PDF herunterladen
Nervenheilkunde 2003; 22(04): 189-195
DOI: 10.1055/s-0038-1624395
Original- und Übersichtsarbeiten/Original and Review Articles
Schattauer GmbH

Gemeinsamkeiten und Unterschiede der therapeutischen transkraniellen Magnetstimulation und der Elektrokrampftherapie

Similarities and differences of therapeutic transcranial magnetic stimulation and electroconvulsive therapy
G. W. Eschweiler
1   Universitätsklinik für Psychiatrie und Psychotherapie Tübingen (Ärztl. Direktor: Prof. Dr. med. G. Buchkremer)
,
C. Plewnia
1   Universitätsklinik für Psychiatrie und Psychotherapie Tübingen (Ärztl. Direktor: Prof. Dr. med. G. Buchkremer)
,
B. Wild
1   Universitätsklinik für Psychiatrie und Psychotherapie Tübingen (Ärztl. Direktor: Prof. Dr. med. G. Buchkremer)
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
15. Januar 2018 (online)

    Lizenzen und Reprints

Zusammenfassung

Die Elektrokrampftherapie (EKT) ist ein etabliertes Verfahren zur Behandlung von therapieresistenten Depressionen, während die transkranielle Magnetstimulation (TMS) über dem präfrontalen Kortex zurzeit als experimentelle Behandlungsform dieser Erkrankung gilt. Beide Therapieverfahren, die EKT und die TMS, induzieren intrakortikal ein elektrisches Feld. Dieses Feld führt zu einer neuronalen Depolarisation unter der Spule und zu Fernwirkungen via Projektionen zum anterioren Cingulum und ventralen Striatum sowie anderen tiefer gelegenen Hirnstrukturen. Ein wesentlicher Unterschied ist das subkonvulsive Prinzip der TMS, während die EKT per definitionem einen generalisierten Krampfanfall induziert und somit eine Narkose und Muskelrelaxation benötigt. Die TMS-induzierten Effekte auf den Hypothalamus und Hirnstamm sind im Vergleich zur EKT wesentlich schwächer ausgeprägt, was eventuell die geringere antidepressive Wirksamkeit begründen könnte. Die TMS verursacht andererseits weder passagere noch anhaltende kognitive Nebenwirkungen, sodass die Akzeptanz der TMS bei den Patienten entsprechend hoch ist. Die TMS ist kostengünstiger und kann ambulant durchgeführt werden. Größere Multicenter-Studien könnten helfen, die antidepressive Wirksamkeit dieser subkonvulsiven Technik zu beweisen und das alte Dogma der EKT-Forschung, nur generalisierte Krampfanfälle seien wirksam, zu überwinden.

Summary

Electroconvulsive therapy (ECT) is proven to be a highly effective antidepressant therapy, whereas at this time prefrontal therapeutic transcranial magnetic stimulation (TMS) should be considered as an experimental treatment for major depression. Both induce an intracortical electric field. The TMS acts subconvulsive by a localised depolarisation of a set of neurones which project to limbic structures like the anterior cingulum and ventral striatum, involved in affective processes. The ECT by definition induces a generalized seizure, therefore requiring a short anesthesia with muscle relaxation. The TMS-effects on the hypothalamus and brainstem are less pronounced than in ECT or electroconvulsive shock (ECS) in the animal models. This lack of autonomous and consistent hormonal effects of TMS to the prefrontal cortex may be responsible for its minor therapeutic effect especially in psychotic depression compared to the right unilateral ECT and bilateral ECT. TMS, however, does not induce any temporary or persistent cognitive side effects, rendering this technique highly acceptable to patients and psychiatrists. Multi-center studies of the antidepressive TMS-effects may help to overcome the old ECT-dogma that there is no clinical benefit without a sufficient generalized seizure.

