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Fortschr Neurol Psychiatr 2020; 88(01): 40-51
DOI: 10.1055/a-1003-6678
Übersichtsarbeit

Vagusnervstimulation bei affektiven Störungen

Vagus Nerve Stimulation for Affective Disorders
Maxine Dibué-Adjei
1   Neurochirurgische Klinik, Heinrich Heine Universität Düsseldorf
2   Medical Affairs, LivaNova Deutschland GmbH, München
,
Marcel Alexander Kamp
1   Neurochirurgische Klinik, Heinrich Heine Universität Düsseldorf
,
Jonathan Vogelsang
3   Klinik für Psychiatrie und Psychotherapie, Georg-August- Universität Göttingen
,
Jens Wiltfang
3   Klinik für Psychiatrie und Psychotherapie, Georg-August- Universität Göttingen
4   Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)
5   Biomedizinisches Institut (iBiMED), Universität von Aveiro
,
Claus Wolff-Menzler
3   Klinik für Psychiatrie und Psychotherapie, Georg-August- Universität Göttingen
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Zusammenfassung

Vagusnervstimulation (VNS) ist ein minimalinvasives Neurostimulationsverfahren und wurde 1994 in Europa für die Behandlung von Kindern und Erwachsenen mit medikamentenresistenten Epilepsien zugelassen. Die Beobachtung, dass sich Depressionen, die häufigste Komorbidität der Epilepsie, signifikant unter VNS verbesserten, initiierte Studien der VNS bei Patienten mit therapieresistenten Depressionen (TRD), die 2001 zu der europäischen Zulassung der VNS für TRD führten. Heutzutage ist in Deutschland der Einsatz der VNS für TRD-Patienten auf wenige hochspezialisierte (oft universitäre) Zentren limitiert und das Verfahren in der psychiatrischen Praxis weitestgehend unbekannt. In dieser systematischen Übersicht identifizieren und diskutieren wir deshalb die aktuellsten Studien zu VNS bei TRD sowie Empfehlungen von Fachgesellschaften und diskutieren den Einsatz der VNS in der klinischen Praxis. In den letzten fünf Jahren wurden fünf Studien mit Evidenzgrad 2 und vier Studien mit Evidenzgrad 3 zu der Wirkung von VNS bei TRD-Patienten publiziert. Kurzfristige Wirksamkeit der VNS konnte in klinischen Studien nicht gezeigt werden. Mehrere Studien demonstrieren die Langzeitwirksamkeit der VNS. Die kürzlich publizierte größte Untersuchung der Thematik bestätigt signifikant bessere Behandlungsergebnisse bei Patienten, die eine Zusatztherapie mit VNS erhielten – im Vergleich zu Patienten, die nur Behandlung nach Goldstandard über fünf Jahre erhielten. Die langfristige Wirksamkeit der VNS bei TRD-Patienten ist mit Evidenz des Grades 2 belegt, jedoch ist es unklar, welche TRD-Patienten die höchste Wahrscheinlichkeit eines Ansprechens auf VNS haben, was die Patientenselektion in der Praxis erschweren kann. Zusätzlich wirkt sich möglicherweise die unklare und variable Definition der therapieresistenten Depression problematisch auf den rechtzeitigen Einsatz von Neurostimulationsverfahren aus.

Abstract

Vagus nerve stimulation (VNS) is a minimally invasive neurostimulation method and was approved for drug-resistant epilepsy in children and adults in Europe in 1994. The observation that depression –the most common comorbidity in epilepsy – improved with VNS prompted trials of VNS in treatment-resistant depression (TRD) leading to European approval of VNS for TRD in 2001. Use of VNS for TRD patients in Germany is currently limited to a few highly specialized tertiary centers and the method is largely unknown in psychiatric clinical practice. We therefore systematically review the most recent publications on VNS in TRD as well as recommendations in guidelines and discuss the use of VNS in clinical practice. In the past 5 years, 5 level-2 studies and 4 level-3 studies were published on the effect of VNS in TRD patients. Clinical studies have failed to demonstrate short-term efficacy of VNS in TRD patients. Long-term efficacy of VNS in TRD patients is documented by multiple studies: the recently published largest ever investigation on the subject confirms favorable outcomes in TRD patients receiving adjunctive VNS in addition to treatment-as-usual compared to patients receiving treatment-as-usual-only over a 5-year period. Long-term efficacy of VNS is documented by level-2 evidence; however, it is not known which TRD patients have a higher probability of responding to VNS, which may complicate patient selection in clinical practice. Additionally, the unclear and variable definition of TRD may hinder or postpone adequate use of neurostimulation treatments.

Schlüsselwörter

Neurostimulation - Stimulationsverfahren - Vagusnervstimulation - therapieresistente Depression - Affektive Störungen - Depression

Key words

Neurostimulation - Vagus Nerve Stimulation - Major Depressive Disorder - Affective Disorders - Treatment-Resistant Depression


Publication History

Received: 27 April 2018

Accepted: 22 August 2019

Article published online:
27 January 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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