, Short B, Weickert CS, Weickert TW. Transcranial direct current stimulation influences probabilistic association learning in schizophrenia. Schizophr Res 2011; 131: 198-205.
• 33 Ribolsi M, Lisi G, Di Lorenzo G. et al. Perceptual pseudoneglect in schizophrenia: candidate endophenotype and the role of the right parietal cortex. Schizophr Bull 2013; 39: 601-7.
• 34 Göder R, Baier PC, Beith B. et al. Effects of transcranial direct current stimulation during sleep on memory performance in patients with schizophrenia. Schizophr Res 2013; 144: 153-4.
• 35 Hoy KE, Arnold SL, Emonson MR, Daskalakis ZJ, Fitzgerald PB. An investigation into the effects of tDCS dose on cognitive performance over time in patients with schizophrenia. Schizophr Res 2014; 155: 96-100.
• 36 Mondino M, Haesebaert F, Poulet E, Suaud-Chagny M-F, Brunelin J. Fronto-temporal transcranial direct current stimulation (tDCS) reduces sourcemonitoring deficits and auditory hallucinations in patients with schizophrenia. Schizophr Res 2015; 161: 515-6.
• 37 Ferrucci R, Mameli F, Guidi I. et al. Transcranial direct current stimulation improves recognition memory in Alzheimer disease. Neurology 2008; 71: 493-8.
• 38 Boggio PS, Khoury LP, Martins DC, Martins OE, de Macedo EC, Fregni F. Temporal cortex direct current stimulation enhances performance on a visual recognition memory task in Alzheimer disease. J Neurol Neurosurg Psychiatry 2009; 80: 444-7.
• 39 Boggio PS, Ferrucci R, Mameli F. et al. Prolonged visual memory enhancement after direct current stimulation in Alzheimer’s disease. Brain Stimul 2012; 05: 223-30.
• 40 Penolazzi B, Bergamaschi S, Pastore M, Villani D, Sartori G, Mondini S. Transcranial direct current stimulation and cognitive training in the rehabilitation of Alzheimer disease: A case study. Neuropsychol Rehabil 2014; 07: 1-19.
• 41 Cotelli M, Manenti R, Brambilla M. et al. Anodal tDCS during face-name associations memory training in Alzheimer’s patients. Front Aging Neurosci 2014; 06: 38.
• 42 Khedr EM, Gamal N, El-Fetoh NA. et al. A doubleblind randomized clinical trial on the efficacy of cortical direct current stimulation for the treatment of Alzheimer’s disease. Front Aging Neurosci 2014; 06: 275.
• 43 Suemoto CK, Apolinario D, Nakamura-Palacios EM. et al. Effects of a non-focal plasticity protocol on apathy in moderate Alzheimer’s disease: a randomized, double-blind, sham-controlled trial. Brain Stimul 2014; 07: 308-13.
• 44 Wang J, Wu D, Chen Y, Yuan Y, Zhang M. Effects of transcranial direct current stimulation on language improvement and cortical activation in nonfluent variant primary progressive aphasia. Neurosci Lett 2013; 549: 29-33.
• 45 Cotelli M, Manenti R, Petesi M. et al. Treatment of primary progressive aphasias by transcranial direct current stimulation combined with language training. J Alzheimer Dis 2014; 39: 799-808.
• 46 Fregni F, Liguori P, Fecteau S, Nitsche MA, Pascual-Leone A, Boggio PS. Cortical stimulation of the prefrontal cortex with transcranial direct current stimulation reduces cue-provoked smoking craving: a randomized, sham-controlled study. J Clin Psychiatry 2008; 69: 32-40.
• 47 Boggio PS, Liguori P, Sultani N, Rezende L, Fecteau S, Fregni F. Cumulative priming effects of cortical stimulation on smoking cue-induced craving. Neurosci Lett 2009; 463: 82-6.
• 48 Fecteau S, Agosta Hone-BlanchetS. et al. Modulation of smoking and decision-making behaviors with transcranial direct current stimulation in tobacco smokers: a preliminary study. Drug Alcohol Depend 2014; 140: 78-84.
• 49 Xu J, Fregni F, Brody AL, Rahman AS. Transcranial direct current stimulation reduces negative affect but not cigarette craving in overnight abstinent smokers. Front Psychiatry 2013; 04: 112.
• 50 Meng Z, Liu C, Yu C, Ma Y. Transcranial direct current stimulation of the frontal-parietal-temporal area attenuates smoking behavior. J Psychiatr Res 2014; 54: 19-25.
• 51 Boggio PS, Sultani N, Fecteau S. et al. Prefrontal cortex modulation using transcranial DC stimulation reduces alcohol craving: a double-blind, sham-controlled study. Drug Alcohol Depend 2008; 92: 55-60.
• 52 da Silva MC, Conti CL, Klauss J. et al. Behavioral effects of transcranial direct current stimulation (tDCS) induced dorsolateral prefrontal cortex plasticity in alcohol dependence. J Physiol Paris 2013; 107: 493-502.
• 53 Klauss J, Penido LCPinheiro, Silva BLMerlo. et al. A randomized controlled trial of targeted prefrontal cortex modulation with tDCS in patients with alcohol dependence. Int J Neuropsychopharmacol 2014; 17: 1793-803.
• 54 den Uyl TE, Gladwin TE, Wiers RW. Transcranial direct current stimulation, implicit alcohol associations and craving. Biol Psychiatry 2015; 105: 37-42.