Schlüsselwörter

Transkranielle Magnetstimulation - Elektrokrampftherapie - Wirkmodelle - psychotische Depression - kognitive Nebenwirkungen - »magnetic seizure therapy«

Keywords

Transcranial magnetic stimulation - electroconvulsive therapy - electroconvulsive shock - psychotic depression - cognitive side effects - models of action - magnetic seizure therapy
 

  • Literatur

  • 1 APA. Weiner RD. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training and Privileging: a task force report of the American Psychiatric Association. 2. ed. Washington, DC: American Psychiatric Association; 2001.
    Google Scholar
  • 2 Bailine SH. et al. Comparison of Bifrontal and Bitemporal ECT for Major Depression. Am J Psychiatry 2000; 157: 121-3.
    CrossrefPubMedGoogle Scholar
  • 3 Bench CJ, Friston KJ, Brown RG, Frackowiak RS, Dolan RJ. Regional cerebral blood flow in depression measured by positron emission tomography: the relationship with clinical dimensions. Psychol Med 1993; 23: 579-90.
    CrossrefPubMedGoogle Scholar
  • 4 Burt T, Lisanby SH, Sackeim HA. Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis. Int J Neuropsychopharmacol 2002; 05: 73-103.
    Google Scholar
  • 5 Cohrs S. et al. Suprathreshold repetitive transcranial magnetic stimulation elevates thyroidstimulating hormone in healthy male subjects. J Nerv Ment Dis 2001; 189: 393-7.
    CrossrefPubMedGoogle Scholar
  • 6 Drevets WC. Neuroimaging studies of mood disorders. Biol Psychiatry 2000; 48: 813-29.
    CrossrefPubMedGoogle Scholar
  • 7 Drevets WC, Videen TO, Price JL, Preskorn SH, Carmichael ST, Raichle ME. A functional anatomical study of unipolar depression. J Neurosci 1992; 12: 3628-41.
    CrossrefPubMedGoogle Scholar
  • 8 Duman RS, Malberg J, Nakagawa S, D’Sa C. Neuronal plasticity and survival in mood disorders. Biol Psychiatry 2000; 48: 732-9.
    CrossrefPubMedGoogle Scholar
  • 9 Duman RS, Vaidya VA. Molecular and cellular actions of chronic electroconvulsive seizures. J ECT 1998; 14: 181-93.
    PubMedGoogle Scholar
  • 10 Eschweiler GW, Plewnia C, Bartels M. Welche depressiven Patienten profitieren von präfrontaler repetitiver transkranieller Magnetstimulation (RTMS)?. Fortschr Neurol Psychiatr 2001; 69: 1-8.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Eschweiler GW, Plewnia C, Batra A, Bartels M. Does clinical response to repetitive prefrontal transcranial magnetic stimulation (rTMS) predict response to electroconvulsive therapy (ECT) in major depression?. Can J Psychiatry 2000; 45: 58-9.
    Google Scholar
  • 12 Eschweiler GW, Wegerer C, Schlotter W. et al. Left prefrontal activation predicts therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) in major depression. Psychiatry Res 2000; 99: 161-72.
    CrossrefPubMedGoogle Scholar
  • 13 Frodl T, Meisenzahl EM, Zetzsche T. et al. Hippocampal changes in patients with a first episode of major depression. Am J Psychiatry 2002; 159: 1112-8.
    CrossrefPubMedGoogle Scholar
  • 14 George MS, Wassermann EM, Williams WA. et al. Changes in mood and hormone levels after rapid-rate transcranial magnetic stimulation (rTMS) of the prefrontal cortex. J Neuropsychiatry. Clin Neurosci 1996; 08: 172-80.
    Google Scholar
  • 15 Grunhaus L. et al. Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: an open study. Biol Psychiatry 2000; 47: 314-24.
    CrossrefPubMedGoogle Scholar
  • 16 Höflich G, Kasper S, Hufnagel A, Ruhrmann S, Möller HJ. Application of transcranial magnetic stimulation in treatment of drug-resistant major depression: A report of two cases. Hum Psychopharm 1993; 08: 361-5.
    CrossrefGoogle Scholar
  • 17 Janicak PG, Dowd SM, Martis B. et al. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: preliminary results of a randomized trial. Biol Psychiatry 2002; 51: 659-67.
    CrossrefPubMedGoogle Scholar
  • 18 Kammer T, Thielscher A. Physikalische und physiologische Grundlagen der transkraniellen Magnetstimulation. Nervenheilkunde 2003; 22: 168-76.
