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Fortschr Neurol Psychiatr 2001; 69(9): 402-409
DOI: 10.1055/s-2001-16906
ORIGINALARBEIT
© Georg Thieme Verlag Stuttgart · New York

Welche depressiven Patienten profitieren von präfrontaler repetitiver transkranieller Magnetstimulation (RTMS)?

Which Patients with Major Depression Benefit from Prefrontal Repetitive Magnetic Stimulation (RTMS)?G. W. Eschweiler, C. Plewnia, M. Bartels
  • Universitätsklinik für Psychiatrie und Psychotherapie Tübingen
    (Ärztl. Direktor: Prof. Dr. med. G. Buchkremer)
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Publication History

Publication Date:
03 September 2001 (online)

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Zusammenfassung:

Klinische Besserungsraten nach ein- bis zweiwöchiger Behandlung mittels präfrontaler repetitiver transkranieller Magnetstimulation (RTMS) streuen in der Literatur zwischen 6 % und 60 % Verbesserung (Mittelwert von 37 %) in der Hamilton-Depressions-Skala (HAMD). Diese Varianz ist wahrscheinlich durch unterschiedliche Behandlungsmodalitäten, aber auch durch genetische, psychopathologische und neuropsychologische Merkmale der Patienten sowie den funktionellen Zustand des stimulierten Kortexareals zu Beginn der Behandlung bedingt.

10 offene und 7 plazebokontrollierte publizierte Studien, einschließlich zwei eigener Untersuchungen, mit insgesamt mehr als 300 Patienten deuten auf verschiedene positive Prädiktoren für eine antidepressive Wirksamkeit von präfrontaler RTMS: 1) jüngeres Alter, 2) somatische Zeichen der Angst, 3) fehlende kortikale Hyperaktivierung unter der 10-Hz-gepulsten Spule, 4) Hypermetabolismus unter der 1 Hz gepulsten Spule.

Als negative Prädiktoren für die antidepressive Wirksamkeit einer präfrontalen RTMS zeichnen sich ab: 1) höheres Alter, 2) frontale Hirnatrophie, 3) kognitive Störungen im Bereich frontaler Leistungen, 4) psychotische Merkmale, 5) kortikale Hyperaktivierung unter der 10-Hz-gepulsten Spule und 6) fehlende Wirksamkeit der Elektrokrampftherapie.

Die präfrontale RTMS ist somit wahrscheinlich kein Ersatz, sondern eine Ergänzung zur Pharmakotherapie oder Elektrokrampftherapie der Depression. Von der RTMS sollten insbesondere jüngere, nicht kognitiv beeinträchtigte und ängstliche Patienten profitieren.

Which Patients with Major Depression Benefit from Prefrontal Repetitive Magnetic Stimulation (RTMS)?

Antidepressive benefit of prefrontal repetitive magnetic stimulation (RTMS) for one or two weeks varies between 6 % and 60 % (mean 37 %) improvement of the Hamilton depression scale vs. 12 % improvement following sham RTMS. This variance is probably caused by study specific stimulus parameters but also by genetic, psychopathological and neuropsychological characteristics of the patients as well as by the functional state of the cortex area below the stimulation coil.

Data from 10 open and 7 sham controlled studies including two own studies comprising more than 300 patients with major depression have been published to date. In synopsis several positive predictors for antidepressive response of prefrontal RTMS become apparent: 1) younger age, 2) somatic signs of anxiety, 3) lack of cortical hyperactivity below the magnetic coil pulsed by 10 Hz stimuli, 4) cortical hypermetabolism below the 1 Hz pulsed coil.

Negative predictors of response to prefrontal RTMS were: 1) Advanced age, 2) prefrontal atrophy, 3) cognitive impairment in neuropsychological tasks assigned to the prefrontal cortex, 4) psychotic symptoms, 5) cortical hyperactivity below 10 Hz pulsed coil 6) non-response to electroconvulsive therapy (ECT).

While prefrontal RTMS will probably not replace ECT in severe major depression with psychotic symptoms it could be beneficial especially in younger anxious patients without cognitive impairment.

