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Tiefe Hirnstimulation bei Sucht, Anorexie und Zwang

Rationale, klinische Ergebnisse und ethische Implikationen

Deep brain stimulation for addiction, anorexia and compulsion

Rationale, clinical results and ethical implications

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Zusammenfassung

Hintergrund

Das bei Bewegungsstörungen etablierte Verfahren der tiefen Hirnstimulation (THS) wird seit fast 15 Jahren auch hinsichtlich seines Nutzens zur Behandlung psychiatrischer Indikationen untersucht. Unlängst erfolgte die CE-Zertifizierung bzw. Zulassung der THS im Rahmen der therapieresistenten Zwangsstörung.

Ziel der Arbeit

Ziel dieser Arbeit ist es, die aktuelle Datenlage zur Anwendung der THS bei der therapieresistenten Zwangsstörung zu referieren. Zusätzlich sollen erste experimentelle Arbeiten zum potenziellen Nutzen der THS bei stoffgebundener Abhängigkeit und Anorexia nervosa dargelegt werden, da beide Entitäten Überlappungen zur Zwangsstörung aufweisen.

Material und Methoden

Die Übersicht stützt sich auf eine selektive stichwortgebundene Literaturrecherche in PubMed unter Berücksichtigung einschlägiger Referenzen und eigener Arbeiten.

Ergebnisse

Zur Behandlung therapieresistenter Zwangsstörungen liegen Ergebnisse aus Studien vor, die zwar nur kleine Fallzahlen umfassten, jedoch teilweise methodisch gute Untersuchungsabläufe beinhalteten. Dabei sind deutliche Besserungsquoten (sog. „full-response“) hinsichtlich des primären Zielsymptoms dokumentiert, wenngleich sich nicht bei allen Patienten durch die THS eine Besserung der Beschwerden ergab. Zur THS bei stoffgebundener Abhängigkeit und Anorexia nervosa liegen bisher nur ganz rudimentäre klinische Daten vor, die allenfalls auf einen potenziellen Nutzen hindeuten.

Diskussion

Die vorliegenden Daten zum klinischen Nutzen der THS bei Zwangsstörungen sind ermutigend und eröffnen neue Perspektiven bei der Behandlung therapieresistenter Patienten. Dabei muss aber stets bedacht werden, dass viele Aspekte wie Wirkmechanismus, Prädiktoren und Langzeitnebenwirkungsprofil noch unvollständig oder gar nicht bekannt sind. Bei der THS bei stoffgebundener Abhängigkeit und Anorexia nervosa handelt es sich bisher um einen experimentellen Ansatz, der noch nicht bewertet werden kann. Klinische Studien sollten für alle drei Indikationen noch stets den Goldstandard für die THS darstellen.

Summary

Background

As an established treatment for movement disorders, the application of deep brain stimulation (DBS) for psychiatric indications has been investigated for almost 15 years. A CE label (also FDA approval) has recently been obtained for treatment of refractory obsessive-compulsive disorder (OCD).

Objectives

This article aims at illustrating the current state of DBS in the treatment of refractory OCD. In addition, initial experimental approaches to investigate the potential use of DBS in substance addiction and anorexia nervosa (AN) will also be outlined as both disorders share some common features with OCD.

Materials and methods

The present review is based on a keyword literature search (PubMed) while taking into account relevant references and own investigations

Results

Although the number of clinical trials for treatment of refractory OCD is limited and sample sizes are small, there is some evidence for a substantial improvement, a so-called full response of OCD symptoms under DBS. However, not all patients benefit from the intervention. Regarding substance addiction and AN, data are scarce and are only indicative of a potential benefit at most.

Discussion

Present data regarding the clinical benefits of DBS in OCD are encouraging and open up new avenues for the treatment of therapy refractory patients. However, several aspects, such as mechanisms of action, predictors and long-term side effect profiles, are incomplete or even unknown. In the case of addiction and AN, DBS remains purely experimental, at least for the moment. Hence, clinical trials should remain the gold standard for all three indications.

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Danksagung

Wir danken der DFG (KFO-219, KU2665/1-2) und der Else Kröner-Fresenius-Stiftung, die Teile dieser Arbeit ermöglicht haben.

Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Kuhn ist Studienleiter in Investigator‐initiated Trials, die von Medtronic unterstützt werden. C. Bartsch: keine Angaben Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    C. Bartsch &  J. Kuhn

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  1. C. Bartsch
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  2. J. Kuhn
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Correspondence to J. Kuhn.

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Bartsch, C., Kuhn, J. Tiefe Hirnstimulation bei Sucht, Anorexie und Zwang. Nervenarzt 85, 162–168 (2014). https://doi.org/10.1007/s00115-013-3879-4

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