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Kortikale Erregbarkeit bei Schizophrenie

Untersuchungen mit der transkraniellen Magnetstimulation (TMS)

Cortical excitability in schizophrenia

Studies using transcranial magnetic stimulation

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Zusammenfassung

Veränderungen der synaptischen Plastizität unter Einbeziehung abnormer Erregungsübertragung mit veränderter kortikaler Inhibition und Fazilitation sind bei der Schizophrenie schon länger beschrieben. Mit der transkraniellen Magnetstimulation (TMS) steht eine neurophysiologische Methode zur Messung kortikaler Erregbarkeit, insbesondere des motoneuralen Systems, zur Verfügung, welche in den letzten Jahren mit zunehmend weiterentwickelter Methodik (Doppelpulsmethode, kortikale Silent Period) zur Untersuchung von wichtigen Teilaspekten der pathophysiologischen Grundlagen der Schizophrenie eingesetzt wird. Es wird eine Übersicht über die Ergebnisse der bisher vorliegenden Studien mit der diagnostischen transkraniellen Magnetstimulation (dTMS) bei an Schizophrenie Erkrankten gegeben. Studien, welche die therapeutische Wirksamkeit der repetitiven Magnetstimulation (rTMS) bei therapieresistenten Halluzinationen oder vorherrschender Negativsymptomatik untersuchten, wurden nicht berücksichtigt. Derzeit ergeben sich aus der bisherige Studienlage v. a. Hinweise auf eine verminderte kortikale Inhibition, deren Ursache in einem Defizit in der GABAergen Erregungsübertragung bei der Schizophrenie gesehen wird. Bei der zusammenfassenden Bewertung des aktuellen Forschungsstands bei Schizophrenie werden sowohl die relevanten Einflussgrößen in den dargestellten Studien als auch die Grenzen der TMS-Methodik erläutert und mögliche Perspektiven für die Zukunft aufgezeigt.

Summary

Abnormalities in brain plasticity, including abnormal information processing by disturbed cortical inhibition and facilitation in schizophrenia, have been described several times in the past. Transcranial magnetic stimulation (TMS) provides a neurophysiological technique for the measurement of cortical excitability, especially of the motoneural system. With TMS it is possible to explore important aspects of the pathophysiological mechanisms underlying schizophrenia using recently developed paradigms (paired pulse method, cortical silent period). This review summarizes the results of available diagnostic TMS studies in schizophrenia. Studies investigating the efficacy of therapeutic repetitive magnetic stimulation in patients with treatment resistant hallucinations or predominantly negative symptoms were not considered. The reviewed studies support the assumption of reduced cortical inhibition, probably caused by GABAergic deficit, in schizophrenia. Factors influencing the study results, the limitations of this promising technique in schizophrenia, and further research options are discussed.

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Literatur

  1. Abarbanel JM, Lemberg T, Yaroslavski U et al. (1996) Electrophysiological responses to transcranial magnetic stimulation in depression and schizophrenia. Biol Psychiatry 40: 148–150

    Article  PubMed  CAS  Google Scholar 

  2. Bajbouj M, Gallinat J, Niehaus L et al. (2004) Abnormalities of inhibitory neuronal mechanisms in the motor cortex of patients with schizophrenia. Pharmacopsychiatry 37: 74–80

    Article  PubMed  CAS  Google Scholar 

  3. Barker AT, Jalinous R, Freeston IL (1985) Non-invasive magnetic stimulation of human motor cortex. Lancet 1: 1106–1107

    Article  PubMed  CAS  Google Scholar 

  4. Benes FM (1998) Model generation and testing to probe neural circuitry in the cingulate cortex of postmortem schizophrenic brain. Schizophr Bull 24: 219–230

    PubMed  CAS  Google Scholar 

  5. Benes FM (2000) Cortical Pathology: a new generation of quantitative microscopic studies. In: Harrison PJ, Roberts GW (eds) The neuropathology of schizophrenia: progress and interpretation. Oxford University Press, New York, pp 81–104

  6. Blum BP, Mann JJ (2002) The GABAergic system in schizophrenia. Int J Neuropsychopharmacol 5: 159–179

    Article  PubMed  CAS  Google Scholar 

  7. Boroojerdi B, Topper R, Foltys H et al. (1999) Transcallosal inhibition and motor conduction studies in patients with schizophrenia using transcranial magnetic stimulation. Br J Psychiatry 175: 375–379

    PubMed  CAS  Google Scholar 

  8. Brandt SA, Ploner CJ, Meyer BU (1997) Repetitive transkranielle Magnetstimulation. Möglichkeiten, Grenzen und Sicherheitsaspekte. Nervenarzt 68: 778–784

