Funktionelle Bildgebung und Neuromodulation: Effekte der transkraniellen Magnetstimulation auf kortikale Netzwerke bei Gesunden und Patienten

Zusammenfassung

Technische Stimulationsverfahren können zerebrale Netzwerke modulieren und Änderungen auf Verhaltensebene auslösen. Beim Menschen ist insbesondere die transkranielle Magnetstimulation (TMS) ein interessantes Verfahren, um über eine fokale Stimulation der Hirnrinde ein ganzes Netzwerk zu beeinflussen. Hierbei erlauben nicht-invasive bildgebende Verfahren wie die Positronen-Emissionstomografie (PET) oder die funktionelle Magnetresonanztomografie, die Effekte einer TMS auf neuronale Netzwerke in vivo zu untersuchen. In diesem Übersichtsartikel präsentieren und diskutieren wir funktionelle Bildgebungsstudien, in denen die neuralen Effekte der TMS unter physiologischen sowie pathologischen Bedingungen untersucht worden sind. Es zeigt sich, dass eine fokale TMS mit metabolischen Änderungen in nicht nur der stimulierten Region, sondern auch in damit verbundenen Arealen einhergeht. Diese Netzwerk-Effekte der TMS sind abhängig von der Stimulationsfrequenz und vom Stimulationsort. Insbesondere repetitive TMS-Protokolle können zur gezielten Modifikation pathologischer Netzwerk-Zustände genutzt werden. Hier ermöglichen bildgebende Verfahren einen wichtigen Einblick in den individuellen Zustand eines Netzwerks von Arealen, sodass Vorhersagen über das mögliche Ansprechen auf eine TMS-Intervention getroffen werden können. Hierbei sind sowohl das Aktivitätsniveau der geschädigten als auch der nicht-geschädigten Hemisphäre bedeutsam für den Interventionseffekt. Daher könnte zukünftig die funktionelle Bildgebung eine Entscheidungsgrundlage für eine individualisierte Therapiestrategie zur Behandlung neurologischer Defizite darstellen.

Abstract

Technical stimulation approaches offer great potential to modulate cerebral networks, thereby modifying behaviour. An interesting non-invasive approach to focally interfere with cortical networks is provided by transcranial magnetic stimulation (TMS). Functional neuroimaging techniques such as positron emission tomography (PET) or functional magnetic resonance imaging (fMRI) allow us to gain insights into the effects of TMS on neuronal circuits. Here we review recent papers on PET and fMRI studies investigating the neural effects of TMS under physiological and pathological conditions. We discuss data showing that focally applied TMS does not only regionally interfere with the cortex directly stimulated but also with remote and interconnected areas. The network effects of TMS are dependent on the stimulation frequency and location. Repetitive TMS protocols enable a distinct interference with pathological states of cerebral networks. Functional neuroimaging may serve as a surrogate marker to predict responses to a specific TMS-intervention protocol depending on neural activity levels in the affected or unaffected hemisphere. In the future such a combined approach may enable individualised treatment regimes to support recovery of function in patients suffering from neurological deficits.

Schlüsselwörter

fMRT - Schlaganfall - Neuropharmakologie - rTMS - transkraniellen Magnetstimulation

Key words

fMRI - stroke - neuropharmacology - rTMS - transcranial magnetic stimulation

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