Transkranielle Magnetstimulation zur Behandlung von Bewegungsstörungen

Zusammenfassung

Diese Arbeit gibt einen Überblick über den therapeutischen Einsatz der repetitiven transkraniellen Magnetstimulation (rTMS) bei Patienten mit Bewegungsstörungen. Die meisten Studien untersuchten die therapeutischen Effekte der rTMS beim Morbus Parkinson. Zunächst wurde hier der akute Effekt einer einmaligen rTMS-Anwendung über dem primären motorischen Kortex (M1) auf die Bradykinese und andere Parkinsonsymptome untersucht. Die rTMS erfolgte meist nach kurzzeitigem Absetzen der vorbestehenden dopaminergen Medikation. Mehrere interventionelle Studien zeigten, dass eine erregbarkeitssteigernde, hochfrequente (≥5 Hz) rTMS des M1 kurzzeitig die motorische Symptomatik bessert, insbesondere wenn mehr als 1 000 Stimuli verabreicht werden. In neueren Studien wurde die rTMS mehrfach an unterschiedlichen Tagen verabreicht und mehrere kortikale Zielareale in einer Sitzung stimuliert. Hierdurch ließ sich der günstige Effekt einer hochfrequenten rTMS auf die Parkinsonsymptome verlängern. Bei Patienten mit fokaler Handdystonie, medikamentös induzierten Dyskinesien, essenziellem Tremor, Chorea oder Tics wurden bislang vor allem die therapeutischen Effekte einer hemmenden, niederfrequenten (1 Hz) rTMS untersucht. In Abhängigkeit von der Bewegungsstörung und dem Reizort zeigte sich nach 1 Hz rTMS eine kurzzeitige Besserung der klinischen Symptome. Trotz dieser ermutigenden Resultate ist die interventionelle rTMS bei Patienten mit Bewegungsstörungen immer noch als ein experimentelles Therapieverfahren einzustufen. Die Hindernisse, welche einem breiten therapeutischen Einsatz der rTMS bei Patienten mit Bewegungsstörungen im Wege stehen, werden diskutiert.

Abstract

Here we review the potential use of repetitive transcranial magnetic stimulation (rTMS) as a therapeutic intervention in patients with movement disorders. Most rTMS studies have been conducted in patients with Parkinson's disease (PD). Initially, rTMS was applied in a single session targeting the primary motor cortex (M1). In most single-session studies, rTMS was given after the discontinuation of dopaminergic medication. The majority of studies found a transient clinical improvement of motor symptoms after high-frequency (≥5 Hz) rTMS of the M1, especially when more than 1 000 stimuli had been applied. Recent studies applied multiple rTMS-sessions on several days and targeted multiple cortical sites. These studies provided preliminary evidence that the use of more extended stimulation protocols can prolong the therapeutic effects of high-frequency rTMS on parkinsonism. Inhibitory low-frequency (1 Hz) rTMS was found to be beneficial in some patients with focal hand dystonia, drug-induced dyskinesia, essential tremor, chorea, or tics. While these results are encouraging, the jury is still out whether this interventional technique will emerge as a routine treatment option in PD and other movement disorders. We discuss the challenges that still have to be faced when bringing rTMS treatment into regular clinical practice.

Schlüsselwörter

Chorea - Dystonie - interventionelle Neurophysiologie - motorischer Kortex - Bewegungsstörungen - Parkinsonsyndrom - repetitive transkranielle Magnetstimulation - Tics - Tremor

Key words

Chorea - Dystonia - interventional neurophysiology - motor cortex - movement disorders - Parkinson's disease - repetitive transcranial magnetic stimulation - tics - tremor

