Transkranielle Gleichstromstimulation (tDCS) bei Zwangsstörung: Eine neue Therapieoption?

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.

Schlüsselwörter

Zwang - tDCS - nicht-invasive Hirnstimulation - Neuromodulation

Key words

obsession - compulsion - OCD - non-invasive brain stimulation - neuromodulation

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