Prof. Marc Ziegenbein on Transcranial Pulse Stimulation at Klinikum Wahrendorff
“I consider TPS to be a Significant Procedure with Great Potential for the Future.”
At Klinikum Wahrendorff, Europe’s largest privately-run psychiatric hospital, the medical director and head physician of the hospital, Prof. Marc Ziegenbein, MD, and his team have been working intensively with transcranial pulse stimulation (TPS) for two years and are conducting observational studies on TPS in Alzheimer’s dementia.
In an interview conducted at the beginning of 2022, Prof. Ziegenbein spoke about his decision to bring TPS to Wahrendorff as a still new procedure, the initial results in the treatment of patient:ing with Alzheimer’s dementia and his assessment of the relevance of TPS as a brain stimulation method in the near future.
Alzheimer Science (AS): Professor Ziegenbein, you are a psychiatrist, medical director and head physician of the Wahrendorff Clinic, one of the leading psychiatric hospitals in Europe. How did you come to transcranial pulse stimulation and why did you decide on this therapy, which is still quite unknown among your own colleagues?
Prof. Marc Ziegenbein (M.Z.): That certainly has to do with our special hospital philosophy: As an institution, we are always busy keeping a close eye on what’s new in research and science in the field of psychiatry and psychotherapy, and we always want to have our finger on the pulse for our patients. We are known for being very innovative here and do not hesitate for long when it comes to new treatment options and opportunities for patients. When we learned about the first studies on TPS, we took a close look at the topic of shock waves in neurodegenerative diseases.
Of course, it was not easy for us to form a judgement! We compared TPS with the current standard procedures, based on the current theories and clinical studies on the development of Alzheimer’s dementia and first evaluated them in detail internally. This evaluation then turned out to be so good that we said, a procedure with great potential, we would like to gather practical experience. In addition to a possible therapeutic benefit, safety for the patients was also important to us, and this also stood up to our scrutiny.
AS: You have been using TPS in your clinic for about a year now. How many dementia patients have you treated so far?
M.Z.: To date, we have treated about 35 patients with the six-part initial series and subsequently with refresher units. This is a heterogeneous group of about the same number of women as men. Our patients are all Alzheimer’s dementia patients, but most of them, of course, are actually mixed forms of dementia. This is because Alzheimer’s dementia is rarely a singular disease, but is often accompanied, for example, by vascular dementia or another form of dementia; the overlap rate here is about 80%.
AS: And what is your first verdict on the TPS after one year so far?
M.Z.: First of all, it should be emphasised that we have been able to stop the disease from progressing in the patients we have documented so far. This is remarkable, because being able to stop the disease alone is already a great effect that should not be underestimated. Because the fact is: All the drugs that have been available so far can at most contribute to delaying the course of the disease, but they cannot stop it. This is where the TPS clearly comes out on top. In addition, we have also noticed good results that can be brought about by TPS: People really find themselves again, they are more active, happier, more open after the therapy. Some relatives tell us “I find the person I used to know again”. This is a very important aspect, because many patients withdraw and change into a real stranger. In general, everyday life becomes easier for these people, they get more involved in life again. That is also very relieving for the relatives.
AS: That makes us happy to hear. How do you check the course of therapy?
M.Z.: We document all cases from the beginning and use various psychiatric – and neurological test parameters and scales that are scientifically recognised in our field. In time, all this will be incorporated into our own long-term observational study in our house.
AS: Large placebo-controlled studies on Alzheimer’s dementia and Parkinson’s disease are currently being conducted on TPS and will be completed and published this year. In addition, research is being done on other possible applications of TPS. What opportunities do you see for using TPS elsewhere in the future?
M.Z.: As a psychiatrist, I naturally see the potential possibilities with depression. Science currently assumes that the brain areas amygdala and hippocampus, which are located deep inside the brain, are responsible for depression. These are the areas that can currently only be reached with TPS. It is different with rTMS (editor’s note: repetitive transcranial magnetic simulation), which can only penetrate the brain superficially and cannot effectively reach these segments. Of course, it is still a bit too early to apply it to depression that is not linked to dementia. Further clinical studies need to be done here first. But I can well imagine in principle that TPS could also be a very good treatment option here in the medium term.
AS: What possibilities do you see for using TPS even better or more effectively in dementia diseases?
M.Z.: We are currently discussing in our clinic whether TPS could not be used earlier in the case of incipient dementia or even when those affected and their environment only just notice that something is wrong, i.e. before a dementia disease visibly breaks out. Our results indicate that TPS can be used not only to treat patients who are already clearly impaired, but also for patients who are only at the beginning of a dementia illness.