Literatur

  • 1 Gainotti G, Azzoni A, Marra C. Frequency, phenomenology and anatomical-clinical correlates of major post-stroke depression.  Br J Psychiatry. 1999;  175 163-167
    PubMedGoogle Scholar
  • 2 Barker A T, Jalinous R, Freeston I L. Non-invasive magnetic stimulation of human motor cortex [letter].  Lancet. 1985;  1 1106-1107
    PubMedGoogle Scholar
  • 3 Haag C, Padberg F, Moeller H J. Transcranial magnetic stimulation (TMS): A diagnostic tool from neurology as a therapy in psychiatry? .  Nervenarzt. 1997;  68 274-278
    CrossrefPubMedGoogle Scholar
  • 4 Brandt S A, Ploner C J, Meyer B U. [Repetitive transcranial magnetic stimulation. Possibilities, limits and safety aspects] Repetitive transkranielle Magnetstimulation. Möglichkeiten, Grenzen und Sicherheitsaspekte.  Nervenarzt. 1997;  68 778-784
    CrossrefPubMedGoogle Scholar
  • 5 Höflich G, Kasper S, Hufnagel A, Ruhrmann S, Möller H J. Application of transcranial magnetic stimulation in treatment of drug-resistant major depression: A report of two cases.  Hum Psychopharm. 1993;  8 361-365
    PubMedGoogle Scholar
  • 6 Kolbinger H M, Hoflich G, Hufnagel A, Moller H J, Kasper S. Transcranial magnetic stimulation (TMS) in the treatment of major depression: A pilot study.  Hum Psychopharmacol. 1995;  10 305-310
    PubMedGoogle Scholar
  • 7 Pascual-Leone A, Rubio B, Pallardo F, Catala M D. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression.  Lancet. 1996;  348 233-237
    CrossrefPubMedGoogle Scholar
  • 8 Markwort S, Cordes P, Aldenhoff J. [Transcranial magnetic stimulation as an alternative to electroshock therapy in treatment resistant depressions.  A literature review] Die transkranielle Magnetstimulation als Behandlungsalternative zur Elektrokrampftherapie bei therapieresistenten Depressionen - Eine Literaturübersicht.. Fortschr Neurol Psychiatr. 1997;  65 540-549
    PubMedGoogle Scholar
  • 9 George M S, Wassermann E M, Williams W A, Callahan A, Ketter T A, Basser P, Hallett M, Post R M. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression.  Neuroreport. 1995;  6 1853-1856
    CrossrefPubMedGoogle Scholar
  • 10 George M S, Wassermann E M, Kimbrell T A, Little J T, Williams W E, Danielson A L, Greenberg B D, Hallett M, Post R M. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial.  Am J Psychiatry. 1997;  154 1752-1756
    PubMedGoogle Scholar
  • 11 Padberg F, Zwanzger P, Thoma H, Kathmann N, Haag C, Greenberg B D, Hampel H, Möller H J. Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: comparative study of fast, slow and sham rTMS.  Psychiatry Res. 1999;  88 163-171
    CrossrefPubMedGoogle Scholar
  • 12 Triggs W J, McCoy K J, Greer R, Rossi F, Bowers D, Kortenkamp S, Nadeau S E, Heilman K M, Goodman W K. Effects of left frontal transcranial magnetic stimulation on depressed mood, cognition, and corticomotor threshold.  Biol Psychiatry. 1999;  45 1440-1446
    CrossrefPubMedGoogle Scholar
  • 13 Eschweiler G W, Wegerer C, Schlotter W, Spandl C, Stevens A, Bartels M. Left Prefrontal activation predicts therapeutic effects of repetitive transcranial magnetic stimulation (RTMS) in major depression.  Psychiatry Res (Neuroimaging). 2000;  99 161-172
    PubMedGoogle Scholar
  • 14 Klein E, Kreinin I, Chistyakov A, Koren D, Mecz L, Marmur S, Ben Shachar D, Feinsod M. Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double- blind controlled study.  Arch Gen Psychiatry. 1999;  56 315-320
    PubMedGoogle Scholar
  • 15 Loo C, Mitchell P, Sachdev P, McDarmont B, Parker G, Gandevia S. Double-blind controlled investigation of transcranial magnetic stimulation for the treatment of resistant major depression.  Am J Psychiatry. 1999;  156 946-948
    PubMedGoogle Scholar
  • 16 Lisanby S H, Luber B, Schroeder C M, Osman M, Finck D, Amassian V E, Arezzo J, Sackeim H A. RTMS in Primates: Intracerebral Measurement of rTMS and ECS induced voltage in vivo.  Electroencephalogr Clin Neurophysiol. 1998;  107 79P
