Transkranielle Stimulation in der Neurorehabilitation

Zusammenfassung

Schlaganfall ist der Hauptgrund für Langzeitbehinderung und schränkt das berufliche, private und soziale Leben der Patienten signifikant ein. In Deutschland erleiden jedes Jahr zwischen 200 000 und 250 000 Menschen einen Schlaganfall. Leider erholt sich nur ein kleiner Teil der Patient so, dass sie ihr vorheriges berufliches und soziales Leben wieder voll aufnehmen können. Trotz grosser Anstrengungen zur Entwicklung neuer, effizienter Therapieverfahren ist das Ausmaß der funktionellen Regeneration nach Schlaganfall noch nicht zufrieden stellend. Daher hat die Entwicklung neuer, innovativer und effizienter Therapieverfahren eine grosse Bedeutung für Patienten, deren Umfeld und für das Gesundheitssystem. In ersten ,Proof-of-Principle-Studien‘ konnte nicht-invasive kortikale Hirnstimulation als eine viel versprechende Methode zur Verbesserung der funktionellen Regeneration nach Schlaganfall identifiziert werden. Zur Anwendung kommen die transkranielle Magnetstimulation (TMS) und die transkranielle Gleichstromstimulation (TDCS). In der folgenden Übersichtsarbeit sollen interventionelle Strategien, basierend auf kortikaler Hirnstimulation, im Hinblick auf funktionelle Regeneration nach Schlaganfall vorgestellt und diskutiert werden.

Abstract

Stroke is the leading cause of long-term disability, which significantly impairs the economic and social life of patients and society. Every year 200 000–250 000 patients suffer a stroke in Germany. Only a small number of the stroke survivors recover to a degree that allows them to return into their professional and private life. Despite significant efforts to develop novel and efficient treatment strategies, the level of functional regeneration is still not satisfactory. Thus, the development of innovative and effective treatment strategies will have a major impact for the patients′ life, the society and the public health system. In human beings, ‘proof-of-principle studies’ from different laboratories have shown that non-invasive interventional brain stimulation strategies such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) result in an improvement of sensorimotor functioning of the paretic hand in patients with stroke. In this paper these mechanistically oriented interventional approaches, based on cortical stimulation, are reviewed.

Schlüsselwörter

Hirnstimulation - Plastizität - Schlaganfall - Neurorehabilation

Key words

brain stimulation - plasticity - stroke - neuro rehabilitation

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