Subscribe to RSS
DOI: 10.1055/a-0653-7349
Transkranielle Gleichstromstimulation (tDCS) bei Zwangsstörung: Eine neue Therapieoption?
Transcranial direct current stimulation (tDCS) for obsessive-compulsive disorder: A new treatment option?![](https://www.thieme-connect.de/media/fdn/202007/lookinside/thumbnails/10.1055a-0653-7349-1.jpg)
Zusammenfassung
Trotz der Fortschritte in Psychopharmakologie und etablierter psychotherapeutischer Interventionen respondieren mehr als 40 % der Patienten mit Zwangsstörung nicht auf konventionelle Behandlungsversuche. Seit einigen Jahren gewinnen nicht-invasive Hirnstimulationsverfahren Bedeutung in der Behandlung psychiatrischer Erkrankungen. Die transkranielle Gleichstromstimulation (transcranial direct current stimulation – tDCS), ein nicht-invasives Hirnstimulationsverfahren mit Applikation eines niedrigen konstanten Gleichstroms zur Modulation neuronaler Netzwerkstrukturen, wird seit einiger Zeit als neues therapeutisches Verfahren beforscht, um Symptome behandlungsresistenter Zwangsstörungen zu verbessern. Ziel dieser Übersichtarbeit ist ein umfassender Überblick über den aktuellen Stand der Literatur zu diesem Thema sowie ein Ausblick auf zukünftige Anwendung der tDCS bei Zwangsstörungen. Die Suche in der NIH-Datenbank pubmed und eine erweitere manuelle Suche ergab eine bislang geringe Zahl von neun Fallberichten, drei offenen Studien und einer randomisierten Studie mit zwei aktiven Bedingungen. Plazebokontrollierte Studien liegen nicht vor. Eine Gesamtzahl von 78 Patienten erhielt aktive tDCS mit einer Vielzahl unterschiedlicher Elektrodenplatzierungen, wobei das Hauptziel der dorsolaterale präfrontale Kortex, der orbitofrontale Kortex oder (prä-)supplementär-motorische Areale waren. Trotz der Heterogenität der Stimulationsbedingungen zeigen die berichteten Fälle nicht nur eine Verbesserung von Zwangssymptomen, sondern auch von komorbiden Depressionen und Angststörungen bei Patienten mit therapieresistenter Zwangsstörung. Einschränkend ist festzuhalten, dass keine plazebokontrollierten Studien vorliegen und die bisherigen Resultate einer Bestätigung bedürfen.
Abstract
More than 40 % of patients with obsessive-compulsive disorder (OCD) do not respond to established treatments despite advances in psychopharmacology and psychotherapy. Since a couple of years, non-invasive brain stimulation techniques gain importance in the treatment of psychiatric disorders. Transcranial direct current stimulation (tDCS) uses weak constant direct current to modulate neuronal activation and changes the function of neuronal networks. This technique is recently investigated for the improvement of treatment resistant OCD symptoms. In this review we give a concise overview over the current state of the art and delineate further directions of tDCS application in OCD. The search in the NIH database pubmed and further manual search revealed nine case reports, three open label studies and one controlled study with two active arms. There is no sham controlled study yet. A total of 78 patients received active tDCS with a large variety of different electrode placements, with main target over dorsolateral prefrontal cortex, orbitofrontal cortex, and (pre-)supplementary motor areas. Although stimulation parameters were highly heterogeneous, reported cases show not only an improvement of OCD symptoms, but also an improvement of depression and anxiety symptoms in patients with treatment resistant OCD. This evidence is limited by the lack of sham-controlled studies and needs confirmation in larger studies.
