PDF herunterladen
Fortschr Neurol Psychiatr 2001; 69(9): 402-409
DOI: 10.1055/s-2001-16906
ORIGINALARBEIT
© Georg Thieme Verlag Stuttgart · New York

Welche depressiven Patienten profitieren von präfrontaler repetitiver transkranieller Magnetstimulation (RTMS)?

Which Patients with Major Depression Benefit from Prefrontal Repetitive Magnetic Stimulation (RTMS)?G. W. Eschweiler, C. Plewnia, M. Bartels
  • Universitätsklinik für Psychiatrie und Psychotherapie Tübingen
    (Ärztl. Direktor: Prof. Dr. med. G. Buchkremer)
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
03. September 2001 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung:

Klinische Besserungsraten nach ein- bis zweiwöchiger Behandlung mittels präfrontaler repetitiver transkranieller Magnetstimulation (RTMS) streuen in der Literatur zwischen 6 % und 60 % Verbesserung (Mittelwert von 37 %) in der Hamilton-Depressions-Skala (HAMD). Diese Varianz ist wahrscheinlich durch unterschiedliche Behandlungsmodalitäten, aber auch durch genetische, psychopathologische und neuropsychologische Merkmale der Patienten sowie den funktionellen Zustand des stimulierten Kortexareals zu Beginn der Behandlung bedingt.

10 offene und 7 plazebokontrollierte publizierte Studien, einschließlich zwei eigener Untersuchungen, mit insgesamt mehr als 300 Patienten deuten auf verschiedene positive Prädiktoren für eine antidepressive Wirksamkeit von präfrontaler RTMS: 1) jüngeres Alter, 2) somatische Zeichen der Angst, 3) fehlende kortikale Hyperaktivierung unter der 10-Hz-gepulsten Spule, 4) Hypermetabolismus unter der 1 Hz gepulsten Spule.

Als negative Prädiktoren für die antidepressive Wirksamkeit einer präfrontalen RTMS zeichnen sich ab: 1) höheres Alter, 2) frontale Hirnatrophie, 3) kognitive Störungen im Bereich frontaler Leistungen, 4) psychotische Merkmale, 5) kortikale Hyperaktivierung unter der 10-Hz-gepulsten Spule und 6) fehlende Wirksamkeit der Elektrokrampftherapie.

Die präfrontale RTMS ist somit wahrscheinlich kein Ersatz, sondern eine Ergänzung zur Pharmakotherapie oder Elektrokrampftherapie der Depression. Von der RTMS sollten insbesondere jüngere, nicht kognitiv beeinträchtigte und ängstliche Patienten profitieren.

Which Patients with Major Depression Benefit from Prefrontal Repetitive Magnetic Stimulation (RTMS)?

Antidepressive benefit of prefrontal repetitive magnetic stimulation (RTMS) for one or two weeks varies between 6 % and 60 % (mean 37 %) improvement of the Hamilton depression scale vs. 12 % improvement following sham RTMS. This variance is probably caused by study specific stimulus parameters but also by genetic, psychopathological and neuropsychological characteristics of the patients as well as by the functional state of the cortex area below the stimulation coil.

Data from 10 open and 7 sham controlled studies including two own studies comprising more than 300 patients with major depression have been published to date. In synopsis several positive predictors for antidepressive response of prefrontal RTMS become apparent: 1) younger age, 2) somatic signs of anxiety, 3) lack of cortical hyperactivity below the magnetic coil pulsed by 10 Hz stimuli, 4) cortical hypermetabolism below the 1 Hz pulsed coil.

Negative predictors of response to prefrontal RTMS were: 1) Advanced age, 2) prefrontal atrophy, 3) cognitive impairment in neuropsychological tasks assigned to the prefrontal cortex, 4) psychotic symptoms, 5) cortical hyperactivity below 10 Hz pulsed coil 6) non-response to electroconvulsive therapy (ECT).

While prefrontal RTMS will probably not replace ECT in severe major depression with psychotic symptoms it could be beneficial especially in younger anxious patients without cognitive impairment.

