Elektrokrampftherapie und neue Hirnstimulationsmethoden

Zusammenfassung

Die Elektrokrampftherapie (EKT) wird seit über 70 Jahren angewandt und ist zurzeit wissenschaftlich das potenteste antidepressive Behandlungsverfahren. Insbesondere in Deutschland ist die EKT noch immer ein massiv stigmatisiertes Verfahren. Der Wirkmechanismus ist nicht abschließend geklärt. Trotz ständiger technischer Verbesserungen hat die EKT zwei grundlegende Nachteile: eine hohe Rückfallquote und zum Teil ausgeprägte akute kognitive Nebenwirkungen. Es besteht in der Psychiatrie ein dringender Bedarf an neueren Behandlungsoptionen für schwerste, therapieresistente psychiatrische Erkrankungen. Derzeit werden als potenzielle neue Behandlungsmethoden von psychischen Störungen hauptsächlich vier physikalische Hirnstimulationsmethoden untersucht: die transkranielle Magnetstimulation (TMS), die Magnetkrampftherapie (MKT), die Vagusnervstimulation (VNS) und die tiefe Hirnstimulation (THS). Diese werden nur in Einzelfällen außerhalb von wissenschaftlichen Studien angewendet; ihre klinische Bedeutung und die Wirkmechanismen müssen weiter untersucht werden. Keines der neuen Stimulationsmethoden ist in psychiatrischer Indikation die Therapie der ersten Wahl.

Summary

The electroconvulsive therapy (ECT) has been used for more than 70 years and it is currently the most potent antidepressant treatment with scientifically evidence. Still the ECT is a massive stigmatized treatment, especially in Germany. The mode of action of the ECT is not fully understood. Despite the technical improvements, there are two major disadvantages of the ECT: a high rate of relapse and the acute cognitive side effects, sometimes severe. In psychiatry, there is an urgent need of new treatment methods for severely treatment-resistant diseases. Currently, there are four physical methods of brain stimulation being researched: transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), vagus nerve stimulation (VNS) and deep brain stimulation (DBS). Beyond scientific studies, these are only applied in single cases at present. Their clinical importance and their mode of action have to be subject of further research. None of these new stimulation methods is a measure of first choice treatment presently in psychiatric disorders.

Schlüsselwörter

Elektrokrampftherapie - repetitive Transkranielle Magnetstimulation - Vagusnervstimulation - Magnetkrampftherapie - tiefe Hirnstimulation

Keywords

Electroconvulsive therapy - repetitive transcranial magnetic stimulation - vagus nerve stimulation - magnetic seizure therapy - deep brain stimulation