Publication History
Received: 11 April 2018
Accepted: 24 June 2018
Article published online:
11 December 2018
© Georg Thieme Verlag KG
Stuttgart · New York
-
Literatur
- 1 Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 2010; 15: 53-63
- 2 Fontenelle IS, Fontenelle LF, Borges MC, Prazeres AM, Rangé BP, Mendlowicz MV, Versiani M. Quality of life and symptom dimensions of patients with obsessive-compulsive disorder. Psychiatry Res 2010; 179: 198-203
- 3 Fineberg NA, Reghunandanan S, Simpson HB, Phillips KA, Richter MA, Matthews K. , et al. Accreditation Task Force of The Canadian Institute for Obsessive Compulsive Disorders Obsessive-compulsive disorder (OCD): Practical strategies for pharmacological and somatic treatment in adults. Psychiatry Res 2015; 227: 114-125
- 4 Pallanti S, Quercioli L. Treatment-refractory obsessive-compulsive disorder: methodological issues, operational definitions and therapeutic lines. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30: 400-412
- 5 Mondino M, Bennabi D, Poulet E, Galvao F, Brunelin J, Haffen E. Can transcranial direct current stimulation (tDCS) alleviate symptoms and improve cognition in psychiatric disorders? World J Biol Psychiatry 2014; 15: 261-275
- 6 Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F. , et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol 2017; 128: 56-92
- 7 Klimke A, Nitsche MA, Maurer K, Voss U. Case Report: Successful Treatment of Therapy-Resistant OCD With Application of Transcranial Alternating Current Stimulation (tACS). Brain Stimul 2016; 9: 463-465
- 8 Parazzini M, Rossi E, Rossi L, Priori A, Ravazzani P. Evaluation of the current density in the brainstem during transcranial direct current stimulation with extra-cephalic reference electrode. Clin Neurophysiol 2013; 124: 1039-1040
- 9 Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 2000; 527: 633-639
- 10 Keeser D, Meindl T, Bor J, Palm U, Pogarell O, Mulert C, Brunelin J, Möller HJ, Reiser M, Padberg F. Prefrontal Transcranial Direct Current Stimulation Changes Connectivity of Resting-State Networks during fMRI. J Neurosci 2011; 31: 15 284-15 293
- 11 Monte-Silva K, Kuo MF, Hessenthaler S, Fresnoza S, Liebetanz D, Paulus W, Nitsche MA. Induction of late LTP-like plasticity in the human motor cortex by repeated non-invasive brain stimulation. Brain Stimul 2013; 6: 424-432
- 12 Monte-Silva K, Kuo MF, Liebetanz D, Paulus W, Nitsche MA. Shaping the optimal repetition interval for cathodal transcranial direct current stimulation (tDCS). J Neurophysiol 2010; 103: 1735-1740
- 13 Ritter P, Born J, Brecht M, Dinse HR, Heinemann U, Pleger B, Schmitz D, Schreiber S, Villringer A, Kempter R. State-dependencies of learning across brain scales. Front Comput Neurosci 2015; 9: 1
- 14 De Pretto M, Sallard E, Spierer L. State dependency of inhibitory control performance: an electrical neuroimaging study. Eur J Neurosci 2016; 44: 1826-1832
- 15 Sasai S, Homae F, Watanabe H, Sasaki AT, Tanabe HC, Sadato N, Taga G. Frequency-specific network topologies in the resting human brain. Front Hum Neurosci 2014; 8: 1022
- 16 Hou J, Wu W, Lin Y, Wang J, Zhou D, Guo J. , et al. Localization of cerebral functional deficits in patients with obsessive-compulsive disorder: a resting-state fMRI study. J Affect Disord 2012; 138: 313-321
- 17 van der Straten AL, Denys D, van Wingen G. Impact of treatment on resting cerebral blood flow and metabolism in obsessive compulsive disorder: a meta-analysis. Sci Rep 2017; 7: 17 464
- 18 Nauczyciel C, Le Jeune F, Naudet F, Douabin S, Esquevin A, Vérin M. , et al. Repetitive transcranial magnetic stimulation over the orbitofrontal cortex for obsessive-compulsive disorder: a double-blind, crossover study. Transl Psychiatry 2014; 4: e436
- 19 Rauch SL, Jenike MA, Alpert NM, Baer L, Breiter HC, Fischman AJ. Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. Arch Gen Psychiatry 1994; 51: 62-70
- 20 Milad MR, Rauch SL. Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways. Trends Cogn Sci 2012; 16: 43-51
- 21 Brunelin J, Mondino M, Bation R, Palm U, Saoud M, Poulet E. Transcranial Direct Current Stimulation for Obsessive-Compulsive Disorder: A Systematic Review. Brain Sci 2018; 8: E37
- 22 Hazari N, Narayanaswamy JC, Chhabra H, Bose A, Venkatasubramanian G, Reddy YC. Response to Transcranial Direct Current Stimulation in a Case of Episodic Obsessive Compulsive Disorder. J ECT 2016; 32: 144-146
- 23 Handrack M, Voderholzer U, Schwartz C, Hasan A, Padberg F, Palm U. Prefrontal direct current stimulation in hoarding disorder: A case report. Brain Stimul 2018 DOI: 10.1016 / j.brs.2018.02.001
