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Hirnstimulationsverfahren

Transkranielle Magnetstimulation, Magnetkrampftherapie und tiefe Hirnstimulation

Brain stimulation procedures

Transcranial magnetic stimulation, magnetic seizure therapy and deep brain stimulation

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Zusammenfassung

Hirnstimulationsverfahren sind vielversprechende Behandlungsoptionen bei schweren, therapieresistenten psychiatrischen Erkrankungen. Die transkranielle Magnetstimulation ist ein sicheres und wenig invasives Verfahren, wobei bis heute die Wertigkeit in Bezug auf eine klinische Anwendbarkeit unklar ist. Eine Weiterentwicklung der transkraniellen Magnetstimulation ist die Magnetkrampftherapie. Hierbei werden generalisierte Krampfanfälle zu therapeutischen Zwecken – ähnlich der Elektrokrampftherapie – unter Narkose und Muskelrelaxation ausgelöst. Die bisherigen Ergebnisse bezüglich der antidepressiven Wirkung und dem gegenüber der Elektrokrampftherapie guten kognitiven Nebenwirkungsprofil sind überzeugend. Die tiefe Hirnstimulation ist ein invasives Verfahren, wobei mit einer stereotaktischen Operation Elektroden in definierten Zielregionen eingesetzt werden. Die Wirkung bei schweren therapieresistenten Zwangsstörungen und Depressionen sind vielversprechend, jedoch sollten ethische Gesichtspunkte berücksichtigt werden.

Summary

Brain stimulation methods are promising treatment options in severe treatment-resistant psychiatric disorders. A safe and noninvasive method is transcranial magnetic stimulation, but the clinical application is not clear. Magnetic seizure therapy is a further development of transcranial magnetic stimulation, by which generalized seizures are induced under anaesthesia. Previous results with regard to the antidepressant effects and the fewer cognitive side effects were significant. Deep brain stimulation is an invasive procedure in which electrodes are stereotactically implanted in special brain areas. The effects in severe therapy-resistant obsessive-compulsive disorders and depressions are promising. However, the evaluation of ethical issues remains an important task.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: TS ist Empfänger zweier Investigator Initiated Grants der Firma Medtronic, einem Hersteller von Geräten zur tiefen Hirnstimulation. SK gibt an, dass keine Interessenkonflikte bestehen.

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Uniklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland

    T.E. Schläpfer & S. Kayser

  2. Departments of Psychiatry and Mental Health, The Johns Hopkins University, Baltimore, USA

    T.E. Schläpfer

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  1. T.E. Schläpfer
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  2. S. Kayser
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Correspondence to T.E. Schläpfer.

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Schläpfer, T., Kayser, S. Hirnstimulationsverfahren. Nervenarzt 83, 95–105 (2012). https://doi.org/10.1007/s00115-011-3428-y

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