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Nichtinvasive Hirnstimulation zur Behandlung von Epilepsien

Stand der Forschung und Perspektiven

Non-invasive brain stimulation for the treatment of epilepsy

Status quo of research and perspectives

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Zusammenfassung

Pathophysiologische Grundlage epileptischer Anfälle ist eine erhöhte neuronale Erregbarkeit, die über einen paroxysmalen Depolarisationsshift zu synchroner, hochfrequenter Aktivität neuronaler Netze führt. Die Reduktion dieser pathologisch erhöhten neuronalen Erregbarkeit ist das Ziel antiepileptischer Therapien. Neben pharmakologischen Interventionen stellen Hirnstimulationsverfahren einen alternativen Therapieansatz dar. Insbesondere nichtinvasive Methoden der Hirnstimulation wie die transkranielle Magnetstimulation (TMS) und die transkranielle Gleichstromstimulation („transcranial direct current stimulation”, tDCS) bieten sich als potenziell nebenwirkungsarme und unproblematisch durchführbare Optionen an. In Tiermodellen wurde gezeigt, dass eine Verminderung kortikaler Erregbarkeit durch diese Methoden grundsätzlich geeignet ist, Anfälle zu reduzieren. Die bislang durchgeführten klinischen Studien zeigen allerdings uneinheitliche Ergebnisse. Gründe hierfür sowie Optimierungsstrategien, die zu effizienteren zukünftigen Stimulationsprotokollen führen könnten, werden im Folgenden diskutiert.

Abstract

In epileptic seizures, enhanced neuronal excitation leads to neural networks firing synchronously at high frequency, initiated by a paroxysmal depolarization shift. Reducing neuronal excitability is a common target of anti-epileptic therapies. Beyond or in addition to pharmacological interventions, excitability-reducing brain stimulation is pursued as an alternative therapeutic approach. Hereby, non-invasive brain stimulation tools such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have gained increased interest as efficient tools to modulate cortical excitability and activity. In animal models, stimulation-induced cortical excitability diminution has been shown to reduce seizures. Clinical studies, however, conducted so far have shown mixed results. Reasons for this as well as possible optimization strategies, which might lead to more efficient future stimulation protocols, are discussed.

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  1. Abteilung Klinische Neurophysiologie, Georg-August-Universität, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland

    A.K. Herzer, W. Paulus & M.A. Nitsche

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  1. A.K. Herzer
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  2. W. Paulus
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  3. M.A. Nitsche
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Correspondence to M.A. Nitsche.

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Herzer, A., Paulus, W. & Nitsche, M. Nichtinvasive Hirnstimulation zur Behandlung von Epilepsien. Z. Epileptol. 22, 58–64 (2009). https://doi.org/10.1007/s10309-009-0028-y

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  • DOI: https://doi.org/10.1007/s10309-009-0028-y

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