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Fortschr Neurol Psychiatr 2009; 77(8): 432-443
DOI: 10.1055/s-0028-1109494
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Biologische Korrelate präfrontal aktivierender und temporoparietal inhibierender Behandlung mit repetitiver transkranieller Magnetstimulation (rTMS)

Biological Correlates of Prefrontal Activating and Temporoparietal Inhibiting Treatment with Repetitive Transcranial Magnetic Stimulation (rTMS)A. Mobascher1, 2 , M. Arends1 , G. W. Eschweiler3 , J. Brinkmeyer1, 2 , M. W. Agelink4 , J. Kornischka4 , G. Winterer1, 2 , J. Cordes1
  • 1Klinik und Poliklinik für Psychiatrie und Psychotherapie, Heinrich-Heine-Universität Düsseldorf
  • 2Institut für Medizin, Forschungszentrum Jülich
  • 3Universitätsklinik für Psychiatrie und Psychotherapie, Tübingen
  • 4Klinik für Psychiatrie, Psychotherapie and Psychosomatik, Herford
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Publication History

Publication Date:
16 June 2009 (online)

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Zusammenfassung

Die repetitive transkranielle Magnetstimulation (rTMS) ermöglicht es, auf nicht invasive Weise die kortikale Aktivität zu verändern. Durch hochfrequente rTMS sind überwiegend aktivierende und durch niederfrequente rTMS inhibierende Effekte möglich. Neben ihrer Anwendung als Forschungsinstrument und diagnostisches Werkzeug in der Neurologie ergeben sich potenzielle therapeutische Anwendungsgebiete in der Psychiatrie, und zwar insbesondere in der Behandlung von Krankheiten bzw. Symptomen, die mit regionalen kortikalen Aktivitätsveränderungen einhergehen. Derzeit wird die rTMS u. a. in der Behandlung der Depression und der schizophrenen Negativ-Symptomatik evaluiert. Bei beiden Syndromen könnte eine Hypofrontalität bzw. eine frontolimbische Dysbalance durch eine aktivierende rTMS „korrigiert” bzw. therapiert werden. Umgekehrt besteht beim Tinnitus und bei akustischen Halluzinationen eine Hyperaktivität temporoparietaler Areale. Hier wird der therapeutische Nutzen einer niederfrequenten inhibierenden rTMS untersucht. Neben der direkten Modulation der stimulierten kortikalen Region sind weitere biologische Effekte der rTMS beschrieben, die für die therapeutische Wirkung bedeutsam sein könnten. Hierzu zählen Veränderung der Aktivität in krankheitsrelevanten kortiko-kortikalen Schaltkreisen, Modulation der Ausschüttung biogener Amine aus subkortikalen Kerngebieten und schließlich neuroendokrine Effekte. In dieser Übersicht wird der aktuelle Kenntnisstand über die therapeutisch relevanten biologischen Effekte der rTMS dargestellt. Ein besseres Verständnis der neurophysiologischen Grundlagen der rTMS und der zu behandelnden psychiatrischen Störungen sollte zu optimierten Stimulationsprotokollen und besser definierten Behandlungsindikationen führen.

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is a tool that enables clinicians and neuroscientists to modulate cortical activity in a non-invasive way. High-frequency rTMS has predominantly an activating effect on the stimulated brain region while low-frequency rTMS has an inhibitory effect. In addition to its usefulness as a research tool and in neurological diagnostics, rTMS may prove useful as a therapeutic option in psychiatry, especially in disorders that are associated with regional changes in cortical activity. For instance, rTMS is under current investigation in the treatment of depression and negative symptoms of schizophrenia. A hypofrontality or a fronto-limbic imbalance associated with both syndromes could be corrected by activating, high frequency rTMS. Conversely, a regional hyperactivity in the temporo-parietal cortex has been described in subjects suffering from auditory hallucinations and tinnitus. Low frequency, inhibitory rTMS is currently evaluated as a therapeutic option in these subjects. In addition to the effects on the directly stimulated brain area, other biological effects of rTMS may exert a beneficial influence on brain function. Amongst these are a modulation of cortico-cortical circuits (e. g. fronto-cingular and fronto-parietotemporal circuits), effects on monoaminergic neuromodulation and neuroendocrine effects. The current knowledge about the therapeutically relevant neurophysiological and neuroendocrine effects of rTMS are reviewed. An improved understanding of the neurophysiological basis of the therapeutic effects of rTMS and of the pathophysiology underlying neuropsychiatric diseases may lead to optimized therapeutic rTMS applications and new clinical indications for rTMS.

Schlüsselwörter

rTMS - Schizophrenie - Tinnitus - Depression - Hypofrontalität

Key words

rTMS - schizophrenia - tinnitus - depression - hypofrontality

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Dr. Joachim Cordes

Klinik und Poliklinik für Psychiatrie und Psychotherapie der Heinrich-Heine-Universität

Bergische Landstr. 2

40629 Düsseldorf

Email: joachim.cordes@lvr.de