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Fortschr Neurol Psychiatr 2017; 85(05): 260-269
DOI: 10.1055/s-0043-105389
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Fatigue bei Multipler Sklerose: Neuronale Korrelate und Möglichkeiten nicht-invasiver Hirnstimulation mit tDCS

Multiple sclerosis fatigue, its neural correlates, and its modulation with tDCS
Samar S. Ayache
1   EA 4391 Excitabilité Nerveuse et Thérapeutique, Université Paris-Est, Créteil, Frankreich
2   Service de Physiologie, Funktionelle Untersuchungen, Hôpital Henri Mondor, Assistance Publique – Hôpitaux de Paris, Créteil, Frankreich
3   Neurology Division, Lebanese American University Medical Center – Rizk Hospital (LAUMC-RH), Beirut, Libanon
,
Moussa A. Chalah
1   EA 4391 Excitabilité Nerveuse et Thérapeutique, Université Paris-Est, Créteil, Frankreich
2   Service de Physiologie, Funktionelle Untersuchungen, Hôpital Henri Mondor, Assistance Publique – Hôpitaux de Paris, Créteil, Frankreich
,
Tania Kümpfel
4   Institut für klinische Neuroimmunologie, Klinikum der Universität München
,
Frank Padberg
5   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
,
Jean-Pascal Lefaucheur
1   EA 4391 Excitabilité Nerveuse et Thérapeutique, Université Paris-Est, Créteil, Frankreich
2   Service de Physiologie, Funktionelle Untersuchungen, Hôpital Henri Mondor, Assistance Publique – Hôpitaux de Paris, Créteil, Frankreich
,
Ulrich Palm
5   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
23. Mai 2017 (online)

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Zusammenfassung

Multiple Sklerose (MS) ist eine chronisch-progressive inflammatorische Erkrankung des zentralen Nervensystems und die häufigste Ursache nicht-traumatischer Funktionseinschränkung bei jungen Erwachsenen. Fatigue ist ein häufiges Symptom, das von einer Mehrzahl der MS-Patienten während des Krankheitsverlaufs berichtet wird und ihre Lebensqualität erheblich einschränkt. Trotz ihrer häufigen Prävalenz und ihrer Bedeutung sind die zugrundeliegenden pathophysiologischen Mechanismen nicht gut untersucht. Fatigue wird üblicherweise in ein primäre Fatigue mit aus der Krankheit selbst resultierenden pathologischen Veränderungen und in eine sekundäre Fatigue als Folge von Krankheitssymptomen, komorbiden Schlafstörungen, affektiven Störungen und Nebenwirkungen von Medikamenten eingeteilt. Erkenntnisse aus radiologischen, neurophysiologischen und endokrinologischen Untersuchungen führten zu Überlegungen, dass es eine Verbindung zwischen den Symptomen der Fatigue und strukturellen bzw. funktionellen Veränderungen in verschiedenen neuronalen Netzwerkstrukturen gibt. Über die letzten Jahre konnte gezeigt werden, dass verschiedene nichtinvasive Hirnstimulationsverfahren neuronale Netzwerkstrukturen modulieren können, insbesondere für die transkranielle Gleichstromstimulation (tDCS) konnten in den letzten Jahren übereinstimmende Ergebnisse nachgewiesen werden, wenngleich die Datenlage aufgrund des Pilotcharakters der Studien noch dünn ist. In dieser Übersichtsarbeit werden die neuronalen Korrelate der MS und die Rationale für den Einsatz der tDCS in der Behandlung der Fatigue dargestellt.

Abstract

Multiple sclerosis (MS) is a chronic progressive and inflammatory disease of the central nervous system and causes high rates of non-traumatic disability in young adults. Fatigue is frequently reported by a major part of patients during the disease course and dramatically increases the burden of illness. Despite the high prevalence of fatigue and its enormous impact on quality of life, its pathophysiological mechanisms are still unclear. Its etiology is multifactorial and complex, and is usually classified into ‘primary’ fatigue resulting from the pathological brain changes versus ‘secondary’ fatigue following disease symptoms, sleep disturbances, mood disorders, and side effects of medication. Hypotheses concerning the pathophysiology of this symptom are based on radiological, physiological, and endocrine data. It has been suggested that fatigue refers to structural and functional changes in a variety of neuronal networks. Over the past years, non-invasive brain stimulation methods were used to modulate brain function, especially transcranial direct current stimulation (tDCS) has proven to impact neuronal connectivity; however evidence is still sparse due to the pilot character of the studies. In this review we aim at discussing the neuronal correlates of fatigue and the potential influence of tDCS in the modulation of the symptoms.

Schlüsselwörter

Multiple Sklerose - Fatigue - tDCS - nicht-invasive Hirnstimulation

Key words

multiple sclerosis - fatigue - tDCS - non-invasive brain stimulation
 

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