Zusammenfassung
Der therapeutische Einsatz von Hirnstimulation blieb bisher, bedingt durch eine hohe Variabilität der Wirksamkeit, auf wenige Indikationen und kleine Patientengruppen limitiert. Eine Individualisierung der Stimulationsparameter innerhalb eines Closed-loop-Systems, welches die Stimulation mit einer Auflösung von wenigen Millisekunden mit der Hirnaktivität synchronisiert, hat das Potenzial, die therapeutische Effektivität gegenüber traditionellen Open-loop-Ansätzen relevant zu erhöhen. In diesem Beitrag werden theoretische und experimentelle Ergebnisse vorgestellt, die für einen Closed-loop-Ansatz sprechen, und es werden grundlegende Aspekte bei der Entwicklung einer Closed-loop-Methode diskutiert sowie klinische Arbeiten, welche eine Effektivitätssteigerung quantifizieren konnten, kurz zusammengefasst. Eine deutliche Ausweitung der Indikationen einer therapeutischen Hirnstimulation in der klinischen Praxis ist mit der zukünftigen weiteren Entwicklung von Closed-loop-Methoden zu erwarten.
Summary
The therapeutic application of brain stimulation is still limited to relatively few indications and small groups of patients due to variable efficacy. Individualization of stimulation parameters by employing a closed-loop system, i.e. synchronization of stimulation with endogenous brain activity with millisecond precision, has the potential to significantly improve the therapeutic efficacy when compared to open-loop systems. In this article the theoretical and experimental results are reviewed including first clinical trials that support the superiority of closed-loop brain stimulation, fundamental aspects in the development of closed loop methods are discussed and clinical studies which could quantify an increase in effectiveness are summarized. A significant increase in the indications for therapeutic applications of closed-loop systems is to be expected in the near future.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. C. Zrenner gibt an, dass kein Interessenkonflikt besteht. U. Ziemann hat Honoraria für Beraterleistungen von Bayer Vital GmbH, Biogen Idec, CorTec GmbH, Medtronic GmbH und Servier erhalten.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Zrenner, C., Ziemann, U. Therapeutischer Einsatz von Closed-loop-Hirnstimulation. Nervenarzt 86, 1523–1527 (2015). https://doi.org/10.1007/s00115-015-4318-5
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DOI: https://doi.org/10.1007/s00115-015-4318-5