Long-Covid: The long-term effects of COVID-19 and treatment with TPS

Transcranial Pulse Stimulation (TPS): An option for Long Covid patients with neuro-symptoms

Long Covid is a new clinical picture that has emerged as a result of the coronavirus pandemic and for whose treatment there are still no medical guidelines. It is estimated that around 10 to 30 percent of people worldwide who have had a COVID-19 infection develop symptoms of Long Covid. Long Covid, also known as Post-Acute Sequelae SARS-CoV-2 Infection (PASC), encompasses a variety of symptoms and health problems that can persist or reappear after the acute phase of a COVID-19 infection and can last for weeks to months. The most common symptoms include fatigue, breathing problems, cognitive impairment (“brain fog”), and cardiovascular problems.

The heterogeneity of the symptoms and the very different individual courses of the disease make it difficult to draw up standardized treatment guidelines. Research is in full swing to better understand the pathomechanisms and develop effective treatment strategies. In the meantime, interdisciplinary approaches and symptom-oriented therapies are the core of treatment practice, with individually tailored rehabilitation programs and supportive therapies being used.

The non-invasive brain stimulation procedure transcranial pulse stimulation (TPS) has also been investigated for around two years as part of individual treatment trials and clinical research, and those involved attest to a success rate of around 80 percent for TPS shockwave therapy. We spoke to Dr. Markus Böbel, who has made a name for himself as a Long Covid expert in the greater Reutlingen area in Baden-Württemberg, about this.

Alzheimer Science (AS): “Dr. Böbel, you are particularly well-known in Baden-Württemberg as a Long Covid expert and have been interviewed several times by ZDF and other media. How did that come about?”

Dr. Markus Böbel (MB): “That’s explained briefly. As a specialist in general medicine, I run a large GP practice. When the coronavirus pandemic began in March 2020, the Reutlingen District Health Office sent me the first patient suffering from COVID-19 with the urgent request that I take care of him. From that day on, coronavirus was part of my everyday practice. Until the end of 2023, we were a coronavirus-focused practice, carried out thousands of vaccinations and swabs and looked for sensible treatment approaches. The large number of coronavirus patients turned into numerous long Covid patients.”

AS: “Like your colleagues, you were now faced with a completely new disease. How did you proceed?”

MB: “Well, like many of my colleagues, I familiarized myself intensively with the topic, gained experience, studied all the literature that came out successively and, of course, looked for ways to help my patients myself.”

“There is no such thing as Long Covid disease! Long Covid is a generic term for a variety of symptoms that need to be considered individually.”
Markus Böbel, M.D.

Markus Böbel, M.D.

AS: “How do you define Long-Covid?”

MB: “First of all: There is no such thing as Long Covid disease! Long Covid is a generic term for a variety of symptoms that need to be considered individually. According to the WHO, there are over 200 symptoms that can indicate Long Covid. One person may have brain fog, another cognitive impairment, breathing problems or post-exertional malaise, i.e. a worsening of symptoms after minor physical and/or mental exertion. There are also combinations of these symptoms. It doesn’t matter whether the patient was previously in intensive care or only had a mild case of Covid-19. You can’t just lump them all together. There are also numerous hypotheses regarding the causes, but these must currently only be regarded as pieces of the puzzle. There is therefore no conclusive causal definition yet.”

AS: “Does it matter which Covid variant a patient was infected with?”

MB: “At the moment, it looks like the Omikron variant, which usually had a mild course, is leading to an increased incidence of Long Covid. But all of this is difficult to record because we don’t yet have any biomarkers that could be used in everyday practice. We are still looking for them.”

AS: “In the course of your own search to help your patients, you came across transcranial pulse stimulation. How did that come about?”

MB: “I had heard and read about transcranial pulse stimulation (TPS). As many of my Long Covid patients suffered from neurological symptoms such as brain fog, concentration problems, fatigue, depression and anxiety, which we now refer to as neuro-Covid, I came to the conclusion that TPS could help my patients. At the beginning of 2022, I therefore brought a NEUROLITH, the device for performing TPS, into my practice. Thank goodness, as I can say today.”

AS: “Since then, have you been treating your Long Covid patients with neurological symptoms using TPS? You are currently treating around 120 chronic Long Covid patients.”

MB: “Yes, if these symptoms are leading, then I use TPS and it works really well. After more than two years of use, this therapy is simply my number one choice.”

