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Übersichtsarbeiten / Review articles

Transkranielle Magnetstimulation in der Kinder- und Jugendpsychiatrie: Exzitabilität des motorischen Systems bei Tic-Störungen und/oder Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörungen

Published Online:September 01, 2006https://doi.org/10.1024//1422-4917.29.4.312

Abstract

Zusammenfassung: Mit der transkraniellen Magnetstimulation (TMS) kann die Exzitabilität des motorischen Systems direkt in vivo untersucht werden. Diese Methode wurde deshalb bei Kindern mit solchen Störungsbildern angewandt, bei denen sich eine unzureichende Steuerung, Kontrolle und/oder Regulation motorischer Abläufe feststellen lässt: Eine “musterbezogene” Überaktivität bei Tic-Störungen, eine “allgemeine” motorische Überaktivität bei Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (ADHS). Im Vergleich zu gesunden Kindern waren bei Kindern mit diesen hypermotorischen Störungsbildern unterschiedliche Auffälligkeiten festzustellen: (1) Eine verkürzte Kortikale Silent Period und damit ein Hinweis auf defizitäre inhibitorische Prozesse wahrscheinlich auf Ebene der Basalganglien bei Kindern mit Tic-Störungen (offenbar kein Einfluss klinisch wirksamer Medikamente), (2) eine verminderte intrakortikale Inhibition und damit ein Hinweis auf defizitäre inhibitorische Prozesse eher im Bereich des Motorkortex bei Kindern mit ADHS (Zunahme der intrakortikalen Inhibition unter Methylphenidatgabe). (3) Bei Kindern mit komorbider ADHS und Tic-Störung waren beide neurophysiologischen Veränderungen i.S. eines “additiven” Inhibitionsdefizites im motorischen System aufzeigbar. Mit diesen TMS-Untersuchungen konnten bei Kindern mit den hypermotorischen Störungsbildern Tic-Störungen und ADHS neue Befunde zur Darstellung neurobiologischer Grundlagen (“Inhibitionsdefizite im motorischen System”), zur Frage der Komorbidität (“additiver Effekt im motorischen System”) sowie zum Wirkmechanismus entsprechender Psychopharmaka (“Verbesserung des Inhibitionsvermögens im motorischen System bei ADHS unter Methylphenidat”) erarbeitet werden.


Summary:Transcranial magnetic stimulation in child and adolescent psychiatry: Excitability of the motor system in tic disorders and/or attention deficit hyperactivity disorders

Motor system excitability can be investigated in vivo by means of single and paired pulse transcranial magnetic stimulation (TMS). Whereas the cortical silent period reflects the general degree of inhibitory mechanisms mainly within the sensorimotor loop, intracortical excitability measures the focused degree of inhibitory and facilitatory mechanisms within the motor cortex. In child and adolescent psychiatric disorders with uncontrollable motor behavior such as tics in tic disorder or motoric hyperactivity in attention deficit hyperactivity disorder (ADHD), different dysfunctional patterns of motor system excitability could be demonstrated compared to age-matched healthy controls: (1) In tic disorder, a shortened cortical silent period was observed, providing evidence of deficient inhibitory mechanisms within the sensorimotor loop, probably primarily at the level of the basal ganglia. (2) In ADHD, a decreased intracortical inhibition was found, probably reflecting deficient inhibitory mechanisms within the motor cortex (but enhancement of intracortical inhibition after oral intake of 10 mg methylphenidate). In order to investigate neurophysiological aspects of comorbidity, (3) motor system excitability was also measured in children with combined ADHD and tic disorder. The findings of a reduced intracortical inhibition as well as a shortened cortical silent period in these comorbid children provide evidence of additive effects at the level of motor system excitability. These decreased inhibitory mechanisms within the entire sensorimotor loop and especially the motor cortex could be essential neurobiological substrates of the deficient inhibitory motor control and regulation, respectively, in tic disorder and ADHD.

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