Transkranielle Gleichstromstimulation: Neues Werkzeug in der Schmerztherapie?

Zusammenfassung

Mit dem Paradigma der transkraniellen Gleichstromstimulation (tDCS) haben wir eine Technik entwickelt die es ermöglicht, im Humanexperiment kortikale Erregbarkeitsmodifikationen nicht invasiv zu erzeugen, die über längere Zeit anhalten und somit wesentliche Kriterien extern modulierter Neuroplastizität erfüllen. tDCS bewirkt dies primär über eine Hyper- oder Depolarisierung neuronaler Membranen; die Nacheffekte sind NMDA-Rezeptor-abhängig. Klassisches Instrumentarium hierzu war bisher die repetitive transkranielle Magnetstimulation (rTMS), die über wiederholte kurz induzierte Stromflüsse im Gehirn ähnliche plastische Veränderungen erzielen kann. Wir setzen tDCS derzeit in der experimentellen Schmerzforschung ein, um einerseits Migräneattacken zu kupieren und andererseits chronische Schmerzen zu reduzieren.

Abstract

Transcranial direct current stimulation (tDCS) was developed by our group as a non-invasive tool to induce neuroplasticity in the human cerebral cortex. The primary effect of tDCS is a neuronal de- or hyperpolarisation; the after-effects are dependent upon NMDA receptor-efficacy changes. Applying repetitive transcranial magnetic stimulation (rTMS), a classical stimulation method, we can obtain similar plastic changes by inducing short current flows repeatedly in the brain. tDCS as a tool aims to induce prolonged neuronal excitability and activity alterations in the human brain in order to decrease the frequency of migraine attacks and attenuate subjective pain sensation in chronic pain.

Schlüsselwörter

Gleichstromstimulation - kortikale Erregbarkeit - Schmerztherapie - Migräne

Key words

tDCS - pain - cortical excitability - migraine

Literatur

• 1 Bindman L J, Lippold O CJ, Redfearn J WT. The action of brief polarizing currents on the cerebral cortex of the rat (1) during current flow and (2) in the production of long-lasting after-effects.  J Physiol. 1964;  172 369-382
• 2 Creutzfeldt O D, Fromm G H, Kapp H. Influence of transcortical d-c currents on cortical neuronal activity.  Exp Neurol. 1962;  5 436-52
• 3 Gartside I B. Mechanisms of sustained increases of firing rate of neurones in the rat cerebral cortex after polarization: reverberating circuits or modification of synaptic conductance?.  Nature. 1968;  220 382-383
• 4 Purpura D P, McMurtry J G. Intracellular activities and evoked potential changes during polarization of motor cortex.  J Neurophysiol. 1965;  28 166-185
• 5 Nitsche M A, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.  J Physiol. 2000;  527 633-639
• 6 Frégnac Y, Smith D, Friedlander M J. Postsynaptic membrane potential regulates synaptic potentiation and depression in visual cortical neurons.  Society for Neuroscience Abstracts. 1990;  16 798
• 7 Hattori Y, Moriwaki A, Hori Y. Biphasic effects of polarizing current on adenosine-sensitive generation of cyclic AMP in rat cerebral cortex.  Neurosci Lett. 1990;  116 320-324
• 8 Islam N, Aftabuddin M, Moriwaki A. et al . Increase in the calcium level following anodal polarization in the rat brain.  Brain Res. 1995;  684 206-208
• 9 Lolas F. Brain polarization: behavioral and therapeutic effects.  Biol Psychiatry. 1977;  12 37-47
• 10 Nitsche M A, Paulus W. Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans.  Neurology. 2001;  57 1899-1901
• 11 Liebetanz D, Nitsche M A, Tergau F, Paulus W. Pharmacological approach to synaptic and membrane mechanisms of DC-induced neuroplasticity in man.  Brain. 2002;  125 2238-2247
• 12 Nitsche M A, Fricke K, Henschke U. et al . Pharmacological modulation of cortical excitability shifts induced by transcranial DC stimulation.  J Physiol. 2003;  553 293-301
• 13 Antal A, Nitsche M A, Paulus W. Transcranial direct current stimulation and the visual cortex.  Brain Res Bull. 2006;  68 459-463
• 14 Antal A, Kincses T Z, Nitsche M A. et al . Excitability changes induced in the human primary visual cortex by transcranial direct current stimulation: direct electrophysiological evidence.  Invest Ophthalmol Vis Sci. 2004;  45 702-707
• 15 Sommer M, Alfaro A, Rummel M. et al . Half sine, monophasic and biphasic transcranial magnetic stimulation of the human motor cortex.  Clin Neurophysiol. 2006;  117 838-844
• 16 Fregni F, Boggio P S, Lima M C. et al . A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury.  Pain. 2006;  122 197-209
• 17 Csifcsák G, Antal A, Hillers F. et al .Modulatory effect of transcranial direct current stimulation on acute pain perception. Congress of the Federation of European Psychophysiological Societies. 2006: A-0118
• 18 Bolay H, Reuter U, Dunn A K. et al . Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model.  Nat Med. 2002;  8 136-142
• 19 Chadaide Z, Arlt S, Antal A. et al . The efficacy of inhibition is reduced in migraine: a tDCS study.  Cephalalgia. 2007;  72 208-214
• 20 Tamura Y, Hoshiyama M, Inui K. et al . Facilitation of Adelta-fiber-mediated acute pain by repetitive transcranial magnetic stimulation.  Neurology. 2004;  62 2176-2181
• 21 Lefaucheur J P, Drouot X, Keravel Y, Nguyen J P. Pain relief induced by repetitive transcranial magnetic stimulation of precentral cortex.  Neuroreport. 2001;  12 2963-2965
• 22 Lefaucheur J P, Drouot X, Nguyen J P. Interventional neurophysiology for pain control: duration of pain relief following repetitive transcranial magnetic stimulation of the motor cortex.  Neurophysiol Clin. 2001;  31 247-252
• 23 Pleger B, Janssen F, Schwenkreis P. et al . Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I.  Neurosci Lett. 2004;  356 87-90
• 24 Lefaucheur J P, Drouot X, Menard-Lefaucheur I. et al . Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain.  J Neurol Neurosurg Psychiatry. 2004;  75 612-616
• 25 Huang Y Z, Edwards M J, Rounis E. et al . Theta burst stimulation of the human motor cortex.  Neuron. 2005;  45 201-206
• 26 Fregni F, Freedman S, Pascual-Leone A. Recent advances in the treatment of chronic pain with non-invasive brain stimulation techniques.  Lancet Neurology. 2007;  6 188-191