Literatur

• 1 Siebner HR, Rothwell J. Transcranial magnetic stimulation: new insights into representational cortical plasticity.  Experimental brain research. 2003;  148 1-16
• 2 Lang N, Siebner HR. Repetitive transkranielle Magnetstimulation (rTMS). In: Siebner HR, Ziemann U, Hrsg. Das TMS-Buch, Handbuch der transkraniellen Magnetstimulation. Heidelberg: Springer Medizin Verlag 2007: 499-509
• 3 Karim AA, Birbaumer N, Siebner HR. Therapeutische Ansätze der transkraniellen Kortexstimulation. In: Siebner HR, Ziemann U, Hrsg. Das TMS-Buch, Handbuch der transkraniellen Magnetstimulation. Heidelberg: Springer Medizin Verlag 2007: 555-565
• 4 Helmich RC, Siebner HR, Bakker M. et al . Repetitive transcranial magnetic stimulation to improve mood and motor function in Parkinson's disease.  J Neurol Sci. 2006;  248 84-96
• 5 Fregni F, Simon DK, Wu A. et al . Non-invasive brain stimulation for Parkinson's disease: a systematic review and meta-analysis of the literature.  J Neurol Neurosurg Psychiatry. 2005;  76 1614-1623
• 6 Edwards MJ, Talelli P, Rothwell JC. Clinical applications of transcranial magnetic stimulation in patients with movement disorders.  Lancet Neurol. 2008;  7 827-840
• 7 Braak H, Ghebremedhin E, Rub U. et al . Stages in the development of Parkinson's disease-related pathology.  Cell Tissue Res. 2004;  318 121-134
• 8 Cantello R, Tarletti R, Civardi C. Transcranial magnetic stimulation and Parkinson's disease.  Brain Res Brain Res Rev. 2002;  38 309-327
• 9 Valls-Sole J, Pascual-Leone A, Brasil-Neto JP. et al . Abnormal facilitation of the response to transcranial magnetic stimulation in patients with Parkinson's disease.  Neurology. 1994;  44 735-741
• 10 Chen R, Kumar S, Garg RR. et al . Impairment of motor cortex activation and deactivation in Parkinson's disease.  Clin Neurophysiol. 2001;  112 600-607
• 11 Pascual-Leone A, Valls-Sole J, Brasil-Neto JP. et al . Akinesia in Parkinson's disease. I. Shortening of simple reaction time with focal, single-pulse transcranial magnetic stimulation.  Neurology. 1994;  44 884-891
• 12 Pascual-Leone A, Valls-Sole J, Brasil-Neto JP. et al . Akinesia in Parkinson's disease. II. Effects of subthreshold repetitive transcranial motor cortex stimulation.  Neurology. 1994;  44 892-898
• 13 Ghabra MB, Hallett M, Wassermann EM. Simultaneous repetitive transcranial magnetic stimulation does not speed fine movement in PD.  Neurology. 1999;  52 768-770
• 14 Siebner HR. Simultaneous repetitive transcranial magnetic stimulation does not speed fine movement in PD.  Neurology. 2000;  54 272 , (comment)
• 15 Strafella AP, Ko JH, Monchi O. Therapeutic application of transcranial magnetic stimulation in Parkinson's disease: the contribution of expectation.  Neuroimage. 2006;  31 1666-1672
• 16 Siebner HR, Mentschel C, Auer C. et al . Repetitive transcranial magnetic stimulation has a beneficial effect on bradykinesia in Parkinson's disease.  Neuroreport. 1999;  10 589-594
• 17 Siebner HR, Rossmeier C, Mentschel C. et al . Short-term motor improvement after sub-threshold 5-Hz repetitive transcranial magnetic stimulation of the primary motor hand area in Parkinson's disease.  J Neurol Sci. 2000;  178 91-94
• 18 de Groot M, Hermann W, Steffen J. et al . Contralateral and ipsilateral repetitive transcranial magnetic stimulation in Parkinson patients.  Nervenarzt. 2001;  72 932-938
• 19 Sommer M, Tergau F, Paulus W. TMS in hypokinetic movement disorders. In: George M, Belmaker RH, Hrsg. Transcranial Magnetic Stimulation in Neuropsychiatry. Washington DC: American Psychiatric Press 2000: 163-172
• 20 Bornke C, Schulte T, Przuntek H. et al . Clinical effects of repetitive transcranial magnetic stimulation versus acute levodopa challenge in Parkinson's disease.  J Neural Transm Suppl. 2004;  111 61-67
• 21 Tergau F, Wassermann EM, Paulus W. et al . Lack of clinical improvement in patients with Parkinson's disease after low and high frequency repetitive transcranial magnetic stimulation.  Electroencephalogr Clin Neurophysiol Suppl. 1999;  51 281-288
• 22 Lefaucheur JP, Drouot X, Von Raison F. et al . Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson's disease.  Clin Neurophysiol. 2004;  115 2530-2541
• 23 Boylan LS, Pullman SL, Lisanby SH. et al . Repetitive transcranial magnetic stimulation to SMA worsens complex movements in Parkinson's disease.  Clin Neurophysiol. 2001;  112 259-264
