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Nervenheilkunde 2015; 34(12): 1006-1011
DOI: 10.1055/s-0038-1627655
Hirnstimulationsverfahren
Schattauer GmbH

Angst und Zwang

Erfahrungen und Evidenz für den therapeutischen Einsatz von rTMSrTMS for the treatment of anxiety and obsessivecompulsive disorder
S. Notzon
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Uniklinik Münster, Münster
,
P. M. Kreuzer
2   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg
,
B. Langguth
2   Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg
,
J.-P. Lefaucheur
3   Department of Physiology, Henri Mondor Hospital, Assistance Publique – Hôpitaux de Paris, Créteil, France
4   EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
,
P. Zwanzger
5   LMU München, München
6   kbo-InnSalzach-Klinikum gemeinnützige GmbH, Fachkrankenhaus für Psychiatrie, Psychotherapie, Psychosomatische Medizin, Geriatrie und Neurologie
› Author Affiliations
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Publication History

eingegangen am: 21 September 2015

angenommen am: 21 September 2015

Publication Date:
22 January 2018 (online)

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Zusammenfassung

Gegenstand und Ziel: Sowohl medikamentöse Therapieverfahren als auch die kognitive Verhaltenstherapie zählen bei Angst- und Zwangserkrankungen zu den Mitteln der ersten Wahl. Allerdings spricht ein Teil der Patienten nicht oder nur unzureichend auf die Therapie an. Vor dem Hintergrund der vergleichsweise guten Erfahrungen bei Depression wird die rTMS auch in der Indikation Angst oder Zwang immer wieder als alternative Therapiestrategie diskutiert. Material und Methoden: Eine Einschätzung zur Datenlage wurde mittels Pubmed-Recherche bis 6/2015 durchgeführt zur repetitiven transkraniellen Magnetstimulation (rTMS) sowie zur Theta Burst Stimulation (TBS). Im Fokus standen posttraumatische Belastungsstörung (PTSD), Panikstörung, generalisierte Angststörung und soziale Angststörung sowie die Zwangsstörung. Ergebnisse: Die mit Abstand umfangreichsten Ergebnisse liegen zur PTSD vor und legen eine Wirksamkeit der rTMS nahe. Für die anderen Angsterkrankungen gibt es vergleichsweise wenig kontrollierte Studien. Die Ergebnisse zu Zwangserkrankungen müssen als uneinheitlich bewertet werden. Schlussfolgerungen: Vor diesem Hintergrund wird für die Behandlung der PTSD mittels rTMS eine mögliche Wirksamkeit (Level C) konstatiert. Für die anderen Erkrankungen ist angesichts der begrenzten Evidenz eine Bewertung noch nicht möglich. Allerdings kann – insbesondere bei Zwang – bei fehlendem Ansprechen auf andere Verfahren ein Therapieversuch mit rTMS als Ultima Ratio erwogen werden.

Summary

Objective: For the treatment of anxiety and obsessive-compulsive disorder (OCD) both pharmacological treatment and cognitive behavioral therapy are available as high-evidence treatment options. However, some patients respond only incompletely to these standard treatments. Considering the good efficacy of rTMS for the treatment of depression rTMS has also been proposed as an alternative therapeutic strategy for OCD and anxiety disorders. Materials and methods: A PubMed research has been carried out in June 2015 to identify studies investigating the use of repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS) for the treatment of posttraumatic stress disorder (PTSD), panic disorder, generalized anxiety disorder, social anxiety disorder and obsessive-compulsive disorder. Results: Most data are available for PTSD suggesting an efficacy of rTMS. For the treatment of other anxiety disorders, there are only few controlled studies available. Study investigating TMS for the treatment of OCD revealed inconsistent results. Conclusions: The evidence for an effect of rTMS treatment on posttraumatic stress disorder is rated as a possible efficacy (Level C). For other anxiety disorders and OCD no statement is possible because of lack of sufficient data. However in selected cases rTMS may represent a possible treatment option for compassionate use treatment after failure of standard therapies.

Schlüsselwörter

Angsterkrankungen - repetitive transkranielle Magnetstimulation - Theta-Burst-Stimulation - Zwangserkrankungen

Keywords

Anxiety disorders - repetitive transcranial magnetic stimulation - theta burst stimula tion - obsessive-compulsive disorder
 

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