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Klinische Neurophysiologie 2009; 40(2): 126-133
DOI: 10.1055/s-0029-1224117
Originalia

© Georg Thieme Verlag KG Stuttgart · New York

Transkranielle Magnetstimulation zur Behandlung von Bewegungsstörungen

Transcranial Magnetic Stimulation in the Treatment of Movement DisordersM. Peller 1 , H. R. Siebner 2
  • 1Universitätsklinik für Neurologie, Christian Albrechts Universität, Kiel
  • 2Danish Research Center for Magnetic Resonance, Department for Magnetic Resonance Imaging, Hvidovre University Hospital, Hvidovre, Dänemark
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Publication History

Publication Date:
01 July 2009 (online)

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Zusammenfassung

Diese Arbeit gibt einen Überblick über den therapeutischen Einsatz der repetitiven transkraniellen Magnetstimulation (rTMS) bei Patienten mit Bewegungsstörungen. Die meisten Studien untersuchten die therapeutischen Effekte der rTMS beim Morbus Parkinson. Zunächst wurde hier der akute Effekt einer einmaligen rTMS-Anwendung über dem primären motorischen Kortex (M1) auf die Bradykinese und andere Parkinsonsymptome untersucht. Die rTMS erfolgte meist nach kurzzeitigem Absetzen der vorbestehenden dopaminergen Medikation. Mehrere interventionelle Studien zeigten, dass eine erregbarkeitssteigernde, hochfrequente (≥5 Hz) rTMS des M1 kurzzeitig die motorische Symptomatik bessert, insbesondere wenn mehr als 1 000 Stimuli verabreicht werden. In neueren Studien wurde die rTMS mehrfach an unterschiedlichen Tagen verabreicht und mehrere kortikale Zielareale in einer Sitzung stimuliert. Hierdurch ließ sich der günstige Effekt einer hochfrequenten rTMS auf die Parkinsonsymptome verlängern. Bei Patienten mit fokaler Handdystonie, medikamentös induzierten Dyskinesien, essenziellem Tremor, Chorea oder Tics wurden bislang vor allem die therapeutischen Effekte einer hemmenden, niederfrequenten (1 Hz) rTMS untersucht. In Abhängigkeit von der Bewegungsstörung und dem Reizort zeigte sich nach 1 Hz rTMS eine kurzzeitige Besserung der klinischen Symptome. Trotz dieser ermutigenden Resultate ist die interventionelle rTMS bei Patienten mit Bewegungsstörungen immer noch als ein experimentelles Therapieverfahren einzustufen. Die Hindernisse, welche einem breiten therapeutischen Einsatz der rTMS bei Patienten mit Bewegungsstörungen im Wege stehen, werden diskutiert.

Abstract

Here we review the potential use of repetitive transcranial magnetic stimulation (rTMS) as a therapeutic intervention in patients with movement disorders. Most rTMS studies have been conducted in patients with Parkinson's disease (PD). Initially, rTMS was applied in a single session targeting the primary motor cortex (M1). In most single-session studies, rTMS was given after the discontinuation of dopaminergic medication. The majority of studies found a transient clinical improvement of motor symptoms after high-frequency (≥5 Hz) rTMS of the M1, especially when more than 1 000 stimuli had been applied. Recent studies applied multiple rTMS-sessions on several days and targeted multiple cortical sites. These studies provided preliminary evidence that the use of more extended stimulation protocols can prolong the therapeutic effects of high-frequency rTMS on parkinsonism. Inhibitory low-frequency (1 Hz) rTMS was found to be beneficial in some patients with focal hand dystonia, drug-induced dyskinesia, essential tremor, chorea, or tics. While these results are encouraging, the jury is still out whether this interventional technique will emerge as a routine treatment option in PD and other movement disorders. We discuss the challenges that still have to be faced when bringing rTMS treatment into regular clinical practice.

Schlüsselwörter

Chorea - Dystonie - interventionelle Neurophysiologie - motorischer Kortex - Bewegungsstörungen - Parkinsonsyndrom - repetitive transkranielle Magnetstimulation - Tics - Tremor

Key words

Chorea - Dystonia - interventional neurophysiology - motor cortex - movement disorders - Parkinson's disease - repetitive transcranial magnetic stimulation - tics - tremor

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Korrespondenzadresse

Prof. Dr. med. H. R. Siebner

Danish Research Center for Magnetic Resonance

MR Department

Hvidovre University Hospital

Kettegård Allé 30

2650 Hvidovre

Denmark

Email: hartwig.siebner@drcmr.dk

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