Neurologist and psychiatrist Frank Schmidt-Staub on brain stimulation in practice
“With Transcranial Pulse Stimulation, we are on the threshold of undreamt-of possibilities.”
Frank Schmidt-Staub, specialist in psychiatry and psychotherapy, specialist in neurology and specialist in neurology, practices in Hanover. In addition to neurodegenerative diseases such as Alzheimer’s, dementia, Parkinson’s and post-stroke conditions, his main focus is on psychiatric and psychological conditions such as anxiety disorders, depression, burnout, trauma management, pain syndromes, ADHD, schizophrenia and addiction. Frank Schmidt-Staub uses a wide range of medical options in diagnostics and therapy for his patients and is a pioneer in the practical use of non-invasive brain stimulation methods (NIBS) such as Transcranial Pulse Stimulation (TPS)..
We spoke to the expert about his patient-oriented approach in psychiatry and neurology as well as the opportunities and benefits of combining drug and biophysical therapies.
Alzheimer Science (AS): “Mr. Schmidt-Staub, let’s start by talking about Transcranial Pulse Stimulation. You have been working with the shockwave procedure for over two years now. What indications do you treat with TPS?”
Frank Schmidt-Staub (FSS): “First and foremost, of course, we treat Alzheimer’s patients in my practice. But we also use TPS ‘off-label’ for other forms of dementia, Parkinson’s disease, aphasia and now long Covid symptoms. We are also gaining initial experience in the treatment of ADHD and therapy-resistant depression, Parkinson’s patients and migraine sufferers. The procedure is excellent and I am excited to see what other possibilities TPS has in store for us in the future. For example, it has just been shown that TPS can open the blood-brain barrier. This would be an option for using drugs more effectively, as their active ingredients could reach the brain better.”
“With TPS and other brain stimulation methods, we have simply reached a new level of treatment options.”
Frank Schmidt-Staub
AS: “You work with TPS and other brain stimulation procedures in your practice, which is still unusual for a neurologist and psychiatrist in private practice today. How did this come about?”
FSS: “For a long time, I looked after chronically seriously ill patients in acute and residential psychiatric wards. I worked with all forms of medication there, but realized that I simply couldn’t get anywhere on my own. After setting up my own practice in 2014, I initially came across neurofeedback in my search for further treatment options. Then I discovered tDCS, transcranial direct current stimulation, to treat treatment-resistant patients, i.e. those for whom medication was of no benefit. I then had very good results with tDCS in the field of pain therapy, for example in fibromyalgia or organic affective disorders, for example after a stroke, as well as in stroke-related hemiparesis. I became more and more involved with the topic of physical therapy and then also brought a magnetic stimulator, i.e. rTMS, into the practice, and later also a deep rTMS device for the treatment of addiction and therapy-resistant obsessive-compulsive disorders. This form of therapy also shows good results in cases of depression, anxiety disorders or post-stroke conditions. Transcranial Pulse Stimulation was added about two years ago and has since become a core therapy for numerous indications. With TPS and other brain stimulation methods, we have simply reached a new level of treatment options.”
AS: “But before you treat your patients, you carry out extensive diagnostics, which is rarely found in this form in conventional practices. How do you proceed?”
FSS: “It’s not enough for me if a patient comes to me with an MRI and a diagnosis. In my practice, we work very intensively with each patient to get an overall picture. We always carry out sleep diagnostics because this is a very big risk factor, we compensate for vitamin deficiencies and we also include bioidentical hormone replacement therapies. The gut also plays a major role, as many patients have a disorder of the intestinal barrier, known as ‘leaky gut syndrome’. The gut and brain are closely linked and the resulting chronic inflammation can lead to neurophysiological disorders. This needs to be balanced out. Incidentally, there are many women in the menopause who believe they have dementia because they notice symptoms of this kind. However, in most cases it is actually only necessary to regulate the hormones, although other risk factors must of course be ruled out beforehand, such as cancer. This is all part of the process of correctly determining any biological factors.”
AS: “Keyword medication: do you also rely on very individual settings here?”
FSS: “Yes, it’s important to check patients’ medication, because many people suffer from side effects. There are many patients with depression who also suffer from pseudo-dementia and are not or cannot be optimally treated with medication. Even if someone has ADHD, for example – a disease that we treat frequently and that occurs in every age group – and the patient is given a serotonin uptake inhibitor or neuroleptics, then we switch here because these preparations can have very negative effects. It is therefore important to first optimize the vital parameters and minimize the risk factors, because then the TPS, for example, can develop its optimal effect when we finally start treatment.”
AS: “Time and attention are very important for patients, also with regard to the best possible therapy?”
FSS: “Yes, that’s the case, a lot can go wrong. I have a 61-year-old Alzheimer’s patient who is a doctor himself, but from a different field. He initially went to a university clinic because of memory problems, where a lumbar puncture was performed. Neurodegenerative parameters were found in the cerebrospinal fluid, i.e. beta-amyloid and tau fibrils. He was then given a cholinesterase inhibitor and was simply told: “We’ll see you again in six months”. That was it, and unfortunately this is not an isolated case. He was completely shocked. Unfortunately, there is often a lack of information about other sensible treatment strategies beyond pharmacotherapy.”