    Article  PubMed  CAS  Google Scholar 

  9. Brasil-Neto JP, Cohen LG, Hallett M (1994) Central fatigue as revealed by postexercise decrement of motor evoked potentials. Muscle Nerve 17: 713–719

    Article  PubMed  CAS  Google Scholar 

  10. Chen YL, Chen YH, Mak FL (2000) Soft neurological signs in schizophrenic patients and their nonpsychotic siblings. J Nerv Ment Dis 188: 84–89

    Article  PubMed  CAS  Google Scholar 

  11. Daskalakis ZJ, Christensen BK, Chen R et al. (2002) Evidence for impaired cortical inhibition in schizophrenia using transcranial magnetic stimulation. Arch Gen Psychiatry 59: 347–354

    Article  PubMed  Google Scholar 

  12. Daskalakis ZJ, Christensen BK, Chen R et al. (2003) Effect of antipsychotics on cortical inhibition using transcranial magnetic stimulation. Psychopharmacology (Berl) 170: 255–262

    Google Scholar 

  13. Daskalakis ZJ, Molnar GF, Christensen BK et al. (2003) An automated method to determine the transcranial magnetic stimulation-induced contralateral silent period. Clin Neurophysiol 114: 938–944

    Article  PubMed  Google Scholar 

  14. Davey NJ, Puri BK (2000) Motor responses to transcranial magnetic stimulation in schizophrenia. Br J Psychiatry 176: 400

    Article  PubMed  CAS  Google Scholar 

  15. Davey NJ, Puri BK, Lewis HS et al. (1997) Effects of antipsychotic medication on electromyographic responses to transcranial magnetic stimulation of the motor cortex in schizophrenia. J Neurol Neurosurg Psychiatry 63: 468–473

    PubMed  CAS  Google Scholar 

  16. Di Lazarro V, Oliviero A, Profice P et al. (2003) Ketamine increases human motor cortex excitability to transcranial magnetic stimulation. J Physiol 547: 485–496

    Article  CAS  Google Scholar 

  17. Eichhammer P, Langguth B, Zowe M et al. (2004) GABA-B-assoziierte neuropsychiatrische Erkrankungen. Psychiatr Prax 31(Suppl 1): S44–S46

    Article  PubMed  Google Scholar 

  18. Eichhammer P, Wiegand R, Kharraz A et al. (2004) Cortical excitability in neuroleptic-naive first-episode schizophrenic patients. Schizophr Res 67: 253–259

    Article  PubMed  Google Scholar 

  19. Eichhammer P, Langguth B, Muller J et al. (2005) The neuronal level of motor activity: determination of motor cortex excitability by TMS. Psychiatr Prax 32(Suppl 1): S43–S46

    Article  PubMed  Google Scholar 

  20. Fitzgerald PB, Brown TL, Daskalakis ZJ et al. (2002) A study of transcallosal inhibition in schizophrenia using transcranial magnetic stimulation. Schizophr Res 56: 199–209

    Article  PubMed  CAS  Google Scholar 

  21. Fitzgerald PB, Brown TL, Daskalakis ZJ et al. (2002) A transcranial magnetic stimulation study of inhibitory deficits in the motor cortex in patients with schizophrenia. Psychiatry Res 114: 11–22

    Article  PubMed  Google Scholar 

  22. Fitzgerald PB, Brown TL, Daskalakis ZJ et al. (2002) A transcranial magnetic stimulation study of the effects of olanzapine and risperidone on motor cortical excitability in patients with schizophrenia. Psychopharmacology (Berl) 162: 74–81

    Google Scholar 

  23. Fitzgerald PB, Brown TL, Marston NA et al. (2003) A transcranial magnetic stimulation study of abnormal cortical inhibition in schizophrenia. Psychiatry Res 118: 197–207

    Article  PubMed  Google Scholar 

  24. Fitzgerald PB, Brown TL, Marston NA et al. (2004) Reduced plastic brain responses in schizophrenia: a transcranial magnetic stimulation study. Schizophr Res 71: 17–26

    Article  PubMed  Google Scholar 

  25. Höppner J, Kunesch E, Grossmann A et al. (2001) Dysfunction of transcallosally mediated motor inhibition and callosal morphology in patients with schizophrenia. Acta Psychiatr Scand 104: 227–235

    Article  Google Scholar 

  26. Ilic TV, Meintzschel F, Cleff U et al. (2002) Short-interval paired-pulse inhibition and facilitation of human motor cortex: the dimension of stimulus intensity. J Physiol 545: 153–167

    Article  PubMed  CAS  Google Scholar 

  27. Kiers L, Cros D, Chiappa KH et al. (1993) Variability of motor potentials evoked by transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol 89: 415–423

