Die repetitive transkranielle Magnetstimulation in der Behandlung von Handfunktionsstörungen nach Schlaganfall

Zusammenfassung

Ein Schlaganfall verändert Struktur und Funktion des kortikalen motorischen Systems beider Hemisphären. Die repetitive transkranielle Magnetstimulation kann die Erregbarkeit der motorischen Hirnrinde modulieren und sich dadurch positiv auf die Funktion und/oder Funktionserholung des motorischen Defizits nach Schlaganfall auswirken. Anhand einer systematischen Literaturrecherche wurden 33 Placebo-kontrollierte Studien identifiziert, die die Wirkung der repetitiven transkraniellen Magnetstimulation auf die Verbesserung der Handfunktion nach Schlaganfall untersucht haben. Trotz bekannter Limitationen stützte sich die Anwendung der repetitiven transkraniellen Magnetstimulation überwiegend auf das Erklärungsmodell der interhemisphärischen Kompetition innerhalb des motorischen Systems nach Schlaganfall. In einer vergleichenden Darstellung werden Methodik und Effektivität (a) der Inhibition der nicht betroffenen Hemisphäre, (b) der Fazilitierung der betroffenen Hemisphäre und (c) der kombinierten Anwendung der repetitiven transkraniellen Magnetstimulation über beiden Hemisphären zur Behandlung von Handfunktionsstörungen nach Schlaganfall vorgestellt. Probleme und Schwächen der aktuellen Datenlage zur Anwendung der repetitiven transkraniellen Magnetstimulation in der Rehabilitation nach Schlaganfall werden erörtert und mögliche künftige Schwerpunkte der klinischen Forschung zur Hirnstimulation diskutiert.

Abstract

Stroke induces structural and functional changes within the cortical motor network of both hemispheres. Repetitive transcranial magnetic stimulation modulates the excitability of the motor cortex and thereby may facilitate motor function and/or recovery of motor function after stroke. Based on a systematic literature search we identified 33 placebo-controlled trials which examined the effectiveness of repetitive transcranial magnetic stimulation in the treatment of impaired hand function following stroke. Despite limitations, the majority of the studies referred to the interhemispheric competition model after stroke to apply repetitive transcranial magnetic stimulation. In a comparative approach, methodology and effectiveness of (a) inhibition of the unaffected hemisphere, (b) facilitation of the affected hemisphere and (c) combined application of repetitive transcranial magnetic stimulation over the affected and unaffected hemispheres to treat impaired hand function after stroke are presented. Problems and limitations of repetitive transcranial magnetic stimulation in stroke rehabilitation are discussed and visions for future clinical research are presented.

Schlüsselwörter

rTMS - Schlaganfall - Handfunktion

Key words

rTMS - stroke - upper limb

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