Elektrokrampftherapie und neue Hirnstimulationsmethoden

S. Kayser; H. Walter; T. Schläpfer

doi:10.1055/s-0038-1628725

Nervenheilkunde, Table of Contents

Nervenheilkunde 2010; 29(03): 117-123
DOI: 10.1055/s-0038-1628725

CME-Fortbildung

Schattauer GmbH

Elektrokrampftherapie und neue Hirnstimulationsmethoden

Electroconvulsive therapy and new brain stimulation methods

S. Kayser

¹Universitätsklinikum Bonn, Klinik für Psychiatrie und Psychotherapie, Bonn

,

H. Walter

¹Universitätsklinikum Bonn, Klinik für Psychiatrie und Psychotherapie, Bonn

²Universitätsklinikum Bonn, Klinik für Psychiatrie und Psychotherapie, Abteilung Medizinische Psychologie, Bonn

,

T. Schläpfer

¹Universitätsklinikum Bonn, Klinik für Psychiatrie und Psychotherapie, Bonn

³Departments of Mental Health and Psychiatric Neuroimaging, Johns Hopkins University, Baltimore, MD, USA

› Author Affiliations

Abstract

Zusammenfassung

Die Elektrokrampftherapie (EKT) wird seit über 70 Jahren angewandt und ist zurzeit wissenschaftlich das potenteste antidepressive Behandlungsverfahren. Insbesondere in Deutschland ist die EKT noch immer ein massiv stigmatisiertes Verfahren. Der Wirkmechanismus ist nicht abschließend geklärt. Trotz ständiger technischer Verbesserungen hat die EKT zwei grundlegende Nachteile: eine hohe Rückfallquote und zum Teil ausgeprägte akute kognitive Nebenwirkungen. Es besteht in der Psychiatrie ein dringender Bedarf an neueren Behandlungsoptionen für schwerste, therapieresistente psychiatrische Erkrankungen. Derzeit werden als potenzielle neue Behandlungsmethoden von psychischen Störungen hauptsächlich vier physikalische Hirnstimulationsmethoden untersucht: die transkranielle Magnetstimulation (TMS), die Magnetkrampftherapie (MKT), die Vagusnervstimulation (VNS) und die tiefe Hirnstimulation (THS). Diese werden nur in Einzelfällen außerhalb von wissenschaftlichen Studien angewendet; ihre klinische Bedeutung und die Wirkmechanismen müssen weiter untersucht werden. Keines der neuen Stimulationsmethoden ist in psychiatrischer Indikation die Therapie der ersten Wahl.

Summary

The electroconvulsive therapy (ECT) has been used for more than 70 years and it is currently the most potent antidepressant treatment with scientifically evidence. Still the ECT is a massive stigmatized treatment, especially in Germany. The mode of action of the ECT is not fully understood. Despite the technical improvements, there are two major disadvantages of the ECT: a high rate of relapse and the acute cognitive side effects, sometimes severe. In psychiatry, there is an urgent need of new treatment methods for severely treatment-resistant diseases. Currently, there are four physical methods of brain stimulation being researched: transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), vagus nerve stimulation (VNS) and deep brain stimulation (DBS). Beyond scientific studies, these are only applied in single cases at present. Their clinical importance and their mode of action have to be subject of further research. None of these new stimulation methods is a measure of first choice treatment presently in psychiatric disorders.

Schlüsselwörter

Elektrokrampftherapie - repetitive Transkranielle Magnetstimulation - Vagusnervstimulation - Magnetkrampftherapie - tiefe Hirnstimulation

Keywords

Electroconvulsive therapy - repetitive transcranial magnetic stimulation - vagus nerve stimulation - magnetic seizure therapy - deep brain stimulation

Full Text

References

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