    Artikel in Thieme ConnectGoogle Scholar
  • 19 Keck ME, Sillaber I, Ebner K. et al. Acute transcranial magnetic stimulation of frontal brain regions selectively modulates the release of vasopressin, biogenic amines and amino acids in the rat brain. Eur J Neurosci 2000; 12: 3713-20.
    CrossrefPubMedGoogle Scholar
  • 20 Kritzer MF, Goldman-Rakic PS. Intrinsic circuit organization of the major layers and sublayers of the dorsolateral prefrontal cortex in the rhesus monkey. J Comp.Neurol 1995; 359: 131-43.
    PubMedGoogle Scholar
  • 21 Liotti M, Mayberg HS, McGinnis S, Brannan SL, Jerabek P. Unmasking disease-specific cerebral blood flow abnormalities: mood challenge in patients with remitted unipolar depression. Am J Psychiatry 2002; 159: 1830-40.
    CrossrefPubMedGoogle Scholar
  • 22 Lisanby SH. Update on Magnetic Seizure Therapy: A Novel Form of Convulsive Therapy. Journal of ECT 2002; 18: 182-8.
    CrossrefPubMedGoogle Scholar
  • 23 Lisanby SH, Bazil CW, Resor SR, Nobler MS, Finck DA, Sackeim HA. ECT in the treatment of status epilepticus. J ECT 2001; 17: 210-5.
    CrossrefPubMedGoogle Scholar
  • 24 Lisanby SH, Belmaker RH. Animal models of the mechanisms of action of repetitive transcranial magnetic stimulation (rTMS): Comparisons with electroconvulsive shock (ECS). Depress Anxiety 2000; 12: 178-87.
    CrossrefPubMedGoogle Scholar
  • 25 Lisanby SH, Gutman D, Luber B, Schroeder C, Sackeim HA. Sham TMS: intracerebral measurement of the induced electrical field and the induction of motor-evoked potentials. Biol Psychiatry 2001; 49: 460-3.
    CrossrefPubMedGoogle Scholar
  • 26 Lisanby SH, Luber B, Sackeim HA, Finck AD, Schroeder C. Deliberate seizure induction with repetitive transcranial magnetic stimulation in nonhuman primates. Arch Gen Psychiatry 2001; 58: 199-200.
    CrossrefPubMedGoogle Scholar
  • 27 Lisanby SH. et al. The effects of electroconvulsive therapy on memory of autobiographical and public events. Arch Gen Psychiatry 2000; 57: 581-90.
    CrossrefPubMedGoogle Scholar
  • 28 Lisanby SH, Schlaepfer TE, Fisch HU, Sackeim HA. Magnetic seizure therapy of major depression. Arch Gen Psychiatry 2001; 58: 303-5.
    CrossrefPubMedGoogle Scholar
  • 29 Little JT, Kimbrell TA, Wassermann EM. et al. Cognitive effects of 1-and 20-hertz repetitive transcranial magnetic stimulation in depression: preliminary report. Neuropsychiatry Neuropsychol Behav Neurol 2000; 13: 119-24.
    PubMedGoogle Scholar
  • 30 Loo C, Sachdev P, Elsayed H. et al. Effects of a 2-to 4-week course of repetitive transcranial magnetic stimulation (rTMS) on neuropsychologic functioning, electroencephalogram, and auditory threshold in depressed patients. Biol Psychiatry 2001; 49: 615-23.
    CrossrefPubMedGoogle Scholar
  • 31 Maeda F, Keenan JP, Tormos JM, Topka H, Pascual-Leone A. Modulation of corticospinal excitability by repetitive transcranial magnetic stimulation. Clin Neurophysiol 2000; 111: 800-5.
    CrossrefPubMedGoogle Scholar
  • 32 Martin JL, Barbanoj MJ, Schlaepfer TE. et al. Transcranial magnetic stimulation for treating depression. Cochrane Database Syst Rev. 2002: CD003493.
    PubMedGoogle Scholar
  • 33 Mayberg HS. et al. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry 1999; 156: 675-82.
    PubMedGoogle Scholar
  • 34 McCall WV, Reboussin DM, Weiner RD, Sackeim HA. Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Arch Gen Psychiatry 2000; 57: 438-44.
    CrossrefPubMedGoogle Scholar
  • 35 Moser DJ. et al. Improved executive functioning following repetitive transcranial magnetic stimulation. Neurology 2002; 58: 1288-90.
    CrossrefPubMedGoogle Scholar
  • 36 Müller MB, Toschi N, Kresse AE, Post A, Keck ME. Long-term repetitive transcranial magnetic stimulation increases the expression of brain-derived neurotrophic factor and cholecystokinin mRNA, but not neuropeptide tyrosine mRNA in specific areas of rat brain. Neuropsychopharmacology 2000; 23: 205-15.
