Funktionelle Neuroanatomie der Depression

ZUSAMMENFASSUNG

Zur funktionellen Neuroanatomie der Depression gehört schon lange die Einsicht, dass es kein „Depressionszentrum“ gibt, sondern vielmehr Bereiche von grauer Substanz (kortikale Areale und subkortikale Kerne), die durch Nervenfaserbündel verbunden sind und daher oft als „Netzwerke“ oder „Schaltkreise“ bezeichnet werden. In den letzten Jahrzehnten ist es besonders durch die funktionelle Bildgebung möglich geworden, diese Netzwerke sowohl bei gesunden Probanden als auch bei Patienten mit Depression darzustellen, und Änderungen in der funktionellen Verknüpfung der Netzwerke zu identifizieren, die im Zusammenhang mit der Psychopathologie stehen. Vor diesem Hintergrund ist auch das Verständnis gewachsen, wie Hirnstimulationsverfahren wie die tiefe Hirnstimulation (THS) oder die repetitive transkranielle Magnetstimulation (rTMS) durch Modulation der Netzwerkfunktion ihre therapeutische Wirkung entfalten. In einem Rückblick wird die Entwicklung der funktionellen Bildgebung sowie der Hirnstimulationsverfahren nachgezeichnet und es werden aktuelle Entwicklungen des Einsatzes dieser Verfahren erörtert. Neuere Studien zur rTMS-Behandlung postulieren, dass der optimale Stimulationsort in Abhängigkeit von der psychopathologischen Ausprägung der Depression ausgewählt werden kann, unter Berücksichtigung der veränderten Konnektivität. Im Bereich der THS ist ein Fallbericht erschienen, in dem zunächst ein Mapping mit 10 implantierten Elektroden durchgeführt wurde. Verschiedene Stimulationsorte haben zu reproduzierbaren instantanen Veränderungen der Psychopathologie geführt. Die Patientin ist nun mit einer Closed-loop-Stimulation chronisch versorgt, die über Aktivität der rechten Amygdala geregelt wird.

ABSTRACT

In contrast to older concepts of a „depression center“ in the brain, the current view of functional anatomy of major depression comprises distributed parts of cortical and subcortical grey matter, connected by fibers, constituting so called networks, circuits, or loops, respectively. These networks can be measured by means of functional imaging in healthy subjects, as well as in depressed patients, yielding differences in connectivity related to psychopathology. In the light of this background, a more rational understanding of the therapeutic action of deep brain stimulation (DBS) as well as transcranial magnetic stimulation (rTMS) appears possible. The concurrent development of functional imaging and brain stimulation techniques is reviewed and translational applications are discussed. In recent rTMS treatment studies it is postulated that an optimal stimulation site can be chosen, dependent upon patterns of psychopathology and specific changes in connectivity. As regards THS, a case report has been published recently demonstrating a mapping procedure based on 10 implanted electrodes. Different stimulation sites resulted in immediate, reproducible positive changes of mood. This patient is now doing well for several months through treatment with closed-loop stimulation controlled by activity of the right amygdala.

Schlüsselwörter

Depression - Netzwerke - Schaltkreise - Magnetstimulation - tiefe Hirnstimulation - Stimulationsorte - funktionelle Konnektivität

Key words

Major depression - networks - loops - magnetic stimulation - deep brain stimulation - stimulation sites - functional connectivity

Publication History

Article published online:
03 March 2022

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