“In my practice, we have a success rate of around 80 percent with TPS.”
Markus Böbel, M.D.

Markus Böbel, M.D.

AS: “What results do you achieve with transcranial pulse stimulation in your patients and can you evaluate this statistically?”

MB: “In my practice, we have a success rate of around 80 percent, as do our colleagues who work with TPS. I understand successful treatment to mean achieving a lasting, significant reduction in symptoms or even freedom from symptoms.”

AS: “What about the other 20 percent of these patients?”

MB: “Some patients didn’t want treatment with TPS because brain stimulation procedures were still too scary for them or because they were afraid of TPS – unfortunately, there are still distorted and negative opinions on the internet, which are also outdated. Others had to stop the treatment for logistical reasons, as TPS is not yet widespread and the distances to my practice were too long. Finally, there is the financial aspect: unfortunately, this therapy is not yet covered by statutory health insurance and not all patients have private insurance.”

AS: “How many treatment sessions with TPS are necessary to make your patients symptom-free?”

MB: “We do a three- to six-session initial treatment, depending on how quickly the patient improves, and then we wait and see. After four to six weeks, we contact the patient again and then decide whether a booster treatment is indicated or whether the patient is still doing so well that no further treatment is required.”

AS: “Would you say that TPS cures patients?”

MB: “Cure is a big word, but yes, I would actually go so far as to define it that way in my experience with many patients.”

AS: “Can you please explain that in more detail?”

MB: “We had a case of a 48-year-old female patient with severe symptoms. When she came to us, she could barely walk eight meters on her own. She suffered from constant headaches, brain fog and memory problems. Even during the first TPS treatment, the headaches subsided significantly. Interestingly, the pain disappeared first in the right temporal lobe after the first treatment and then in the left temporal lobe after the next treatment. Initially, the pain remained gone for three days, later on it became permanent. For logistical reasons, we were only able to treat the patient once a week. In the end, however, she remained completely symptom-free.”

“It is the mechanism of action of the TPS shock waves, called mechanotransduction, that triggers various processes. And the lymph flow also seems to be stimulated.”
Markus Böbel, M.D.

Markus Böbel, M.D.

AS: “What do you think makes TPS so good at helping these Long Covid patients?”

MB: “First of all, it’s the mechanism of action of the TPS shock waves, called mechanotransduction. Mechanotransduction is a process in which cells convert mechanical stimuli from their environment into biochemical signals. This enables the cells themselves to react to physical changes and to regulate corresponding functions such as growth, differentiation and, above all, repair. In addition, in some cases we also experience swelling of the lymph nodes, especially in the neck. Here we find that the outflow of lymph is stimulated by TPS, as has already been established in science. And possibly the anti-inflammatory effects in the brain that mechanotransduction can trigger there can also have a positive effect on the rest of the body. But that’s just a postulation at the moment, of course.”

AS: “Do you treat these patients singularly with TPS or do you also substitute with medication or food supplements?”

MB: “It’s true that some patients come to us after a veritable odyssey through clinics and practices with a whole list of medications; once a patient even brought a list of 37 preparations. But we actually only use TPS for patients who have Neuro-Covid. It may be different in other practices, but I can see that TPS alone does the whole job, so to speak, without further burdening the patients.”

AS: “What should patients affected by Long Covid do in general, how and where should they get a proper diagnosis?”

MB: “The Federal Joint Committee published a guideline on Long Covid on December 21, 2023, which has not yet come into force because Federal Health Minister Karl Lauterbach has not yet signed it. This is likely to happen soon. According to the guideline, patients with Long Covid symptoms should first go to a Long Covid outpatient clinic, coordinated by their GP. The GP is supposed to determine which diagnostics make the most sense. This needs to be regulated, as I also have patients who have spent over 20,000 euros on diagnostics as IGeL services without anything coming of it.”

AS: “Dr. Böbel, how do you think TPS should proceed with regard to Long-Covid and Neuro-Covid?”

MB: “I very much hope, and I agree with all colleagues who work with TPS, that this therapy will quickly gain more recognition and become more widespread. Of course, a lot of study work is still needed and intensive research is also being carried out. But it is also important to help patients here and now and we should do everything we can to ensure that this effective and, above all, side-effect-free therapy is available to those affected across the board.”

AS: “Dr. Böbel, thank you for this interview.”