Zusammenfassung
Schmerz ist ein Schlüsselsymptom vieler neurologischer Erkrankungen. Systematische
Studien zum Entstehungsmechanismus von Schmerz sind von großer Bedeutung für die Entwicklung
verbesserter Behandlungsstrategien. In den letzten Jahren sind neue Methoden erarbeitet
worden, die die Änderung der neuronalen Aktivität oder des Membranpotenzials durch
Induktion und Modulation von neuroplastischen Veränderungen ermöglichen. Beispiele
dafür sind die repetitive transkranielle Magnetstimulation (rTMS) und die transkranielle
Gleichstromstimulation (tDCS). rTMS induziert auf elektromagnetischer Grundlage kleine
elektrische Ströme im Kortex und führt zu plastischen Veränderungen im ZNS sowohl
auf zellulärer als auch funktioneller Ebene. rTMS kann kurzfristige Veränderungen
der Schmerzwahrnehmung bei chronischem Schmerz auslösen. tDCS als Methode zielt darauf
ab, prolongierte neuronale Erregbarkeits- und Aktivitätsänderungen im menschlichen
Gehirn über Veränderungen des neuronalen Membranpotenzials hervorzurufen. tDCS ist
wie rTMS eine nicht-invasive und schmerzfreie Methode. Dementsprechend hat tDCS beim
Menschen ebenfalls ein viel versprechendes Potenzial zur Behandlung von Krankheiten,
die auf Änderungen kortikaler Erregbarkeit beruhen.
Abstract
Many neurological diseases are characterized by pain as a key symptom. Systematic
studies to investigate the mechanisms of pain are of outmost importance, since they
may subsequently result in improved treatment strategies. In recent years, possibilities
have emerged to manipulate ongoing neuroplastic changes by external modulation, either
by interfering with neuronal firing rate or with neuronal membrane potentials. The
first can be performed by repetitive transcranial magnetic stimulation (rTMS), the
latter by direct current stimulation (tDCS). rTMS is a technology which uses electromagnetic
principles to produce small electrical currents in the cortex. Evidence indicates
that rTMS-produced plastic changes in the CNS are observable at both the cellular
and functional levels. It is proposed by many studies that rTMS can provide short-term
relief in chronic pain. tDCS as a tool aims to induce prolonged neuronal excitability
and activity alterations in the human brain via alterations of the neuronal membrane
potential. Apart from its impressive persistent excitability effects, it is a non-invasive
method and can be applied painlessly. Accordingly, tDCS in the human is a promising
tool in the treatment of diseases that are accompanied by changes of cortical excitability.
Key words
Pain - transcranial magnetic stimulation - transcranial direct current stimulation
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Prof. Dr. med. Walter Paulus
Univ.-Klinikum Göttingen · Abt. Klinische Neurophysiologie
Robert-Koch-Straße 40
37075 Göttingen
Email: w.paulus@med.uni-goettingen.de