• 55 Boggio PS, Zaghi S, Villani AB, Fecteau S, Pascual-Leone A, Fregni F. Modulation of risk-taking in marijuana users by transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC). Drug Alcohol Depend 2010; 112: 220-5.
• 56 Gorini A, Lucchiari C, Russell-Edu W, Pravettoni G. Modulation of risky choices in recently abstinent dependent cocaine users: a transcranial direct-current stimulation study. Front Hum Neurosci 2014; 08: 661.
• 57 Conti CL, Nakamura-Palacios EM. Bilateral transcranial direct current stimulation over dorsolateral prefrontal cortex changes the drug-cued reactivity in the anterior cingulate cortex of crack-cocaine addicts. Brain Stimul 2014; 07: 130-2.
• 58 Conti CL, Moscon JA, Fregni F, Nitsche MA, Nakamura-Palacios EM. Cognitive related electrophysiological changes induced by non-invasive cortical electrical stimulation in crack-cocaine ad- diction. Int J Neuropsychopharmacol 2014; 17: 1465-75.
• 59 Shahbabaie A, Golesorkhi M, Zamanian B. et al. State dependent effect of transcranial direct current stimulation (tDCS) on methamphetamine craving. Int J Neuropsychopharmacol 2014; 17: 1591-8.
• 60 Fregni F, Orsati F, Pedrosa W. Transcranial direct current stimulation of the prefrontal cortex modulates the desire for specific foods. Appetite 2008; 51: 34-41.
• 61 Goldman RL, Borckardt JJ, Frohman HA. Prefrontal cortex transcranial direct current stimulation (tDCS) temporarily reduces food cravings and increases the self-reported ability to resist food in adults with frequent food craving. Appetite 2011; 56: 741-6.
• 62 Kekic M, McClelland J, Campbell I. et al. The effects of prefrontal cortex transcranial direct current stimulation (tDCS) on food craving and temporal discounting in women with frequent food cravings. Appetite 2014; 78: 55-62.
• 63 Lapenta OM, Sierve KD, de Macedo EC, Fregni F, Boggio PS. Transcranial direct current stimulation modulates ERP-indexed inhibitory control and reduces food consumption. Appetite 2014; 83: 42-8.
• 64 Hecht D. Transcranial direct current stimulation in the treatment of anorexia. Med Hypotheses 2010; 74: 1044-7.
• 65 Khedr EM, Elfetoh NA, Ali AM, Noamany M. Anodal transcranial direct current stimulation over the dorsolateral prefrontal cortex improves anorexia nervosa. Restor Neurol Neurosci 2014; 32: 789-97.
• 66 Shiozawa P, Leiva AP, Castro CD. et al. Transcranial direct current stimulation for generalized anxiety disorder: a case study. Biol Psychiatry 2014; 75: e17-18.
• 67 Narayanaswamy JC, Jose D, Chhabra H. et al. Successful Application of Add-on Transcranial Direct Current Stimulation (tDCS) for Treatment of SSRI Resistant OCD. Brain Stimul 2015; 08: 655-7.
• 68 Mondino M, Haesebaert F, Poulet E, Saoud M, Brunelin J. Efficacy of Cathodal Transcranial Direct Current Stimulation Over the Left Orbitofrontal Cortex in a Patient With Treatment-Resistant Obsessive-Compulsive Disorder. J ECT. 2015 [Epub ahead of print].
• 69 Volpato C, Piccione F, Cavinato M. et al. Modulation of affective symptoms and resting state activity by brain stimulation in a treatment-resistant case of obsessive-compulsive disorder. Neurocase 2013; 19: 360-70.
• 70 Mrakic-Sposta S, Marceglia S, Mameli F, Dilena R, Tadini L, Priori A. Transcranial direct current stimulation in two patients with Tourette syndrome. Mov Disord 2008; 23: 2259-61.
• 71 Palm U, Ayache SS, Padberg F, Lefaucheur JP. Noninvasive brain stimulation therapy in multiple sclerosis: A review of tDCS, rTMS and ECT results. Brain Stimul 2014; 07: 849-54.
• 72 Bueno VF, Brunoni AR, Boggio PS, Bensenor IM, Fregni F. Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression. Neurocase 2011; 17: 318-22.
• 73 Shekhawat GS, Stinear CM, Searchfield GD. Modulation of perception or emotion? A scoping review of tinnitus neuromodulation using transcranial direct current stimulation. Neurorehab Neural Repair 2015; 29: 837-46.
• 74 Shenoy S, Bose A, Chhabra H. et al. Transcranial direct current stimulation (tDCS) for auditory verbal hallucinations in schizophrenia during pregnancy: a case report. Brain Stimul 2015; 08: 163-4.
• 75 Raimundo RJ, Uribe CE, Brasil-Neto JP. Lack of clinically detectable acute changes on autonomic or thermoregulatory functions in healthy subjects after transcranial direct current stimulation (tDCS). Brain Stimul 2012; 05: 196-200.
• 76 Vigod S, Dennis CL, Daskalakis Z. et al. Transcranial direct current stimulation (tDCS) for treatment of major depression during pregnancy: study protocol for a pilot randomized controlled trial. Trials 2014; 15: 366.
• 77 Nitsche MA, Liebetanz D, Lang N, Antal A, Tergau F, Paulus W. Safety criteria for transcranial direct current stimulation (tDCS) in humans. Clin Neurophysiol 2003; 114: 2220-2222.