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Klinische Neurophysiologie 2004; 35(2): 55-60
DOI: 10.1055/s-2003-814948
Originalia
© Georg Thieme Verlag KG Stuttgart · New York

Erzeugung und Modulation von Neuroplastizität durch transkranielle Gleichstromstimulation beim Menschen

Induction and Modulation of Neuroplasticity by Transcranial Direct Current Stimulation in HumansM.  A.  Nitsche1 , A.  Antal1 , D.  Liebetanz1 , N.  Lang1 , F.  Tergau1 , W.  Paulus1
  • 1Georg-August-Universität, Göttingen
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Publication History

Publication Date:
18 June 2004 (online)

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Zusammenfassung

Die Erzeugung zerebraler Erregbarkeitsveränderungen mittels schwacher Gleichstromstimulation geht auf tierexperimentelle Untersuchungen der 50er- und 60er-Jahre des letzten Jahrhunderts zurück. Grundlegender Wirkungsmechanismus ist eine unterschwellige Ruhemembranpotenzialverschiebung, je nach Stimulationspolarität in hyper- oder depolarisierender Richtung, die zu Veränderungen der Exzitabilität kortikaler Neurone führt. Analoge Erregbarkeitsveränderungen können auch nicht invasiv durch transkranielle Gleichstromstimulation (tDCS) im menschlichen Kortex erzeugt werden. In Abhängigkeit von der Stimulationspolarität kann die kortikale Exzitabilität erhöht oder vermindert werden, bei ausreichender Stimulationsdauer halten diese Veränderungen nach Beendigung der Stimulation an. Die Dauer der Nacheffekte lässt sich durch die Wahl adäquater Stimulationsdauer und -intensität steuern. Neuere Studien zeigen, dass die Nacheffekte NMDA-Rezeptor-abhängig sind. Des Weiteren konnte belegt werden, dass tDCS sowohl im motorischen, als auch im präfrontalen, visuellen und somatosensorischen Kortex effektiv ist. Hierbei eignet sich tDCS nicht nur zur Erzeugung, sondern auch zur Modulation neuroplastischer Vorgänge. Erste funktionelle Studien belegen die Effektivität der Stimulation zur Modulation übungsabhängiger Neuroplastizität, visuomotorischer Koordination sowie motorischen und semantischen Lernens. Die transkranielle Gleichstromstimulation stellt somit ein viel versprechendes neues Verfahren zur Induktion und Beeinflussung von Neuroplastizität beim Menschen dar; es ermöglicht die fokale, selektive, reversible, schmerzfreie und noninvasive Induktion kortikaler Erregbarkeitsveränderungen. Mögliche zukünftige therapeutische Optionen werden diskutiert.

Abstract

In the past, weak direct currents were used for the induction of cerebral excitability modifications primarily in animal experiments. These excitability shifts are accomplished by a sub-threshold modulation of neuronal resting membrane potentials, and thus a polarity-dependent de- or hyperpolarisation of cortical neurons. Similar effects are achieved by the non-invasive transcranial direct current stimulation (tDCS) in humans. Here cathodal stimulation diminishes, while anodal tDCS enhances excitability. Given a sufficient stimulation duration and strength, after-effects are induced, which are NMDA receptor-dependent. As shown, tDCS is not only effective in the primary motor cortex, but also in prefrontal, visual and somatosensory areas. In this case the technique has been demonstrated not only to induce, but also to modulate neuroplastic mechanisms, as shown for use-dependent neuroplasticity, visuo-motor coordination, motor and semantic learning. Altogether, tDCS is a promising new tool to induce and modulate neuroplasticity in humans. It enables a focal, selective, prolonged, reversible, painless and non-invasive modification of cortical excitability. Possible future clinical applications are discussed.

Key words

Transcranial direct current stimulation - transcranial magnetic stimulation - polarization - brain - neuroplasticity

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Dr. med. M. A. Nitsche

Georg-August-Universität

Robert-Koch-Straße 40

37075 Göttingen

Email: mnitsch1@gwdg.de

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