    PubMedGoogle Scholar
  • 17 George M S, Lisanby S H, Sackeim H A. Transcranial magnetic stimulation: applications in neuropsychiatry.  Arch Gen Psychiatry. 1999;  56 300-311
    CrossrefPubMedGoogle Scholar
  • 18 Siebner H R, Peller M, Willoch F, Minoshima S, Boecker H, Auer C, Drzezga A, Conrad B, Bartenstein P. Lasting cortical activation after repetitive TMS of the motor cortex - A glucose metabolic study.  Neurology. 2000;  54 956-963
    PubMedGoogle Scholar
  • 19 Post A, Müller M B, Engelmann M, Keck M E. Repetitive transcranial magnetic stimulation in rats: evidence for a neuroprotective effect in vitro and in vivo.  Eur J Neurosci. 1999;  11 3247-3254
    CrossrefPubMedGoogle Scholar
  • 20 Müller M B, Toschi N, Kresse A E, Post A, Keck M E. Long-term repetitive transcranial magnetic stimulation increases the expression of brain-derived neurotrophic factor and cholecystokinin mRNA, but not neuropeptide tyrosine mRNA in specific areas of rat brain.  Neuropsychopharmacology. 2000;  23 205-215
    CrossrefPubMedGoogle Scholar
  • 21 Massot O, Grimaldi B, Bailly J M, Kochanek M, Deschamps F, Lambrozo J, Fillion G. Magnetic field desensitizes 5-HT(1B) receptor in brain: pharmacological and functional studies.  Brain Res. 2000;  858 143-150
    CrossrefPubMedGoogle Scholar
  • 22 Beique J C, de-Montigny C, Blier P, Debonnel G. Effects of sustained administration of the serotonin and norepinephrine reuptake inhibitor venlafaxine: I.  In vivo electrophysiological studies in the rat.. Neuropharmacology. 2000;  39 1800-1812
    PubMedGoogle Scholar
  • 23 Villringer A. Functional neuroimaging.  Optical approaches.. Adv Exp Med Biol. 1997;  413 1-18
    PubMedGoogle Scholar
  • 24 Heekeren H R, Kohl M, Obrig H, Wenzel R, von Pannwitz W, Matcher S J, Dirnagl U, Cooper C E, Villringer A. Noninvasive assessment of changes in cytochrome-c oxidase oxidation in human subjects during visual stimulation.  J Cereb Blood Flow Metab. 1999;  19 592-603
    PubMedGoogle Scholar
  • 25 Eschweiler G W, Plewnia C, Batra A, Bartels M. Does clinical response to repetitive prefrontal transcranial magnetic stimulation (rTMS) predict response to electroconvulsive therapy (ECT) in major depression? .  Can J Psychiatry. 2000;  45 58-59
    PubMedGoogle Scholar
  • 26 Paus T, Jech R, Thompson C J, Comeau R, Peters T, Evans A C. Dose-dependent reduction of cerebral blood flow during rapid-rate transcranial magnetic stimulation of the human sensorimotor cortex.  J Neurophysiol. 1998;  79 1102-1107
    PubMedGoogle Scholar
  • 27 Kimbrell T A, Little J T, Dunn R T, Frye M A, Greenberg B D, Wassermann E M, Repella J D, Danielson A L, Willis M W, Benson B E, Speer A M, Osuch E, George M S, Post R M. Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism.  Biol Psychiatry. 1999;  46 1603-1613
    CrossrefPubMedGoogle Scholar
  • 28 Davidson R J. Anterior electrophysiological asymmetries, emotion, and depression: conceptual and methodological conundrums.  Psychophysiology. 1998;  35 607-614
    CrossrefPubMedGoogle Scholar
  • 29 Figiel G S, Epstein C, McDonald W M, Amazon Leece J, Figiel L, Saldivia A, Glover S. The use of rapid-rate transcranial magnetic stimulation (rTMS) in refractory depressed patients.  J Neuropsychiatry Clin Neurosci. 1998;  10 20-25
    PubMedGoogle Scholar
  • 30 Kozel F A, Nahas Z, deBrux C, Molloy M, Lorberbaum J P, Bohning D, Risch S C, George M S. How coil-cortex distance relates to age, motor threshold, and antidepressant response to repetitive transcranial magnetic stimulation.  J Neuropsychiatry Clin Neurosci. 2000;  12 376-384
    PubMedGoogle Scholar
  • 31 Grunhaus L, Dannon P N, Schreiber S, Dolberg O H, Amiaz R, Ziv R, Lefkifker E. Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: an open study.  Biol Psychiatry. 2000;  47 314-324
