Neurologist Prof. M. Zülküf Önal, M.D., interviewed on Transcranial Pulse Stimulation

“TPS in patients with Alzheimer’s dementia is an essential additive treatment option to pharmacologic approaches”

Prof. M. Zülküf Önal, M.D., is a specialist in neurology and holds a professorship at Atilim University in Ankara, Türkiye. He is among the nation’s leading experts in research and treatment of Alzheimer’s dementia, other forms of dementia, Parkinson’s disease, cerebrovascular disease, multiple sclerosis, and other neurophysiological disorders.

In addition to his academic responsibilities, Prof. Önal runs two neurology clinics in Ankara and Istanbul. His scientific commitment is reflected in numerous studies and publications that have been published in national and international journals. He is also a member of various national and international professional societies and scientific organizations. For more than two years, Prof. Önal has been working with Transcranial Pulse Stimulation (TPS).

We spoke with him about this new form of therapy, his empirical values, as well as the opportunities that Transcranial Pulse Stimulation (TPS) can offer to patient:.

Alzheimer Science (AS): “Prof. Önal, as a scientist you look back on a very large portfolio of published research papers and articles. How did you come to use the Transcranial Pulse Stimulation (TPS) neurostimulation procedure in your clinics in Ankara and Istanbul?”

Prof. Zülküf Önal (Prof. Önal): “As we are all aware, the prevalence of Alzheimer’s disease and other neurophysiological disorders is increasing, and yet advances in treatment are nowhere near what we would like to see. This was the catalyst for my intensive study of TPS therapy, and I have since developed a firm confidence in the efficacy of this method. Also, taking into account my many years of experience with the mode of action of TMS therapy (TMS: Transcranial Magnetic Stimulation – editor’s note) , TPS appeared to me as an extraordinarily promising therapeutic option. After I had used Transcranial Pulse Stimulation in my clinic in Ankara and saw the positive results, it was only a logical consequence for me to establish TPS also in my clinic in Istanbul. Furthermore, I intend to establish a TPS center in Izmir to be able to offer this new therapy option to as many Alzheimer’s patients in Türkiye as possible.”

AS: “You recently published an observational study titled “Revolutionary Add-on Therapeutic Concept for Alzheimer’s Disease“. What results were you able to show in this initial work?”

Prof. Önal: “I presented my results in a poster presentation on the „12th International Conference on Neurological Disorders & Stroke“ in Barcelona, Spain, with results from the first treatment series. It is particularly noteworthy that their cognitive abilities had improved in an amazingly short period of time. In addition, I noticed a very positive change in the mental state of my patients: They appeared more lively, more alert, more active, more humorous – in short, happier.”

AS: “From your point of view, what are the probable mechanisms of action of TPS that cause these good treatment results?”

“I am convinced that TPS therapy can be effective in other neurodegenerative and neuropsychiatric diseases besides Alzheimer’s disease.”
Prof. M. Zülküf Önal, MD

Prof. Dr. med. M. Zülküf Önal

Prof. Önal: “I am convinced that TPS therapy can be effective in other neurodegenerative and neuropsychiatric diseases besides Alzheimer’s disease. This is probably due to the revascularization and activation of mechanoreceptors by the mechanical action and the release of growth factors by the low-energy shock wave pulses of Transcranial Pulse Stimulation.”

AS: “What other indications do you see for TPS?

Prof. Önal: “First of all, I think that TPS treatment, which we know will improve memory and will be a target therapeutic option for limitations in movement control and coordination, improving attention and concentration, mental disorders and especially depressive moods.”

AS: “Research around TPS and other neurostimulation methods is progressing rapidly. Although some of these methods are scientifically accepted and successfully used for certain indications, they are not well known by both the public and professionals and are therefore rarely used. Why do you think that is?”

Prof. Önal: “This is actually still the case almost everywhere in the world. The main reason for this could be that our colleagues in the medical community are reluctant and distant towards new treatment methods due to concerns about possible malpractice. And, of course, “evidence-based therapy” is always required first, which may no longer be appropriate because it is too time-consuming and costly.

Also the costs of TPS treatment is a factor. Since the cost of this treatment method is still relatively high, it can of course be a barrier for many patients and their families. This is because public health insurers and social security agencies do not yet generally cover the cost of such treatments, further limiting accessibility. Nevertheless, the potential of this method is enormous, and continued research in this area will hopefully help overcome some of these obstacles soon.”

AS: “The potential approval of the Alzheimer’s drugs lecanemab and donanemab in Europe as well is currently the subject of heated debate. While studies statistically show a slowing of the course of the disease in early Alzheimer’s, serious side effects occur and the treatment costs are enormously high – about $26,500 per year per patient, and in the U.S., in any case, part of the cost must be paid privately. How do you assess these developments?”

Prof. Önal: “In my opinion, the use of these drugs is being accelerated too much at the moment. We are still far from knowing what the serious side effects and long-term use can actually cause. That is why many of my colleagues worldwide are yet against the use of these drugs at the present time. Much more research is needed here, especially on the long-term effects. In addition, the high cost of the treatment itself is also a major problem.”

AS: “In terms of Alzheimer’s cause research, the amyloid hypothesis is always being questioned. Other potential factors such as tau, astrocytes, and viruses and bacteria are also being explored. For example, last year Epstein-Barr virus was identified as a trigger for multiple sclerosis. What do you think about the current research on Alzheimer’s causes?”

“In addition to further research into the causes of Alzheimer’s, it’s actually becoming increasingly important to take active preventive measures.”
Prof. M. Zülküf Önal, MD

Prof. Dr. med. M. Zülküf Önal

Prof. Önal: “The knowledge gained so far on this topic is very valuable, but as we see in actual treatment, the destruction of amyloid plaques alone cannot stop the disease, but if anything, it can only slow down its worsening. In this case, we can say that amyloids alone are not responsible for the disease and its progression. In fact, in addition to further research into the development of Alzheimer’s, it is becoming increasingly important to take active preventive measures. RECODE, one of the serious studies on nutrition, for example, has not yet been given sufficient attention. Measures also in the area of nutrition are very promising for both treatment and prevention.”

AS: “You attend international congresses and give talks on your work. How do your colleagues react to the topic of neurostimulation?

Prof. Önal: “Some of our colleagues are sadly not yet positive about the treatment. But I think we will overcome this with time. I also see that the scientists:inside who are dedicated to TPS treatment and research today face great challenges, because we cannot ignore the fact that anything new, no matter how good, is first viewed critically. We have to wait for more studies on this topic and prove the effectiveness of the treatment more and more extensively. That will lead to the goal.”

AS: “TPS has already proven in studies that it is safe and well tolerated by patients. We also do not want to leave unmentioned its low side effects and the comparatively extremely simple application on or for the patient:in. What do you think is needed to make TPS accessible to as many people as possible?

Prof. Önal: “In relation to the patient:inside: In addition to informing continuous media work, and by this I mean not only newspapers and television, but also the social media, through which people nowadays also inform themselves about medical issues, I think it is particularly important to reduce the cost of TPS treatment. It will certainly take some time before health insurance companies and social welfare agencies in the various countries will cover the costs. Therefore, the therapy simply has to become more affordable for those affected. This is another reason why it is important to significantly increase the number of scientific studies on TPS and to drive research forward. Only in this way can TPS become the standard in a few years.”

AS: “Finally, Prof. Önal, where do you see Transcranial Pulse Stimulation in 10 years?”

Prof. Önal: “I expect TPS to become mainstream in the near future rather than 10 years from now, and I think it will be an indispensable additive treatment option to pharmacologic approaches.”

AS: “Prof. Önal, thank you very much for this interview.”