• Literatur

• 1 Cerletti U, Bini EL. Un nuevo metodo di shockterapie “L` Elettroshock”. Bollettino Accademia Medica Roma 1938; 64: 136-138.
• 2 Baghai T. et al. (eds.). Elektrokonvulsionstherapie: Klinische und wissenschaftliche Aspekte. Wien: Springer 2004
• 3 Tölle R. Nicht die Elektrokrampftherapie, sondern ihre Gegner stehen in der Kritik. Nervenarzt 2008; 79: 1310-1312.
• 4 Fink M, Taylor MA. Electroconvulsive therapy: evidence and challenges. JAMA 2007; 298: 330-332.
• 5 Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med 2008; 357: 1939-1945.
• 6 Petrides G. et al. ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. J ECT 2001; 17: 244-253.
• 7 Sackeim HA. et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 2001; 285: 1299-1307.
• 8 Weiner RD. (ed.). The practice of electroconvulsive therapy: Recommendations for treatment, training, and privileging: A task force report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 2001
• 9 Spellman T. et al. Differential effects of high-dose magnetic seizure therapy and electroconvulsive shock on cognitive function. Biological Psychiatry 2008; 63 (02) 1163-1170.
• 10 UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799-808.
• 11 Folkerts H. et al. Bekanntmachungen: Stellungnahme zur Elektrokrampftherapie (EKT) als psychiatrische Behandlungsmaßnahme. Deutsches Ärzteblat 2003; 100: A504.
• 12 Bschor T, Adli M. Therapie depressiver Erkrankungen. Deutsches Ärzteblatt 2008; 105: 782-792.
• 13 Henn FA, Vollmayr B, Sartorius A. Mechanisms of depression: the role of neurogenesis. Drug Discovery Today: Disease Mechanisms 2004; 01: 407-411.
• 14 Bourgon LN, Kellner CH. Relapse of depression after ECT: a review. J ECT 2000; 16: 19-31.
• 15 Eschweiler GW, Rapp AM. Aktuelles zur Elektrokrampftherapie bei schweren depressiven Störungen. Nervenheilkunde 2008; 27: 1049-1054.
• 16 Sartorius A, Henn FA. Erhaltungselektrokrampftherapie bei depressiven Störungen. Nervenarzt 2005; 76: 1363-1369.
• 17 McCall WV. et al. Titrated moderately suprathreshold vs fixed highdose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Arch Gen Psychiatry 2000; 57: 438-444.
• 18 Sackeim HA. et al. A prospective, randomized, doubleblind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry 2000; 57: 425-434.
• 19 Squire LR, Slater PC, Miller PL. Retrograde amnesia and bilateral electroconvulsive therapy. Long-term follow-up. Arch Gen Psychiatry 1981; 38: 89-95.
• 20 Sackeim HA. et al. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology 2007; 32: 244-254.
• 21 Devanand DP. et al. Does ECT alter brain structure?. Am J Psychiatry 1994; 151 (07) 957-70.
• 22 Angst J. et al. ECT-Induced and Drug-Induced Hypomania. Convuls Ther 1992; 08 (03) 179-85.
• 23 Devanand D. et al. The development of mania and organic euphoria during ECT. J Clin Psychiatry 1988; 49 (02) 69-71.
• 24 Ridding MC, Rothwell JC. Is there a future for therapeutic use of transcranial magnetic stimulation?. Nat Rev Neurosci 2007; 08 (07) 559-67.
• 25 Schlaepfer TE, Kosel M, Nemeroff CB. Efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of affective disorders. Neuropsychopharmacology 2003; 28 (02) 201-5.
• 26 Schulze-Rauschenbach SC. et al. Distinctive neurocognitive effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in major depression. Br J Psychiatry 2005; 186: 410-6.
• 27 Herrmann LL, Ebmeier KP. Factors modifying the efficacy of transcranial magnetic stimulation in the treatment of depression: a review. J Clin Psychiatry 2006; 67 (12) 1870-6.
• 28 Martin JL. et al. Transcranial magnetic stimulation for treating depression. Cochrane Database Syst Rev 2002; (02) CD003493.
• 29 O’Reardon JP. et al. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry 2007; 62 (11) 1208-16.
• 30 Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June, 1996. Electroencephalogr Clin Neurophysiol 1998; 108 (01) 1-16.
• 31 Lisanby SH. et al. Magnetic seizure therapy of major depression. Arch Gen Psychiatry 2001; 58 (03) 303-5.
• 32 Kayser S. et al. Effects of Magnetic Seizure Therapy and Electroconvulsive Therapy in Treatment-Resistant Depression. Eingereicht.
• 33 Kosel M. et al. Magnetic seizure therapy improves mood in refractory major depression. Neuropsychopharmacology 2003; 28 (11) 2045-8.
• 34 Lisanby SH. et al. Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy. Neuropsychopharmacology 2008; 28 (10) 1852-65.
• 35 Moscrip TD. et al. Randomized controlled trial of the cognitive side-effects of magnetic seizure therapy (MST) and electroconvulsive shock (ECS). Int J Neuropsychopharmacol 2006; 09 (01) 1-11.
• 36 Kayser S. et al. Magnetic seizure therapy of treatment-resistant depression in a patient with bipolar disorder. J ECT 2009; 25 (02) 137-40.
• 37 Kirov G. et al. Quick recovery of orientation after magnetic seizure therapy for major depressive disorder. Br J Psychiatry 2008; 193 (02) 152-5.
• 38 White PF. et al. Anesthetic considerations for magnetic seizure therapy: a novel therapy for severe depression. Anesth Analg 2006; 103 (01) 76-80.
• 39 George MS. et al. Vagus nerve stimulation: a new tool for brain research and therapy. Biol Psychiatry 2000; 47 (04) 287-95.
• 40 Kosel M, Schlaepfer TE. Mechanisms and state of the art of vagus nerve stimulation. J ECT 2002; 18 (04) 189-92.
• 41 Nemeroff CB. et al. VNS therapy in treatment-resistant depression: clinical evidence and putative neurobiological mechanisms. Neuropsychopharmacology 2006; 31 (07) 1345-55.
• 42 Nahas Z. et al. Two-year outcome of vagus nerve stimulation (VNS) for treatment of major depressive episodes. J Clin Psychiatry 2005; 66 (09) 1097-104.
• 43 Schlaepfer TE. et al. Vagus nerve stimulation for depression: efficacy and safety in a European study. Psychol Med 2008; 38 (05) 651-61.
• 44 Frick C. et al. Incident mania during therapy with vagus nerve stimulation. J ECT 2005; 21 (03) 197.
• 45 Deuschl G. et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006; 355 (09) 896-908.
• 46 Synofzik M, Schlaepfer TE. Stimulating personality: ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. Biotechnol J 2008; 03 (12) 1511-20.
• 47 Schlaepfer TE, Lieb K. Deep brain stimulation for treatment of refractory depression. Lancet 2005; 366 9495 1420-1422.
• 48 Malone DA. et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry 2009; 65 (04) 267-75.
• 49 Lozano AM. et al. Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol Psychiatry 2008; 64 (06) 461-7.
• 50 Mayberg HS. et al. Deep brain stimulation for treatment-resistant depression. Neuron 2005; 45: 651-660.
• 51 McNeely HE. et al. Neuropsychological impact of Cg25 deep brain stimulation for treatment-resistant depression: preliminary results over 12 months. J Nerv Ment Dis 2008; 196 (05) 405-10.
• 52 Bewernick B. et al. Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biological Psychiatry 2009; Nov. 13.
• 53 Cohen MX. et al. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 2008; 33 (02) 368-77.
• 54 Schlaepfer TE, Bewernick BH. Deep brain stimulation for psychiatric disorders – state of the art. Wien: Springer 2008
• 55 Dougherty DD, Thase ME. Feasibility Study of an Implantable Cortical Stimulation System for Patients with Major Depressive Disorder. Biol Psychiatry 2008; 63 (67) 930.
• 56 Boros K. et al. Premotor transcranial direct current stimulation (tDCS) affects primary motor excitability in humans. Eur J Neurosci 2008; 27 (05) 1292-300.
• 57 Boggio PS. et al. Temporal cortex direct current stimulation enhances performance on a visual recognition memory task in Alzheimer disease. J Neurol Neurosurg Psychiatry 2009; 80 (04) 444-7.
• 58 Klawansky S. et al. Meta-analysis of randomized controlled trials of cranial electrostimulation. Efficacy in treating selected psychological and physiological conditions. J Nerv Ment Dis 1995; 183 (07) 478-84.