AS: “Back to the therapy: you also use TPS in combination with other brain stimulation methods. Can you explain how you combine them and what benefits the patient receives?”
FSS: “An example: One of my Alzheimer’s patients was treated with rTMS at defined points on the left side of the skull. Then his wife told me that her husband could no longer read the clock. Well, reading the clock has to do with object recognition, which is located in the right parietal lobe. We then combined TPS with rTMS, i.e. we treated the entire brain with TPS and also stimulated the right parietal lobe with rTMS. And lo and behold, after 10 sessions he was able to read the clock again! This is also a really great success for me, which simply shows what is possible with these therapies. It also gives patients and their families hope and improves their quality of life. Incidentally, this patient is maintaining a consistently good level of function because he is regularly treated with TPS.”
“With TPS, on the other hand, we can activate large cortical areas, promote blood flow and trigger regeneration processes that are not possible with other methods.”
Frank Schmidt-Staub
AS: “Combination treatments with TPS and rTMS are also being investigated clinically. Can you briefly explain the differences between the procedures and the shared benefits, as rTMS only penetrates a few centimetres through the skull?”
FSS: “That’s right, rTMS only goes directly three to four centimeters deep. So I reach the upper connection points of the nerve network. Through the cerebral networks, deeper core areas can then also be reached indirectly. With deep RTMS, we also reach deeper and large-volume areas of the brain. With rTMS, I can decide what I want to achieve by setting the frequency individually. The difference is that with rTMS I can both slow down and activate activities in the brain. However, this often requires 20 to 30 treatments. With TPS, on the other hand, we can activate large cortical areas, promote blood flow and trigger regeneration processes that are not possible with other methods, especially as the other methods have to be used much more frequently than TPS. TPS is also a painless and very safe procedure. TPS is the turbo of regeneration, so to speak. Ultimately, I see in my practice that the different technical procedures can complement each other wonderfully and that we can treat our patients in a highly individualized way.”
AS: “Do you have any other examples of these combinations?”
FSS: “Yes, we also combine TPS with vagus nerve stimulation. We used to use this primarily for cluster headaches and post-traumatic stress disorder. However, we have now discovered that the combination works very well for Long Covid. We treat these conditions in the practice with TPS and then also give patients small vagus nerve stimulation devices to take home with them to support the activating and regenerative processes triggered by TPS. This therapy at home makes sense, as you have to treat for three to four hours at a time and not just 30 minutes as with TPS.”
AS: “Initially, only mild and moderate Alzheimer’s disease was treated with TPS shock waves. For a long time now, especially in the clinical field, people have also started to treat severe cases, with equally good results in terms of halting the progression of the disease. What experiences have you had?”
FSS: “Yes, that’s right. We have also started to treat advanced stages of dementia with TPS. With older patients in particular, we achieve functional preservation with TPS so that those affected can continue to live at home and don’t have to go into a care home. The aim is to maintain basal function, improve people’s social opportunities, reduce sleep disorders and also reduce anxiety, in other words simply to improve quality of life.”
AS: “You have been working with TPS for around two years. Can you give us an overview of your experience?”
FSS: “The first aim of TPS is to stop or slow down the progression of the disease. The second goal is to restore brain functions. And around two thirds of our patients benefit from the therapy in this form and then continue it at regular intervals. We then experience that relatives report that, for example, their mother can participate better in conversations again, no longer asks the same questions so often, that the patient’s mood is better and their own drive is stronger. The promotion of neuroplasticity often works very well.”
AS: “Do you have a specific example of this?”
FSS: “A very good example is the doctor with a diagnosis of Alzheimer’s dementia that I mentioned earlier. We have had excellent success with him using TPS. We regularly monitor his vital signs, sleep duration and quality, he takes nutritional supplements and is hormonally well adjusted. TPS can therefore achieve maximum results and the great thing is that this patient has simply remained normal. He has a good marriage, a full life, rides his bike, does sport and, if you didn’t know it, you wouldn’t believe that he has Alzheimer’s disease. It’s excellent that, thanks to TPS, he has been spared the fate of a progressive disease that is still considered normal today. Of course, you can never promise anything, but we have a few patients like him. It really is a dream come true.”
“TPS and other forms of treatment are simply too good to remain in the shadows for much longer.”
Frank Schmidt-Staub
AS: “And even if it sounds incomprehensible at first: TPS can save those affected a lot of costs and reduce financial burdens?”
FSS: “Yes, that’s really the case. If I put the costs of TPS in relation to the expected costs of a care home, it looks very different. The costs that you have to pay each month for a care home, including for aids, are a completely different dimension. A place in a nursing home alone costs at least €3,000 per month, which the family has to pay for itself, despite the level of care etc. In concrete terms: if I can delay moving into a care home for just six months with the TPS, I save € 20,000. You have to put that into perspective.”
AS: “Where do you see TPS and other procedures in neurology and psychiatry in the future?”
FSS: “I think this new form of medicine will significantly change the therapy landscape, and not just in my specialist areas. We are on the threshold of previously unimagined possibilities that will, and indeed must, become established over time. TPS and other forms of treatment are simply too good to remain in the shadows for much longer. They have long been established in the professional world, now it’s a matter of informing people and making it easier for them to access these therapies.”
AS: “Mr. Schmidt-Staub, thank you for this interview.”