    Article  PubMed  CAS  Google Scholar 

  28. Kujirai T, Caramis MD, Rothwell JC et al. (1993) Corticospinal inhibition in human motor cortex. J Physiol 471: 501–519

    PubMed  CAS  Google Scholar 

  29. Maeda F, Pascual-Leone A (2003) Transcranial magnetic stimulation: studying motor neurophysiology of psychiatric disorders. Psychopharmacology (Berl) 168: 359–376

    Google Scholar 

  30. Matsunaga K, Uozumi T, Tsuji S et al. (1998) Age-dependent changes in physiological threshold asymmetries for the motor evoked potential and silent period following transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol 109: 502–507

    Article  PubMed  CAS  Google Scholar 

  31. Meyer BU, Rohricht S, Woiciechowsky C (1998) Topography of fibers in the human corpus callosum mediating interhemispheric inhibition between the motor cortices. Ann Neurol 43: 360–369

    Article  PubMed  CAS  Google Scholar 

  32. Oxley T, Fitzgerald PB, Brown TL et al. (2004) Repetitive transcranial magnetic stimulation reveals abnormal plastic response to premotor cortex stimulation in schizophrenia. Biol Psychiatry 56: 628–633

    Article  PubMed  Google Scholar 

  33. Pascual-Leone A, Manoach DS, Birnbaum R et al. (2002) Motor cortical excitability in schizophrenia. Biol Psychiatry 52: 24–31

    Article  PubMed  Google Scholar 

  34. Phillips M, Woodruff P, David A (1996) Stroop interference and fascilitation in the cerebral hemispheres in schizophrenia. Schizophr Res 20: 57–68

    Article  PubMed  CAS  Google Scholar 

  35. Puri BK, Davey NJ, Ellaway PH et al. (1996) An investigation of motor function in schizophrenia using transcranial magnetic stimulation of the motor cortex. Br J Psychiatry 169: 690–695

    Article  PubMed  CAS  Google Scholar 

  36. von Richthofen S, Tabrizian S, Grabe HJ et al. (2003) Der interhemispherielle Transfer und seine Relevanz in der Neurologie und der Psychiatrie. Fortschr Neurol Psychiatr 71: 449–457

    Article  Google Scholar 

  37. Saka MC, Atbasoglu EC, Ozguven HD et al. (2005) Cortical inhibition in first-degree relatives of schizophrenic patients assessed with transcranial magnetic stimulation. Int J Neuropsychopharmacol 8: 565–569

    Article  Google Scholar 

  38. Smith RC, Hussain MI, Chowdhury SA et al. (1999) Stability of neurological soft signs in chronically hospitalised schizophrenic patients. J Neuropsychiatry Clin Neurosci 11: 91–96

    PubMed  CAS  Google Scholar 

  39. Smith MJ, Keel JC, Greenberg BD et al. (1999) Menstrual cycle effects on cortical excitability. Neurology 53: 2069–2072

    PubMed  CAS  Google Scholar 

  40. Strafella AP, Paus T (2000) Modulation of cortical excitability during action observation: a transcranial magnetic stimulation study. Neuroreport 11: 2289–2292

    Article  PubMed  CAS  Google Scholar 

  41. Triggs WJ, Subramanium B, Rossi F (1999) Hand preference and transcranial magnetic stimulation asymmetry of cortical motor representation. Brain Res 835: 324–329

    Article  PubMed  CAS  Google Scholar 

  42. Werhahn KJ, Kunesch E, Noachtar S et al. (1999) Differential effects on motorcortical inhibition induced by blockade of GABA uptake in humans. J Physiol 517: 501–507

    Article  Google Scholar 

  43. Ziemann U, Hallett M (2000) Basic neurophysiological studies with TMS. In: George MS, Belmaker RH (eds) Transcranial magnetic stimulation in neuropsychiatry, vol. 1. American Psychiatric Press, Washington DC, pp 45–98

  44. Ziemann U, Lonnecker S, Steinhoff BJ et al. (1996) Effects of antiepileptic drugs on motor cortex excitability in humans: a transcranial magnetic stimulation study. Ann Neurol 40: 367–378

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum, Georg-August-Universität , Göttingen, Deutschland

    P. Falkai

  2. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg, Saar, Deutschland

    T. Wobrock & D. Kadovic

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  1. T. Wobrock
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  2. D. Kadovic
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  3. P. Falkai
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Correspondence to D. Kadovic.

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Wobrock, T., Kadovic, D. & Falkai, P. Kortikale Erregbarkeit bei Schizophrenie. Nervenarzt 78, 753–763 (2007). https://doi.org/10.1007/s00115-006-2207-7

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