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Fortschr Neurol Psychiatr 2010; 78(11): 632-643
DOI: 10.1055/s-0029-1245499
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Die Anwendung der repetitiven transkraniellen Magnetstimulation (rTMS) bei akustischen Halluzinationen

The Use of Repetitive Transcranial Magnetic Stimulation (rTMS) in Auditory Verbal Hallucinations (AVH)M. Jandl1
  • 1Klinik für Psychiatrie und Psychotherapie I, Universitätsklinik Ulm
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Publication History

Publication Date:
20 July 2010 (online)

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Zusammenfassung

Bis zu einem Drittel der schizophrenen Patienten, die an verbalen akustischen Halluzinationen (AH) leiden, ist therapieresistent auf Antipsychotika. Repetitive transkranielle Magnetstimulation (rTMS) stellt eine Therapieoption zur Unterbrechung oder Abschwächung therapieresistenter (TR) AH dar. Der Artikel bietet eine Übersicht der rTMS-Anwendung bei AH, von den Ursprüngen bis zu randomisierten kontrollierten Studien, die sowohl Definitionen „refraktärer AH” als auch „aktive” Vergleichsstimulation und MRT-geführte rTMS einschließen. Metaanalysen zeigten positive Effektstärken für AH-Abschwächung nach rTMS. Größere Erhaltungs- und Follow-up-Studien mit klarerer Definition von TR AH sind erforderlich. Die den rTMS-Effekten auf Sprachnetzwerke zugrunde liegenden Mechanismen bedürfen weiterer Klärung. Zukünftige Untersuchungen sollten sich auf Bestimmungsmethoden von AH-Veränderungen, Zeitverläufe des Ansprechens und der Entwicklung von Response-Markern konzentrieren.

Abstract

Up to one-third of all schizophrenic patients suffer from auditory verbal hallucinations (AVH) that are resistant to antipsychotics. The use of repetitive transcranial magnetic stimulation (rTMS) is a therapeutic option that may disrupt or attenuate treatment resistant (TR) AVHs. This article reviews the available literature on the use of rTMS to treat AVHs, particularly focusing on randomised controlled trials, which have introduced new definitions (”refractory AVHs”), and techniques (active comparator strategies and imaging-guided rTMS). A number of meta-analyses are considered, which support a range of positive effect sizes for AVH attenuation in response to rTMS. Larger maintenance and follow-up studies with clearer clinical definitions of TR AVH are required. The underlying mechanism of action of rTMS on language networks needs further clarification and future trials should focus on methods for assessing AVH changes, time courses of response, and the development of response markers.

Schlüsselwörter

Literaturübersicht - repetitive transkranielle Magnetstimulation - Responder - Schizophrenie - Sprachnetzwerk - verbale akustische Halluzination

Keywords

review - repetitive transcranial magnetic stimulation - responder - schizophrenia - language network - auditory verbal hallucination

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Dr. Martin Jandl

Klinik für Psychiatrie und Psychotherapie I Universitätsklinik Ulm

Weingartshofer Str. 2

88214 Ravensburg

Email: martin.jandl@uni-ulm.de

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