Literatur

  • 1 Gainotti G, Azzoni A, Marra C. Frequency, phenomenology and anatomical-clinical correlates of major post-stroke depression.  Br J Psychiatry. 1999;  175 163-167
    PubMedSuche in Google Scholar
  • 2 Barker A T, Jalinous R, Freeston I L. Non-invasive magnetic stimulation of human motor cortex [letter].  Lancet. 1985;  1 1106-1107
    PubMedSuche in Google Scholar
  • 3 Haag C, Padberg F, Moeller H J. Transcranial magnetic stimulation (TMS): A diagnostic tool from neurology as a therapy in psychiatry? .  Nervenarzt. 1997;  68 274-278
    CrossrefPubMedSuche in Google Scholar
  • 4 Brandt S A, Ploner C J, Meyer B U. [Repetitive transcranial magnetic stimulation. Possibilities, limits and safety aspects] Repetitive transkranielle Magnetstimulation. Möglichkeiten, Grenzen und Sicherheitsaspekte.  Nervenarzt. 1997;  68 778-784
    CrossrefPubMedSuche in Google Scholar
  • 5 Höflich G, Kasper S, Hufnagel A, Ruhrmann S, Möller H J. Application of transcranial magnetic stimulation in treatment of drug-resistant major depression: A report of two cases.  Hum Psychopharm. 1993;  8 361-365
    PubMedSuche in Google Scholar
  • 6 Kolbinger H M, Hoflich G, Hufnagel A, Moller H J, Kasper S. Transcranial magnetic stimulation (TMS) in the treatment of major depression: A pilot study.  Hum Psychopharmacol. 1995;  10 305-310
    PubMedSuche in Google Scholar
  • 7 Pascual-Leone A, Rubio B, Pallardo F, Catala M D. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression.  Lancet. 1996;  348 233-237
    CrossrefPubMedSuche in Google Scholar
  • 8 Markwort S, Cordes P, Aldenhoff J. [Transcranial magnetic stimulation as an alternative to electroshock therapy in treatment resistant depressions.  A literature review] Die transkranielle Magnetstimulation als Behandlungsalternative zur Elektrokrampftherapie bei therapieresistenten Depressionen - Eine Literaturübersicht.. Fortschr Neurol Psychiatr. 1997;  65 540-549
    PubMedSuche in Google Scholar
  • 9 George M S, Wassermann E M, Williams W A, Callahan A, Ketter T A, Basser P, Hallett M, Post R M. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression.  Neuroreport. 1995;  6 1853-1856
    CrossrefPubMedSuche in Google Scholar
  • 10 George M S, Wassermann E M, Kimbrell T A, Little J T, Williams W E, Danielson A L, Greenberg B D, Hallett M, Post R M. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial.  Am J Psychiatry. 1997;  154 1752-1756
    PubMedSuche in Google Scholar
  • 11 Padberg F, Zwanzger P, Thoma H, Kathmann N, Haag C, Greenberg B D, Hampel H, Möller H J. Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: comparative study of fast, slow and sham rTMS.  Psychiatry Res. 1999;  88 163-171
    CrossrefPubMedSuche in Google Scholar
  • 12 Triggs W J, McCoy K J, Greer R, Rossi F, Bowers D, Kortenkamp S, Nadeau S E, Heilman K M, Goodman W K. Effects of left frontal transcranial magnetic stimulation on depressed mood, cognition, and corticomotor threshold.  Biol Psychiatry. 1999;  45 1440-1446
    CrossrefPubMedSuche in Google Scholar
  • 13 Eschweiler G W, Wegerer C, Schlotter W, Spandl C, Stevens A, Bartels M. Left Prefrontal activation predicts therapeutic effects of repetitive transcranial magnetic stimulation (RTMS) in major depression.  Psychiatry Res (Neuroimaging). 2000;  99 161-172
    PubMedSuche in Google Scholar
  • 14 Klein E, Kreinin I, Chistyakov A, Koren D, Mecz L, Marmur S, Ben Shachar D, Feinsod M. Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double- blind controlled study.  Arch Gen Psychiatry. 1999;  56 315-320
    PubMedSuche in Google Scholar
  • 15 Loo C, Mitchell P, Sachdev P, McDarmont B, Parker G, Gandevia S. Double-blind controlled investigation of transcranial magnetic stimulation for the treatment of resistant major depression.  Am J Psychiatry. 1999;  156 946-948
    PubMedSuche in Google Scholar
  • 16 Lisanby S H, Luber B, Schroeder C M, Osman M, Finck D, Amassian V E, Arezzo J, Sackeim H A. RTMS in Primates: Intracerebral Measurement of rTMS and ECS induced voltage in vivo.  Electroencephalogr Clin Neurophysiol. 1998;  107 79P