    CrossrefPubMedGoogle Scholar
  • 37 Niehaus L, Guldin B, Meyer B. Influence of transcranial magnetic stimulation on pupil size. J Neurol Sci 2001; 182: 123-8.
    CrossrefPubMedGoogle Scholar
  • 38 Niehaus L, Meyer BU, Roricht S. Magnetic stimulation over different brain regions: no differential effects on the elicited sympathetic skin responses. Electroencephalogr Clin Neurophysiol 1998; 109: 94-9.
    CrossrefPubMedGoogle Scholar
  • 39 Nobler MS, Sackeim HA, Prohovnik I. et al. Regional cerebral blood flow in mood disorders, III. Treatment and clinical response. Arch Gen Psychiatry 1994; 51: 884-97.
    CrossrefPubMedGoogle Scholar
  • 40 O’Connor MK, Knapp R, Husain M. et al. The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report. Am J Geriatr Psychiatry 2001; 09: 382-90.
    CrossrefGoogle Scholar
  • 41 Padberg F, Zinka B, Zwanzger P. et al. Präfrontale repetitive transkranielle Magnetstimulation (rTMS) in der Therapie depressiver Erkrankungen. Nervenheilkunde. 2003 (in press).
    PubMedGoogle Scholar
  • 42 Padberg F, Zwanzger P, Thoma H. et al. Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: comparative study of fast, slow and sham rTMS. Psychiatry Res 1999; 88: 163-71.
    CrossrefPubMedGoogle Scholar
  • 43 Pascual-Leone A. et al. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. Lancet 1996; 348: 233-7.
    CrossrefPubMedGoogle Scholar
  • 44 Petrides G, Fink M, Husain MM. et al. ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. J ECT 2001; 17: 244-53.
    CrossrefPubMedGoogle Scholar
  • 45 Pridmore SA. Substitution of rapid transcranial magnetic stimulation treatments for electroconvulsive therapy treatments in a course of electroconvulsive therapy. Depress Anxiety 2000; 12: 118-23.
    CrossrefPubMedGoogle Scholar
  • 46 Sackeim HA, Haskett RF, Mulsant BH. et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 2001; 285: 1299-307.
    CrossrefPubMedGoogle Scholar
  • 47 Sackeim HA. et al. Electrophysiological correlates of the adverse cognitive effects of electroconvulsive therapy. J ECT 2000; 16: 110-20.
    CrossrefPubMedGoogle Scholar
  • 48 Sermet E, Gregoire MC, Galy G. et al. Paradoxical metabolic response of the human brain to a single electroconvulsive shock. Neurosci Lett 1998; 254: 41-4.
    CrossrefPubMedGoogle Scholar
  • 49 Smesny S, Volz HP, Liepert J, Tauber R, Hochstetter A, Sauer H. [Repetitive transcranial magnetic stimulation (rTMS) in the acute and long-term therapy of refractory depression – a case report]. Nervenarzt 2001; 72: 734-8.
    CrossrefPubMedGoogle Scholar
  • 50 Speer AM. et al. Lack of Adverse Cognitive Effects of 1 Hz and 20 Hz Repetitive Transcranial Magnetic Stimulation at 100% of Motor Threshold Over Left Prefrontal Cortex in Depression. J ECT 2001; 17: 259-63.
    CrossrefPubMedGoogle Scholar
  • 51 Staubli U, Scafidi J. Time-dependent reversal of long-term potentiation in area CA1 of the freely moving rat induced by theta pulse stimulation. J Neurosci 1999; 19: 8712-9.
    CrossrefPubMedGoogle Scholar
  • 52 Tew JD. et al. Acute efficacy of ECT in the treatment of major depression in the old-old. Am J Psychiatry 1999; 156: 1865-70.
    CrossrefPubMedGoogle Scholar
  • 53 Triggs WJ, McCoy KJ, Greer R. et al. Effects of left frontal transcranial magnetic stimulation on depressed mood, cognition, and corticomotor threshold. Biol Psychiatry 1999; 45: 1440-6.
    CrossrefPubMedGoogle Scholar
  • 54 Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalogr Clin Neurophysiol 1998; 108: 1-16.
    CrossrefPubMedGoogle Scholar
  • 55 Wassermann EM, Lisanby SH. Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol 2001; 112: 1367-77.
    CrossrefPubMedGoogle Scholar
  • 56 Yoshida T, Yoshino A, Kobayashi Y, Inoue M, Kamakura K, Nomura S. Effects of slow repetitive transcranial magnetic stimulation on heart rate variability according to power spectrum analysis. J Neurol Sci 2001; 184: 77-80.
    CrossrefPubMedGoogle Scholar