- 24 Alizadeh Goradel J, Pouresmali A, Mowlaie M, Sadeghi Movahed F. The Effects of Transcranial Direct Current Stimulation on Obsession-compulsion, Anxiety, and Depression of a Patient Suffering from Obsessive-compulsive Disorder. Pract Clin Psychol 2016; 4: 75-80
- 25 Volpato C, Piccione F, Cavinato M, Duzzi D, Schiff S, Foscolo L, Venneri A. Modulation of affective symptoms and resting state activity by brain stimulation in a treatment-resistant case of obsessive-compulsive disorder. Neurocase 2013; 19: 360-370
- 26 Narayanaswamy JC, Jose D, Chhabra H, Agarwal SM, Shrinivasa B, Hegde A. , et al. Successful Application of Add-on Transcranial Direct Current Stimulation (tDCS) for Treatment of SSRI Resistant OCD. Brain Stimul 2015; 8: 655-657
- 27 Mondino M, Haesebaert F, Poulet E, Saoud M, Brunelin J. Efficacy of Cathodal Transcranial Direct Current Stimulation Over the Left Orbitofrontal Cortex in a Patient With Treatment-Resistant Obsessive-Compulsive Disorder. J ECT 2015; 31: 271-272
- 28 D’Urso G, Brunoni AR, Anastasia A, Micillo M, de Bartolomeis A, Mantovani A. Polarity-dependent effects of transcranial direct current stimulation in obsessive-compulsive disorder. Neurocase 2016; 22: 60-64
- 29 Silva R, Brunoni AR, Miguel EC, Shavitt RG. Transcranial direct current stimulation for treatment-resistant obsessive-compulsive disorder: report on two cases and proposal for a randomized, sham-controlled trial. Sao Paulo Med J Rev 2016; 134: 446-450
- 30 Palm U, Leitner B, Kirsch B, Behler N, Kumpf U, Wulf L. , et al. Prefrontal tDCS and sertraline in obsessive compulsive disorder: a case report and review of the literature. Neurocase 2017; 23: 173-177
- 31 Dinn WM, Aycicegi-Dinn A, Göral F, Karamursel S, Yildirim EA, Hacioglu-Yildirim M. , et al. Treatment-resistant obsessive-compulsive disorder: Insights from an open trial of transcranial direct current stimulation (tDCS) to design a RCT. Neurol Psychiatry Brain Res 2016; 3-4: 146-154
- 32 Bation R, Poulet E, Haesebaert F, Saoud M, Brunelin J. Transcranial direct current stimulation in treatment-resistant obsessive-compulsive disorder: An open-label pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65: 153-157
- 33 Najafi K, Fakour Y, Zarrabi H, Heidarzadeh A, Khalkhali M, Yeganeh T. , et al. Efficacy of Transcranial Direct Current Stimulation in the Treatment: Resistant Patients who Suffer from Severe Obsessive-compulsive Disorder. Indian J Psychol Med 2017; 39: 573-578
- 34 D’Urso G, Brunoni AR, Mazzaferro MP, Anastasia A, de Bartolomeis A, Mantovani A. Transcranial direct current stimulation for obsessive-compulsive disorder: A randomized, controlled, partial crossover trial. Depress Anxiety 2016; 33: 1132-1140
- 35 Mansur CG, Myczkowki ML, de Barros Cabral S, Sartorelli M, Bellini BB, Dias A. , et al. Placebo effect after prefrontal magnetic stimulation in the treatment of resistant obsessive-compulsive disorder: a randomized controlled trial. Int J Neuropsychopharmacol 2011; 14: 1389-1397
- 36 Senço NM, Huang Y, D’Urso G, Parra LC, Bikson M, Mantovani A. , et al. Transcranial direct current stimulation in obsessive-compulsive disorder: emerging clinical evidence and considerations for optimal montage of electrodes. Exp Rev Med Dev 2015; 12: 381-391
- 37 Monte-Silva K, Kuo MF, Liebetanz D, Paulus W, Nitsche MA. Shaping the Optimal Repetition Interval for Cathodal Transcranial Direct Current Stimulation (tDCS). J Neurophysiol 2010; 103: 1735-1740
- 38 Monte-Silva K, Kuo MF, Hessenthaler S, Fresnoza S, Liebetanz D, Paulus W, Nitsche MA. Induction of Late LTP-Like Plasticity in the Human Motor Cortex by Repeated Non-Invasive Brain Stimulation. Brain Stimul 2013; 6: 424-432
- 39 McLaren ME, Nissim NR, Woods AJ. The effects of medication use in transcranial direct current stimulation: A brief review. Brain Stimul 2017; 11: 52-58
- 40 Nitsche MA, Kuo MF, Karrasch R, Wächter B, Liebetanz D, Paulus W. Serotonin Affects Transcranial Direct Current – Induced Neuroplasticity in Humans. Biol Psychiatry 2009; 66: 503-508
- 41 Kuo HI, Paulus W, Batsikadze G, Jamil A, Kuo MF, Nitsche MA. Chronic Enhancement of Serotonin Facilitates Excitatory Transcranial Direct Current Stimulation-Induced Neuroplasticity. Neuropsychopharmacol 2016; 41: 1223-1230
- 42 Brunoni AR, Valiengo L, Baccaro A, Zanão TA, de Oliveira JF, Goulart A. , et al. The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry 2013; 70: 383-391
- 43 D’Urso G, Dell’Osso B, Rossi R, Brunoni AR, Bortolomasi M, Ferrucci R. , et al. Clinical predictors of acute response to transcranial direct current stimulation (tDCS) in major depression. J Affect Disord 2017; 219: 25-30