Tiefe Hirnstimulation bei der Schizophrenie

Zusammenfassung

Die tiefe Hirnstimulation (THS) hat die Grenzen der Behandlungsmöglichkeiten einiger, vermeintlich therapieresistenter, neuropsychiatrischer Erkrankungen erfolgreich erweitert. Vor diesem Hintergrund werden immer mehr psychische Störungen im Stadium der Therapieresistenz als mögliche Indikationen der THS erwogen. Mittlerweile ist auch die Schizophrenie in den Fokus des Interesses gelangt. Diese, wie alle anderen potenziellen psychiatrischen Indikationen, bedürfen der kritischen Prüfung, ob der aktuelle Wissensstand in Hinblick auf die propagierten Wirkmechanismen der THS und die angenommene Pathophysiologie der Erkrankung einen Einsatz des Verfahrens rechtfertigen. Die vorliegende Arbeit betrachtet synoptisch die aktuellen Ansätze, die einen THS-Einsatz begründen könnten, und diskutiert die Übertragbarkeit bisheriger THS-Anwendungen, Studienergebnisse zur dopaminergen Transmission und zu neuronalen Oszillationen sowie tierexperimentelle Daten. In der Zusammenschau ist die aktuelle Datenlage durchaus zukunftsweisend für einige Symptome der Schizophrenie, rechtfertigt zum gegenwärtigen Zeitpunkt jedoch womöglich noch nicht den klinischen Einsatz der THS in der Behandlung. Vordringliche Aufgabe ist der Schluss bis dato bestehender Wissenslücken, um indikationsbegründende Hypothesen mit möglichst geringem Spekulationscharakter generieren zu können.

Abstract

Deep brain stimulation (DBS) has successfully advanced our treatment options for putative therapy-resistant neuropsychiatric diseases. Building on this strong foundation, more and more mental disorders in the stadium of therapy-resistance are considered as possible indications for DBS. Especially, schizophrenia with its associated severe and difficult to treat symptoms is gaining attention. This attention demands critical questions regarding the assumed mechanisms of DBS and its possible influence on the supposed pathophysiology of schizophrenia. Here, we synoptically compare current approaches and theories of DBS and discuss the feasibility of DBS in schizophrenia as well as the transferability from other psychiatric disorders successfully treated with DBS. For this we consider recent advances in animal models of schizophrenic symptoms, results regarding the influence of DBS on dopaminergic transmission as well as data concerning neural oscillation and synchronisation. In conclusion, the use of DBS for some symptoms of schizophrenia seems to be a promising approach, but the lack of a comprehensive theory of the mechanisms of DBS as well as its impact on schizophrenia might hinder the use of DBS for schizophrenia at this point in time.

Schlüsselwörter

Tiefe Hirnstimulation - Schizophrenie - Translationale Medizin - Neuronale Oszillationen

Keywords

deep brain stimulation - schizophrenia - translational medicine - neural oscillations

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1 Die Autoren J. Kuhn und M. Bodatsch haben in gleicher Weise zum Manuskript beigetragen.