• 24 Koch G, Oliveri M, Brusa L. et al . High-frequency rTMS improves time perception in Parkinson disease.  Neurology. 2004;  63 2405-2406
• 25 Koch G, Brusa L, Caltagirone C. et al . rTMS of supplementary motor area modulates therapy-induced dyskinesias in Parkinson disease.  Neurology. 2005;  65 623-625
• 26 Buhmann C, Gorsler A, Baumer T. et al . Abnormal excitability of premotor-motor connections in de novo Parkinson's disease.  Brain. 2004;  127 2732-2746
• 27 Mir P, Matsunaga K, Gilio F. et al . Dopaminergic drugs restore facilitatory premotor-motor interactions in Parkinson disease.  Neurology. 2005;  64 1906-1912
• 28 Okabe S, Ugawa Y, Kanazawa I. 0.2-Hz repetitive transcranial magnetic stimulation has no add-on effects as compared to a realistic sham stimulation in Parkinson's disease.  Mov Disord. 2003;  18 382-388
• 29 Khedr EM, Farweez HM, Islam H. Therapeutic effect of repetitive transcranial magnetic stimulation on motor function in Parkinson's disease patients.  Eur J Neurol. 2003;  10 567-572
• 30 Khedr EM, Rothwell JC, Shawky OA. et al . Effect of daily repetitive transcranial magnetic stimulation on motor performance in Parkinson's disease.  Mov Disord. 2006;  21 2201-2205
• 31 Lomarev MP, Kanchana S, Bara-Jimenez W. et al . Placebo-controlled study of rTMS for the treatment of Parkinson's disease.  Mov Disord. 2006;  21 325-331
• 32 Dragasevic N, Potrebic A, Damjanovic A. et al . Therapeutic efficacy of bilateral prefrontal slow repetitive transcranial magnetic stimulation in depressed patients with Parkinson's disease: an open study.  Mov Disord. 2002;  17 528-532
• 33 Fregni F, Santos CM, Myczkowski ML. et al . Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson's disease.  J Neurol Neurosurg Psychiatry. 2004;  75 1171-1174
• 34 Del Olmo MF, Bello O, Cudeiro J. Transcranial magnetic stimulation over dorsolateral prefrontal cortex in Parkinson's disease.  Clin Neurophysiol. 2007;  118 131-139
• 35 Brusa L, Versace V, Koch G. et al . Low frequency rTMS of the SMA transiently ameliorates peak-dose LID in Parkinson's disease.  Clin Neurophysiol. 2006;  117 1917-1921
• 36 Siebner HR. Treatment of movement disorders (Chapter 17). In: Hallett M, Chokroverty S, Hrsg. Magnetic Stimulation in Clinical Neurophysiology. Butterworth & Heinemann 2004: 223-238
• 37 Siebner HR, Tormos JM, Ceballos-Baumann AO. et al . Low-frequency repetitive transcranial magnetic stimulation of the motor cortex in writer's cramp.  Neurology. 1999;  52 529-537
• 38 Siebner HR, Auer C, Ceballos-Baumann A. et al . Has repetitive transcranial magnetic stimulation of the primary motor hand area a therapeutic application in writer's cramp?.  Electroencephalogr Clin Neurophysiol Suppl. 1999;  51 265-275
• 39 Murase N, Rothwell JC, Kaji R. et al . Subthreshold low-frequency repetitive transcranial magnetic stimulation over the premotor cortex modulates writer's cramp.  Brain. 2005;  128 104-115
• 40 Gironell A, Kulisevsky J, Lorenzo J. et al . Transcranial magnetic stimulation of the cerebellum in essential tremor: a controlled study.  Arch Neurol. 2002;  59 413-417
• 41 Brusa L, Versace V, Koch G. et al . Improvement of choreic movements by 1 Hz repetitive transcranial magnetic stimulation in Huntington's disease patients.  Ann Neurol. 2005;  58 655-656
• 42 Di Lazzaro V, Dileone M, Pilato F. et al . Repetitive transcranial magnetic stimulation of the motor cortex for hemichorea.  J Neurol Neurosurg Psychiatry. 2006;  77 1095-1097
• 43 Orth M, Kirby R, Richardson MP. et al . Subthreshold rTMS over pre-motor cortex has no effect on tics in patients with Gilles de la Tourette syndrome.  Clin Neurophysiol. 2005;  116 764-768
• 44 Chae JH, Nahas Z, Wassermann E. et al . A pilot safety study of repetitive transcranial magnetic stimulation (rTMS) in Tourette's syndrome.  Cogn Behav Neurol. 2004;  17 109-117
• 45 Munchau A, Bloem BR, Thilo KV. et al . Repetitive transcranial magnetic stimulation for Tourette syndrome.  Neurology. 2002;  59 1789-1791
• 46 Mantovani A, Lisanby SH, Pieraccini F. et al . Repetitive transcranial magneticstimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS).  Int J Neuropsychopharmacol. 2006;  9 95-100

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