Who uses Brain Stimulation?
Renowned research institutions, clinics and practices work with brain stimulation procedures (NIBS)
In recent decades, brain stimulation as such has developed from an experimental technique to a key element in neurological and psychiatric therapy. These partly invasive, but increasingly also non-invasive brain stimulation procedures, known as NIBS, have caused a stir in the medical community as they open new doors for the treatment of diseases such as Alzheimer’s, dementia or Parkinson’s, but also depression, chronic pain and stroke sequelae. However, despite their increasing use in clinics and at renowned universities worldwide, knowledge about these revolutionary methods remains limited among the general public. In view of this lack of information, leading professional societies are calling for greater awareness of the potential and areas of application of brain stimulation. In the following, we shed light on why and to what extent the various brain stimulation methods have already established themselves as accessible treatment options for patients and why a broader knowledge of these forms of treatment is so crucial for the future of medicine.
Brain stimulation in the guidelines: Deep brain stimulation (DBS) makes a start
Deep brain stimulation (DBS) marks a first milestone in the history of brain stimulation technologies. This neurosurgical procedure, which has been used for over 25 years, has established itself as a safe and effective treatment method for motor symptoms in Parkinson’s disease. After many years of research and around 11 years of long-term observation, DBS has now been included in medical guidelines1, a testament to its importance and effectiveness in neurological therapy. However, DBS is not without its challenges: It is a neurosurgical procedure that requires inpatient hospitalization and is associated with certain risks and side effects. Nevertheless, DBS is an example of progress in brain stimulation – the first procedure in the field of brain stimulation to be widely recognized and used.
Non-invasive brain stimulation techniques (NIBS) on their way to patients
Various non-invasive brain stimulation techniques (NIBS) such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have also made considerable progress in the treatment of mental and neurological disorders. TMS uses magnetic pulses to treat various disorders using both excitatory and inhibitory protocols. Newer approaches focus on shortening treatment duration without compromising efficacy. TDCS transmits low-amplitude electrical currents between electrodes placed on the scalp and affects neuronal excitability by promoting or inhibiting synaptic transmission. The effectiveness of tDCS depends on various parameters, such as the duration of the stimulation and the positioning of the electrodes. More and more studies show that NIBS techniques can be effective in the treatment of depression, anxiety disorders, obsessive-compulsive disorder, PTSD and schizophrenia, although results vary in terms of efficacy and heterogeneity. These advances highlight the potential of these therapies as promising treatment approaches with greater specificity, fewer side effects and less burden than traditional therapies.
Transcranial Pulse Stimulation (TPS): Particularly effective with a wide range of indications
Among the non-invasive brain stimulation procedures (NIBS), Transcranial Pulse Stimulation (TPS) stands out due to its particular tolerability and effectiveness. TPS, a particularly advanced NIBS procedure, has been shown to be effective in a wide range of neurological and psychiatric disorders, including dementia – particularly Alzheimer’s disease – Parkinson’s disease, depression, fatigue, ADHD and autism. In contrast to other NIBS methods such as TMS and tDCS, which have a less deep and less precise penetration depth and can be associated with more intensive treatment regimes, TPS is characterized by a particularly patient-friendly application. With only a few outpatient therapy sessions, TPS offers an efficient treatment option that is characterized by low side effects and high patient acceptance. This makes TPS a promising and accessible approach in modern neurological and psychiatric treatment.
Research makes NIBS methods increasingly available to patients
Brain stimulation methods are used worldwide, especially by leading universities and clinics. Through extensive research and development, they contribute significantly to progress in the application of brain stimulation methods. In the USA, for example, Stanford Medicine2, the Cleveland Clinic3, the Emory University School of Medicine4 and Johns Hopkins University5 are among the leading institutions. In Europe, these include Trinity College Dublin6, the University of Kent7, the Dutch Donders Institute, Radboud University Nijmegen8, Imperial College London9, the University of Nottingham10, the University of Oxford11 and ETH Zurich12, which – among many other institutions – are significantly involved in the research and use of NIBS.
