Elektrostimulation des visuellen Systems Von therapeutischer Empirie zur Entwicklung von Sehprothesen

ZusammenfassungDie Erprobung elektrischer Stimulation am visuellen System lässt sich im Wesentlichen drei aufeinander folgenden Entwicklungsabschnitten zuordnen: einer empirischen, einer diagnostischen und einer therapeutisch ausgerichteten Phase. Hierbei wurden die ersten elektrischen Stimulationen des visuellen Systems im 18. Jahrhundert aus wissenschaftlichem Interesse an Tieren durchgeführt. Trotz fehlender klinisch-pathologischer Kenntnisse erfolgten damals auch vereinzelt Stimulationsversuche wagemutig in therapeutischer Absicht an blinden Patienten. Mit zunehmenden neurologischen und technologischen Kenntnissen wurden hundert Jahre später Versuche einer gezielten Anwendung elektrischer Ströme am visuellen System des Menschen im Rahmen neuer elektrophysiologisch-diagnostischer Untersuchungsmethoden unternommen. Ab der späten Mitte des 20. Jahrhunderts setzten systematische Bemühungen ein, blinden Patienten, unter Zuhilfenahme elektrotechnisch arbeitender Implantate, eine visuell verwertbare Bildinformation zu vermitteln. Inzwischen haben sich weltweit neun Forschungsgruppen mit z. T. unterschiedlichen Arbeitsmodellen zur Erarbeitung epi-, subretinal, kortikal oder sehnervgebundener Prothesen etabliert. Die historische Entwicklung der elektrophysiologischen Stimulation des visuellen Systems und aktuelle Fortschritte bei der Konzeption von Sehprothesen sollen dargestellt werden.AbstractThe investigation of the influence of electrical stimulation on the visual system can be subdivided into empirical, diagnostic and therapeutic phases of development. The first electrical stimulations of the visual system in animals dating back to the eighteenth century represent empirical approaches well before knowledge on the principles of bioelectrical nerve activity was available. Despite this lack of understanding, attempts were made at that time to treat blind people by electrical stimulation. More than 100 years later, with the advancement of technology and knowledge on nerve function, attempts were made to establish various methods of electrical stimulation for the diagnosis of different diseases of the visual system. For more than 30 years attempts to develop electrical devices have been made to by-pass defects of the visual system and to restore basic orientation. Presently nine different groups world-wide are focusing on retinal, optic or cortical implants. A short review on the historical use of electrical stimulation and new therapeutical attempts are given in this paper.

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