Neuromodulatorische nicht-invasive Hirnstimulation: Methodik und klinische Anwendungsmöglichkeiten

Zusammenfassung

Pathologisch veränderte Neuroplastizität wird zunehmend als pathophysiologische Grundlage verschiedenster neurologischer und psychiatrischer Erkrankungen identifiziert. Nicht-invasive Hirnstimulationsverfahren bieten zum einen die Möglichkeit, Neuroplastizität und kortikale Exzitabilität am Patienten zu untersuchen und zum anderen pathologische Neuroplastizität therapeutisch zu modulieren. In den letzten Jahrzehnten wurden verschiedene Verfahren zur Beeinflussung von Neuroplastizität im Menschen etabliert. Hierzu gehören die repetitive transkranielle Magnetstimulation, die gepaarte assoziative Stimulation, die transkranielle Gleichstromstimulation, und oszillatorische elektrische Stimulationsverfahren wie die transkranielle Wechselstromstimulation oder Random Noise Stimulation. Im klinischen Alltag regelmäßig eingesetzt und in den USA von der FDA bei schweren Depressionen zur Behandlung zugelassen ist bisher die repetitive transkranielle Magnetstimulation, die übrigen Verfahren haben gegenwärtig einen experimentellen Charakter. Im folgenden Artikel geben wir einen Überblick über die Methodik der unterschiedlichen Stimulationsverfahren, die bisherigen klinischen Daten zum therapeutischen Einsatz und Zukunftsperspektiven.

Abstract

Pathological alterations of plasticity are increasingly discussed as pathophysiological foundation of diverse neurologic and psychiatric diseases. The tools of non-invasive brain stimulation (NIBS) offer the possibility to examine altered plasticity in patients and furthermore modulate pathological plasticity therapeutically. Multiple methods to affect human neuroplasticity were developed and established during the last years. These include repetitive transcranial magnetic stimulation (rTMS), paired associative stimulation (PAS), transcranial direct current stimulation (tDCS) and oscillatory electric stimulation procedures like transcranial alternating current stimulation (tACS) and random noise stimulation. The only FDA-approved and clinically implemented method of NIBS is the repetitive transcranial magnetic stimulation that is used for the treatment of major depressions. All other tools of NIBS have so far been mainly applied experimentally. In the following article we provide an overview of the different methods of NIBS, the present clinical and therapeutic data and future perspectives.

Schlüsselwörter

Nicht-invasive Hirnstimulation - repetitive transkranielle Magnetstimulation (rTMS) - transkranielle direkte Gleichstromstimulation (tDCS)

Key words

Non-invasive brain stimulation - repetitive transcranial magnetic stimulation (rTMS) - transcranial direct current stimulation (tDCS) - paired associative stimulation (PAS)

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