AS: So you are an absolute advocate of TPS. What can you and your institution do to ensure that this therapy, which is still quite new, can be evaluated and supported by better data in addition to the studies?
M.Z.: I see great opportunities for TPS if the current clinical studies continue to confirm what has been researched so far. In addition, we want to start working in an international exchange with other psychiatrists and also neurologists in order to compare the different therapy options offered today and to document and evaluate our experience data with the TPS in a common pool. By the way, this is not an exclusion criterion for other medical fields, but only in psychiatry and neurology can we have certain discussions and comparisons on an in-depth professional level. Certain diagnostic and measurement procedures are very rarely used outside our field, so it is important to use the expertise of psychiatrists and neurologists to constantly increase the pool of valid data.
AS: To be very specific about Klinikum Wahrendorff: What can TPS patients expect at your clinic and what are the prerequisites for being treated at your clinic?
M.Z.: First of all, all relatives and people affected by dementia can inquire with us without obligation. In a personal conversation, on the basis of the respective preliminary findings and our own tests, we then determine whether the TPS makes sense in the individual case. Another aspect is also very important: we are psychiatrists, we are doctors for the soul. Every patient deserves a holistic approach. We take time for the patients, for the worries and needs of the relatives, we do not only look at dementia from the organic side. That is why we prefer to treat fewer patients, so that we can be there for those who are with us. Half an hour of therapy routine is not enough for us. This also has a positive effect on the course of therapy.
AS: What would you say about transcranial pulse stimulation if you had to summarise it in one sentence?
M.Z.: In any case, I consider TPS to be a thoroughly significant procedure with great potential for the future.
AS: Professor Ziegenbein, thank you for this interview.
About the Wahrendorff Clinic.
Klinikum Wahrendorff is one of Europe’s leading hospitals in the field of psychiatry and psychosomatics. In its now 160-year history, Wahrendorff has expanded steadily. To date, the clinic offers 345 hospital beds and around 350 day-care places. More than 1,000 residents are cared for in the home sector, distributed in more than 60 buildings of the clinic over numerous places such as Köthenwald and Sehnde to Hanover and Celle. Whether it is a men’s day clinic, mental health in old age or trauma treatment – the range of facilities is comprehensive: more than 1,400 doctors, psychologists, nurses, geriatric nurses and numerous other professional groups work in all areas of psychiatry and neurology at Wahrendorff.
On 19 April 2023, the hospital will open another chapter: The new clinic building “Centralisation Acute Clinic Wahrendorff Klinikum” was opened after five years of construction. The new specialist hospital for the soul at the Sehnde-Köthenwald site, which was built on an area of around 15,000 square metres, will again offer up to 350 full inpatient beds and 30 day-clinic places.
In this largest new psychiatric building in northern Germany, which offers a free and light-flooded architecture for the patients, transcranial pulse stimulation (TPS) also finds an adequate place in its own department. With spacious waiting and lounge areas for the patients and their relatives or accompanying persons, the TPS therapy is now carried out in a particularly pleasant ambience under the direction of Daniel Clark, MD, specialist in psychiatry and psychotherapy and specialist in neurology.
About Prof. Dr. med. Marc Ziegenbein
Prof. Dr. med. Marc Ziegenbein is a specialist in psychiatry and psychotherapy and has been Medical Director and Chief Physician of the Wahrendorff Clinic since 2016. He has broad clinical expertise covering the entire spectrum of treatment of mental illnesses. In addition to the care of chronically mentally ill patients, his clinical-scientific focal points include scientific work in the field of psychopharmacology, affective disorders and mental health in old age. In addition, there is research on transcranial pulse stimulation (TPS) in Alzheimer’s dementia.
Prof. Ziegenbein’s portfolio includes over 80 international publications. For their scientific work, Ziegenbein and members of his research groups have received various prizes and scholarships/funding from the Max Planck Society and the Robert Enke Foundation, among others.
Prof. Ziegenbein is a member of numerous national and international professional societies such as the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN), the Working Group for Neuropsychopharmacology and Pharmacopsychiatry (AGNP) as well as a member of numerous committees such as the State Advisory Council for Psychiatry, Hardship Commission of the State of Lower Saxony. He is also chairman of the psychiatry committee of the state of Lower Saxony.
Publications to date on transcranial pulse stimulation:
Rößner-Ruff, V., Ziegenbein, M., Stürmann, H., Penkov, C.A., Friedrich, K., Krieger, J., Hauser, C., & Clark, D. (2022). TPS with the Neurolith system as a method for treating the central nervous system of patients with Alzheimer’s disease. E-poster at the Congress of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology, Berlin 2022.
Klinikum Wahrendorff GmbH – Juliane Wahrendorff Clinic
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