    PubMedSuche in Google Scholar
  • 17 George M S, Lisanby S H, Sackeim H A. Transcranial magnetic stimulation: applications in neuropsychiatry.  Arch Gen Psychiatry. 1999;  56 300-311
    CrossrefPubMedSuche in Google Scholar
  • 18 Siebner H R, Peller M, Willoch F, Minoshima S, Boecker H, Auer C, Drzezga A, Conrad B, Bartenstein P. Lasting cortical activation after repetitive TMS of the motor cortex - A glucose metabolic study.  Neurology. 2000;  54 956-963
    PubMedSuche in Google Scholar
  • 19 Post A, Müller M B, Engelmann M, Keck M E. Repetitive transcranial magnetic stimulation in rats: evidence for a neuroprotective effect in vitro and in vivo.  Eur J Neurosci. 1999;  11 3247-3254
    CrossrefPubMedSuche in Google Scholar
  • 20 Müller M B, Toschi N, Kresse A E, Post A, Keck M E. Long-term repetitive transcranial magnetic stimulation increases the expression of brain-derived neurotrophic factor and cholecystokinin mRNA, but not neuropeptide tyrosine mRNA in specific areas of rat brain.  Neuropsychopharmacology. 2000;  23 205-215
    CrossrefPubMedSuche in Google Scholar
  • 21 Massot O, Grimaldi B, Bailly J M, Kochanek M, Deschamps F, Lambrozo J, Fillion G. Magnetic field desensitizes 5-HT(1B) receptor in brain: pharmacological and functional studies.  Brain Res. 2000;  858 143-150
    CrossrefPubMedSuche in Google Scholar
  • 22 Beique J C, de-Montigny C, Blier P, Debonnel G. Effects of sustained administration of the serotonin and norepinephrine reuptake inhibitor venlafaxine: I.  In vivo electrophysiological studies in the rat.. Neuropharmacology. 2000;  39 1800-1812
    PubMedSuche in Google Scholar
  • 23 Villringer A. Functional neuroimaging.  Optical approaches.. Adv Exp Med Biol. 1997;  413 1-18
    PubMedSuche in Google Scholar
  • 24 Heekeren H R, Kohl M, Obrig H, Wenzel R, von Pannwitz W, Matcher S J, Dirnagl U, Cooper C E, Villringer A. Noninvasive assessment of changes in cytochrome-c oxidase oxidation in human subjects during visual stimulation.  J Cereb Blood Flow Metab. 1999;  19 592-603
    PubMedSuche in Google Scholar
  • 25 Eschweiler G W, Plewnia C, Batra A, Bartels M. Does clinical response to repetitive prefrontal transcranial magnetic stimulation (rTMS) predict response to electroconvulsive therapy (ECT) in major depression? .  Can J Psychiatry. 2000;  45 58-59
    PubMedSuche in Google Scholar
  • 26 Paus T, Jech R, Thompson C J, Comeau R, Peters T, Evans A C. Dose-dependent reduction of cerebral blood flow during rapid-rate transcranial magnetic stimulation of the human sensorimotor cortex.  J Neurophysiol. 1998;  79 1102-1107
    PubMedSuche in Google Scholar
  • 27 Kimbrell T A, Little J T, Dunn R T, Frye M A, Greenberg B D, Wassermann E M, Repella J D, Danielson A L, Willis M W, Benson B E, Speer A M, Osuch E, George M S, Post R M. Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism.  Biol Psychiatry. 1999;  46 1603-1613
    CrossrefPubMedSuche in Google Scholar
  • 28 Davidson R J. Anterior electrophysiological asymmetries, emotion, and depression: conceptual and methodological conundrums.  Psychophysiology. 1998;  35 607-614
    CrossrefPubMedSuche in Google Scholar
  • 29 Figiel G S, Epstein C, McDonald W M, Amazon Leece J, Figiel L, Saldivia A, Glover S. The use of rapid-rate transcranial magnetic stimulation (rTMS) in refractory depressed patients.  J Neuropsychiatry Clin Neurosci. 1998;  10 20-25
    PubMedSuche in Google Scholar
  • 30 Kozel F A, Nahas Z, deBrux C, Molloy M, Lorberbaum J P, Bohning D, Risch S C, George M S. How coil-cortex distance relates to age, motor threshold, and antidepressant response to repetitive transcranial magnetic stimulation.  J Neuropsychiatry Clin Neurosci. 2000;  12 376-384
    PubMedSuche in Google Scholar
  • 31 Grunhaus L, Dannon P N, Schreiber S, Dolberg O H, Amiaz R, Ziv R, Lefkifker E. Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: an open study.  Biol Psychiatry. 2000;  47 314-324
