Zusammenfassung:
Die nichtinvasive morphologische Bildgebung (Computertomographie, Kernspintomographie, MRT) hat wesentlich zu der Erkenntnis beigetragen, dass die Schizophrenien Erkrankungen des Gehirns sind. Eine verbesserte MRT-Technik erlaubt zwischenzeitlich die Analyse anatomischer Substrukturen. In diesem aktuellen Überblick wurden peer-reviewed MRT-Studien von 1994 bis Juli 2000 ausgewertet und mit eigenen Befunden verglichen.
Bei chronisch schizophrenen Patienten zeigen sich als häufigste Befunde vergrößerte Liquorräume und ein vermindertes Volumen der grauen Substanz. Eine detaillierte Aufteilung in kortikale und subkortikale Regionen zeigt, dass die Volumenreduktion nicht einheitlich über das Gehirn verteilt ist sondern auf distinkte Areale beschränkt bleibt.
Im Temporallappen sind der Hippokampus und der Gyrus temporalis superior am häufigsten betroffen. Die Veränderungen korrelieren mit klinischen Symptomen wie Halluzinationen und Denkstörungen. Im frontalen Kortex zeigen 70 % aller Untersuchungen eine Volumenabnahme, im Thalamus finden 63 % und im Zerebellum 60 % aller Studien eine Größenminderung. Diese Strukturen haben aus morphologischer Sicht damit die größte Bedeutung für die Pathophysiologie der Schizophrenie und für das Auftreten klinischer Symptome.
Subgruppen von Patienten zeigen eine über die normale Alterung hinausgehende Progredienz in der Volumenminderung, die auf einen neurodegenerativen Prozess hinweist. Zusätzlich finden sich differenzielle Antipsychotikaeffekte nach Langzeitbehandlung mit typischen Neuroleptika im Vergleich zu atypischen Antipsychotika. Aufgrund dieser aktuellen Daten sollten zukünftige Longitudinalstudien mit automatischen Auswertestrategien prüfen, inwieweit eine progrediente Volumenabnahme durch moderne Antipsychotika beeinflussbar ist.
Structural Magnetic Resonance Imaging in Schizophrenia: An Overview:
Non-invasive morphologic imaging (computer tomography, magnetic resonance imaging, MRT) has contributed significantly to our understanding of schizophrenic disorders as diseases of the brain. Improved MRT techniques enable us to analyse anatomical substructures. The present overview evaluates peer-reviewed MRT studies published between 1994 and July 2000 and provides a comparison with our own results.
Chronic schizophrenic patients most frequently show an enlargement in the ventricular system along with a reduction in grey matter. A more detailed subdivision into cortical and subcortical regions additionally shows the noted volume reduction to be limited to specific areas within the brain rather than being distributed equally throughout the brain.
Within the area of the temporal lobes the two most frequently affected areas are the hippocampus and the gyrus temporalis superior. Alterations within these areas correlate with clinical symptoms such as hallucinations or thought disorders. Within the frontal cortex nearly 70 % of all studies show a decrease in overall volume, while 63 % note a reduction in size within the thalamus and 60 % in the cerebellum. Morphologically speaking these structures therefore play the greatest role in the pathophysiology of schizophrenia and the onset of clinical symptoms.
More recent studies also showed a specific progression in subgroups of patients pointing toward a neurodegenerative process. Additionally there are a number of differential antipsychotic effects following longterm treatment with typical neuroleptics as compared to atypical antipsychotics. Based on these findings future longitudinal studies should examine to what extent such a progressive decrease in volume might be influenced by treatment with modern antipsychotics.
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Priv.-Doz. Dr. med. D. F. Braus
NMR-Forschung
Zentralinstitut für Seelische Gesundheit
J5
68159 Mannheim
eMail: E-mail: dfbraus@as200.zi-mannheim.de
