Elektrokonvulsive Therapie bei Depression: Welche Erkenntnisse erbringen fMRT-, PET- und SPECT-Untersuchungen?

Zusammenfassung

Die elektrokonvulsive Therapie (EKT) zeigt überlegene klinische Wirksamkeit bei therapieresistenter Depression. Befunde aus nuklearmedizinischen und funktionellen magnetresonanztomografischen (fMRT) Untersuchungen zur EKT können zunehmend im Kontext pathophysiologischer Modelle von Depression interpretiert werden und leisten einen Beitrag zur Validierung von Theorien zum Wirkmechanismus von EKT. Modellvorstellungen depressiver Störungen postulieren eine dysfunktionale Modulation von Gehirnaktivität innerhalb kortiko-limbischer Regelkreise sowie eine aberrante Interaktion von funktionellen zerebralen Netzwerken, die an emotionalen Prozessen beteiligt sind. Nuklearmedizinische Methoden haben konvergierende Belege für iktale Gehirnfunktionsänderungen im Rahmen von EKT erbracht, die spezifisch mit klinischer Wirkung und Nebenwirkungen assoziiert zu sein scheinen; bezüglich länger anhaltender zerebraler Effekte nach EKT bestehen Hinweise für z. T. weitreichende Gehirnfunktionsänderungen, die sich allerdings sowohl in vergleichender Wertung untereinander als auch im Kontext von Annahmen zur funktionellen Neuroanatomie von Depression nicht übereinstimmend interpretieren lassen. Mittels fMRT wurden erste überzeugende Belege für EKT-induzierte, interiktal überdauernde Veränderungen der Interaktion von zerebralen Strukturen vorgelegt, deren Relevanz in der Pathophysiologie von Depression als gesichert angenommen werden kann. Ein konsistentes Modell über den Wirkmechanismus von EKT kann ausgehend von diesen Befunden gleichwohl gegenwärtig nicht formuliert werden. Ein weiterreichendes Verständnis des Einflusses von EKT auf die Pathophysiologie depressiver Störungen könnte in der Etablierung von Biomarkern zur Prädiktion von Behandlungsresponse und/oder unerwünschten Nebenwirkungen eine klinisch hilfreiche Anwendung finden.

Abstract

Electroconvulsive therapy (ECT) is the most potent and rapidly acting of all antidepressant treatments in major depressive disorder (MDD). Nuclear and functional magnetic (fMRI) brain imaging studies of ECT have substantially contributed to the neurobiological understanding of this treatment modality. Neuroimaging methods may also validate potential mechanisms of antidepressant action. Models of neural dysfunction in MDD suggest impaired modulation of activity within a cortico-limbic circuitry, along with alterations in the functional organisation of multiple brain networks implicated in emotional processes. Nuclear imaging techniques have demonstrated consistent patterns of ECT-induced ictal changes in brain activity that appear to be linked to efficacy and side effects of ECT. Interictally, widespread alterations of brain function have been reported, however, results remain inconclusive. FMRI studies of ECT have demonstrated longer-lasting, interictal changes of neural activity in multiple cerebral regions that are in accordance with functional neuroanatomical models of mood disorders. Future research detailing ECT interactions with brain pathophysiology in MDD could potentially provide a clinically useful framework to better predict ECT treatment response and/or side effects, and may also facilitate the development of more focused brain stimulation techniques.

Schlüsselwörter

Elektrokonvulsive Therapie - EKT - Depression - fMRT - PET - SPECT

Key words

electroconvulsive therapy - ECT - depression - fMRI - PET - SPECT

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