NIBS are finding their way into therapy services in clinics and private practices
More and more clinics and practices are integrating non-invasive brain stimulation techniques (NIBS) into their everyday practice in order to expand the range of treatment options. This development is a sign of the growing consensus on the effectiveness and patient-friendliness of these procedures. NIBS also offer practicing neurologists and psychiatrists innovative approaches to treating a variety of neurological and psychiatric conditions, making them a valuable addition to modern medical practice. Their increasing prevalence in clinical use underscores the potential these technologies offer for more effective and targeted patient care. NIBS methods are particularly practical for everyday medical use, with TPS standing out for its patient-friendliness and effectiveness. To date, for example, over 10,000 patients have already been treated on an outpatient basis using TPS.
Creating greater public awareness of NIBS: Social information still clearly too low
The general public, and thus above all those affected by neurodegenerative and neurophysiological diseases and their relatives, have so far only been informed to a limited extent about non-invasive brain stimulation (NIBS) procedures such as TMS, tDCS and TPS, as media coverage of non-invasive brain stimulation (NIBS) procedures does not seem to keep pace with scientific interest and clinical applications. Although NIBS is increasingly used in the treatment of neurological and neuropsychiatric disorders, there is a lack of consistent and comprehensive coverage in the mainstream media. This may be due in part to the methodological diversity of NIBS studies, which makes uniform reporting difficult. There is therefore a great need for improved public education and information about these innovative treatment methods, as the “Center for Responsible Research and Innovation (CeRRi)” of the Fraunhofer Institute for Industrial Engineering (IAO), in collaboration with the University of Göttingen and international partners, has elaborated in its guidelines for the development and introduction of “Non-Invasive Brain Stimulation (NIBS)”. In this white paper from July 2023 entitled “STIMCODE – Participative developed recommendations for non-invasive brain stimulation in the European Union”, the authors call, among other things, for societies to be informed more extensively about the possibilities of NIBS (see: Non-Invasive Brain Stimulation procedures: Increasingly Essential for Healthcare).
NIBS – a new era with treatments that can significantly improve the quality of life of those affected
Non-invasive brain stimulation techniques (NIBS) open up new horizons in medicine and mark the beginning of a new era in the treatment of neurological and psychiatric disorders. With technologies such as TMS, tDCS and TPS, they offer innovative and patient-friendly treatment options that significantly expand the range of therapeutic possibilities. In particular, their application in therapy-resistant cases shows promising results. Despite current challenges, such as the need for greater standardization and broader public awareness, NIBS represent a significant advance in personalized medicine. They represent not only a complement to existing therapies, but also a step towards more precise and effective treatment that can sustainably improve the lives of patients with complex neurological and mental illnesses. In the future, NIBS could help to redefine the limits of what is medically possible and significantly improve the quality of life of those affected.
Sources and references:
1 https://deutsch.medscape.com/artikelansicht/4913104
2 https://med.stanford.edu/news/all-news/2024/01/brain-stimulation-hypnosis.html
3 https://my.clevelandclinic.org/podcasts/neuro-pathways/non-invasive-brain-stimulation-whats-possible-whats-on-the-horizon
4 https://med.emory.edu/departments/neurosurgery/research/entice/neuromodulation.html
5 https://www.hopkinsmedicine.org/physical-medicine-rehabilitation/specialty-areas/neuro-rehab/brain-stimulation/treatment
6 https://www.tcd.ie/Neuroscience/research/platform.php
7 https://blogs.kent.ac.uk/development/2023/11/22/non-invasive-brain-stimulation-nibs-for-parkinsons-disease
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9 https://www.imperial.ac.uk/news/248635/surgery-free-brain-stimulation-could-provide-treatment
10 https://www.institutemh.org.uk/research/centre-for-mood-disorders/about-centre-for-mood-disorders/1518-new-network-to-develop-non-invasive-brain-stimulation-therapies
11 https://www.ndcn.ox.ac.uk/research/physiological-neuroimaging-group/techniques/non-invasive-brain-stimulation-nibs
12 https://www.research-collection.ethz.ch/handle/20.500.11850/556483