    CrossrefPubMedSuche in Google Scholar
  • 32 Bench C J, Friston K J, Brown R G, Scott L C, Frackowiak R S, Dolan R J. The anatomy of melancholia-focal abnormalities of cerebral blood flow in major depression.  Psychol Med. 1992;  22 607-615
    PubMedSuche in Google Scholar
  • 33 Dolan R J, Bench C J, Liddle P F, Friston K J, Frith C D, Grasby P M, Frackowiak R S. Dorsolateral prefrontal cortex dysfunction in the major psychoses; symptom or disease specificity?.  J Neurol Neurosurg Psychiatry. 1993;  56 1290-1294
    PubMedSuche in Google Scholar
  • 34 Holthoff V A, Beuthien-Baumann B, Pietrzyk U, Pinkert J, Oehme L, Franke W G, Bach O. Regionale zerebrale Funktionsstörung bei der Depression im Verlauf.  Nervenarzt. 1998;  69 67-77
    PubMedSuche in Google Scholar
  • 35 Drevets W C, Videen T O, Price J L, Preskorn S H, Carmichael S T, Raichle M E. A functional anatomical study of unipolar depression.  J Neurosci. 1992;  12 3628-3641
    PubMedSuche in Google Scholar
  • 36 Mayberg H S, Liotti M, Brannan S K, McGinnis S, Mahurin R K, Jerabek P A, Silva J A, Tekell J L, Martin C C, Lancaster J L, Fox P T. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness.  Am J Psychiatry. 1999;  156 675-682
    PubMedSuche in Google Scholar
  • 37 D’Esposito M, Postle B R, Ballard D, Lease J. Maintenance versus manipulation of information held in working memory: an event-related fMRI study.  Brain Cogn. 1999;  41 66-86
    PubMedSuche in Google Scholar
  • 38 D’Esposito M, Zarahn E, Aguirre G K, Rypma B. The effect of normal aging on the coupling of neural activity to the bold hemodynamic response.  Neuroimage. 1999;  10 6-14
    CrossrefPubMedSuche in Google Scholar
  • 39 Rypma B, D’Esposito M. Isolating the neural mechanisms of age-related changes in human working memory.  Nat Neurosci. 2000;  3 509-515
    CrossrefPubMedSuche in Google Scholar
  • 40 Wiedemann G, Pauli P, Dengler W, Lutzenberger W, Birbaumer N, Buchkremer G. Frontal brain asymmetry as a biological substrate of emotions in patients with panic disorders.  Arch Gen Psychiatry. 1999;  56 78-84
    CrossrefPubMedSuche in Google Scholar
  • 41 Herwig U, Schönfeldt L C. The study of central nervous information processing with transcranial magnetic stimulation.  Fortschr Neurol Psychiatr. 2000;  68 289-300
    Thieme ConnectPubMedSuche in Google Scholar
  • 42 Herwig U, Schönfeldt L C, Lampe Y, Schuster B, Walter H, Spitzer M. Neuronavigierte repetitive Transkranielle Magnetstimulation bei depressiven Patienten, eine plazebokontrollierte Studie.  Nervenarzt. 2000;  71 S74-S74 (Abstract)
    PubMedSuche in Google Scholar
  • 43 Conca A, Koppi S, Konig P, Swoboda E, Krecke N. Transcranial magnetic stimulation: a novel antidepressive strategy? .  Neuropsychobiology. 1996;  34 204-207
    PubMedSuche in Google Scholar
  • 44 Tew J D, Mulsant B H, Haskett R F, Prudic J, Thase M E, Crowe R R, Dolata D, Begley A E, Reynolds C F, Sackeim H A. Acute efficacy of ECT in the treatment of major depression in the old-old.  Am J Psychiatry. 1999;  156 1865-1870
    PubMedSuche in Google Scholar
  • 45 George M S, Wassermann E M, Williams W A, Callahan A, Ketter T A, Basser P, Hallett M, Post R M. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression.  Neuroreport. 1995;  6 1853-1856
    CrossrefPubMedSuche in Google Scholar
  • 46 Berman R M, Narasimhan M, Sanacora G, Miano A P, Hoffman R E, Hu X S, Charney D S, Boutros N N. A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression.  Biol Psychiatry. 2000;  47 332-337
    CrossrefPubMedSuche in Google Scholar
  • 47 Geller V, Grisaru N, Abarbanel J M, Lemberg T, Belmaker R H. Slow magnetic stimulation of prefrontal cortex in depression and schizophrenia.  Prog Neuropsychopharmacol Biol Psychiatry. 1997;  21 105-110
    CrossrefPubMedSuche in Google Scholar

Dr. Gerhard W. Eschweiler

Universitätsklinik für Psychiatrie und Psychotherapie

Osianderstr. 24

72070 Tübingen

eMail: eschweiler@med.uni-tuebingen.de