    CrossrefPubMedGoogle Scholar
  • 32 Bench C J, Friston K J, Brown R G, Scott L C, Frackowiak R S, Dolan R J. The anatomy of melancholia-focal abnormalities of cerebral blood flow in major depression.  Psychol Med. 1992;  22 607-615
    PubMedGoogle Scholar
  • 33 Dolan R J, Bench C J, Liddle P F, Friston K J, Frith C D, Grasby P M, Frackowiak R S. Dorsolateral prefrontal cortex dysfunction in the major psychoses; symptom or disease specificity?.  J Neurol Neurosurg Psychiatry. 1993;  56 1290-1294
    PubMedGoogle Scholar
  • 34 Holthoff V A, Beuthien-Baumann B, Pietrzyk U, Pinkert J, Oehme L, Franke W G, Bach O. Regionale zerebrale Funktionsstörung bei der Depression im Verlauf.  Nervenarzt. 1998;  69 67-77
    PubMedGoogle Scholar
  • 35 Drevets W C, Videen T O, Price J L, Preskorn S H, Carmichael S T, Raichle M E. A functional anatomical study of unipolar depression.  J Neurosci. 1992;  12 3628-3641
    PubMedGoogle Scholar
  • 36 Mayberg H S, Liotti M, Brannan S K, McGinnis S, Mahurin R K, Jerabek P A, Silva J A, Tekell J L, Martin C C, Lancaster J L, Fox P T. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness.  Am J Psychiatry. 1999;  156 675-682
    PubMedGoogle Scholar
  • 37 D’Esposito M, Postle B R, Ballard D, Lease J. Maintenance versus manipulation of information held in working memory: an event-related fMRI study.  Brain Cogn. 1999;  41 66-86
    PubMedGoogle Scholar
  • 38 D’Esposito M, Zarahn E, Aguirre G K, Rypma B. The effect of normal aging on the coupling of neural activity to the bold hemodynamic response.  Neuroimage. 1999;  10 6-14
    CrossrefPubMedGoogle Scholar
  • 39 Rypma B, D’Esposito M. Isolating the neural mechanisms of age-related changes in human working memory.  Nat Neurosci. 2000;  3 509-515
    CrossrefPubMedGoogle Scholar
  • 40 Wiedemann G, Pauli P, Dengler W, Lutzenberger W, Birbaumer N, Buchkremer G. Frontal brain asymmetry as a biological substrate of emotions in patients with panic disorders.  Arch Gen Psychiatry. 1999;  56 78-84
    CrossrefPubMedGoogle Scholar
  • 41 Herwig U, Schönfeldt L C. The study of central nervous information processing with transcranial magnetic stimulation.  Fortschr Neurol Psychiatr. 2000;  68 289-300
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Herwig U, Schönfeldt L C, Lampe Y, Schuster B, Walter H, Spitzer M. Neuronavigierte repetitive Transkranielle Magnetstimulation bei depressiven Patienten, eine plazebokontrollierte Studie.  Nervenarzt. 2000;  71 S74-S74 (Abstract)
    PubMedGoogle Scholar
  • 43 Conca A, Koppi S, Konig P, Swoboda E, Krecke N. Transcranial magnetic stimulation: a novel antidepressive strategy? .  Neuropsychobiology. 1996;  34 204-207
    PubMedGoogle Scholar
  • 44 Tew J D, Mulsant B H, Haskett R F, Prudic J, Thase M E, Crowe R R, Dolata D, Begley A E, Reynolds C F, Sackeim H A. Acute efficacy of ECT in the treatment of major depression in the old-old.  Am J Psychiatry. 1999;  156 1865-1870
    PubMedGoogle Scholar
  • 45 George M S, Wassermann E M, Williams W A, Callahan A, Ketter T A, Basser P, Hallett M, Post R M. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression.  Neuroreport. 1995;  6 1853-1856
    CrossrefPubMedGoogle Scholar
  • 46 Berman R M, Narasimhan M, Sanacora G, Miano A P, Hoffman R E, Hu X S, Charney D S, Boutros N N. A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression.  Biol Psychiatry. 2000;  47 332-337
    CrossrefPubMedGoogle Scholar
  • 47 Geller V, Grisaru N, Abarbanel J M, Lemberg T, Belmaker R H. Slow magnetic stimulation of prefrontal cortex in depression and schizophrenia.  Prog Neuropsychopharmacol Biol Psychiatry. 1997;  21 105-110
    CrossrefPubMedGoogle Scholar

Dr. Gerhard W. Eschweiler

Universitätsklinik für Psychiatrie und Psychotherapie

Osianderstr. 24

72070 Tübingen

Email: eschweiler@med.uni-tuebingen.de

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