New Research Data on the Neurostimulation Procedure Transcranial Pulse Stimulation (TPS)

Transcranial Pulse Stimulation (TPS) therapy undergoes intensive clinical research and shows further potential

Noninvasive brain stimulation techniques are receiving increasing attention. In the scientific community, therapeutic developments based on electrical, electromagnetic, or other physical energies are being discussed as treatment modalities with increasingly high potential. Thanks to the expanding research situation, they are being treated as serious and safe therapy modules applicable to various neurological and psychiatric indications and are increasingly finding their way into clinics and practices.

In addition, given the explosion of costs in health care systems, researchers from various groups, professional societies, and economists have long called for brain stimulation procedures to be made available to as many patients as possible (see also: Non-Invasive Brain Stimulation procedures: Increasingly Essential for Healthcare ), even though much research remains to be done.

TPS: New Data on Alzheimer’s Disease, Depression, and Post-Covid

The neurostimulation procedure Transcranial Pulse Stimulation (TPS), which uses low-energy shock waves and is already well researched in terms of its mode of action and patient safety, accordingly awaits further new scientific work.

Renowned researchers from various faculties have presented new work on TPS in recent weeks. The following new posters were presented at this year’s European Academy of Neurology (EAN 2023) conference in Budapest, Hungary, the Alzheimer’s Association International Conference (AAIC 2023) in Amsterdam, the Netherlands, and the 3rd Joint Congress of the INS European Chapters (e-INS 2023) in Hamburg, Germany:

TPS in Alzheimer’s dementia at all stages and observation periods of up to 1 year

The University of Bonn, led by Prof. Ullrich Wüllner, MD, reports on 22 subjects with Alzheimer’s dementia who were treated with TPS and tested by CERAD test before and after each six-part TPS treatment and again six months later. In 76 percent of the patients, the course of the disease was halted or their condition improved. The condition worsened in only five percent of those affected. All patients tolerated the TPS therapy well; there were no side effects and no subjective complaints.

The team of Prof. Dr. med. Lars Wojtecki, Hospital zum Heiligen Geist, teaching hospital of the Heinrich-Heine-University Düsseldorf, presents retrospective long-term follow-up data on Alzheimer patients including individual medical histories: Again, cognitive and affective performance improved significantly after the first TPS treatment cycle in 25 subjects – independent of symptom severity and biomarkers at baseline (tested with MMST, MoCA, ADAS over five to 12 months). The treatments were well tolerated by the patients, with a minimal number of only transient mild side effects, even in selective patients with mild vascular lesions and platelet aggregation inhibitors.

In another poster by Prof. Wojtecki’s group, the pilot results of the above poster are confirmed in terms of low ADE and the extent of cognitive improvement as a short-term effect. According to the authors, these results show that the initial improvement in cognitive function can be maintained for up to one year. Further studies will follow the long-term course.

A third poster under first author Celine Cont from the teaching hospital of the Heinrich-Heine-University Düsseldorf under the direction of Prof. Wojtecki deals with the question of the evidence of TPS for clinical-practical application. The authors conclude that TPS can be an option for the treatment of Alzheimer’s disease, not only in mild cases but also in more advanced stages. This recommended option is valid regardless of the biomarker constellation and thus also for other types of dementia, if appropriate.

Mild vascular pathology and antiplatelet agents are generally acceptable. In addition, the researcher:s suggest expanding treatment protocols beyond the current standard protocols to include, for example, motor areas to treat concomitant hypokinesia or tremor.

TPS in treatment-resistant depression

The research group led by Prof. Dr. med. Dr. rer. nat. Ulrich Sprick, also of Heinrich Heine University in Düsseldorf and chief physician at the Outpatient Center of the Alexius/Josef Hospital, Neuss, Germany, is studying TPS for treatment-resistant depression, in addition to other indications. In a case report, the group presents a poster on the long-term effect of TPS treatment with stimulation of the nucleus accumbens in a patient with treatment-resistant depression over a follow-up period of one year:

After the first six TPS sessions within two weeks, the patient achieved complete remission. In the outpatient follow-up report, the treating physician documented: He is completely normal again, enjoys playing, is socially active and as if changed. Accordingly, the BDI-II score dropped to 1 point. The patient has now been receiving regular TPS sessions every 4 weeks for more than a year. He has remained relapse-free since then, and the BDI-II score has always remained < 3 points at follow-up visits.

TPS in Post-Covid

Transcranial Pulse Stimulation (TPS) is already being studied extensively with respect to its use in long-covoid symptoms and post-covoid disease cases, and further data will be available in due course. In a case report, also from Prof. Sprick’s team, TPS demonstrates the potential of the procedure in post-covid: In this case, TPS therapy was used (off-label) in a 42-year-old woman with complete loss of smell and taste secondary to long-covid syndrome (following covid 19 infection – delta type). The taste loss and anosmia had persisted for more than one year before treatment.

After six TPS stimulations over a period of only two weeks, the patient regained her ability to smell and taste. No side effects of the treatment were observed. Six weeks after treatment, the patient reported that she was able to participate in wine tasting with great success. The patient was even able to identify different types of wine by taste and smell.

Prof. Sprick and his co-authors conclude that the regenerative effects of TPS, as in other diseases such as Alzheimer’s dementia, can also be achieved in patients with post-covoid symptoms. The fact that the patient’s symptoms of loss of smell and taste, which persisted even a year after covid disease, were eliminated within only two weeks after six stimulations is considered by the researchers to be particularly impressive.

The authors write in their poster that while the exact mechanisms of action of Transcranial Pulse Stimulation (TPS) require further research, several factors are up for discussion. These include mechanical effects of TPS pulses on neuronal membranes, affecting ion channels and inducing cell wall porations, in both neurons and glial cells.

Changes in various neurotransmitter levels were also observed after TPS applications. An increase in dopamine and serotonin levels and a decrease in GABA have been reported in the literature after TPS treatments. In addition, brain stimulation with TPS may lead to induction of neurotrophic factor (BDNF) or glial cell line-derived neurotrophic factor (GDNF) and vascular endothelial growth factor (VEGF). BDNF could contribute to neurogenesis and proliferation of neurons, particularly in the hippocampus, entorhinal cortex, and olfactory brain. VEGF usually leads to a marked enhancement of vascularization. All of these mechanisms have in common that they induce neuroplastic changes.

Transcranial Pulse Stimulation (TPS): further publications in the fall of 2023

In the coming months, TPS will be represented in Germany at the 96th Congress of the German Society of Neurology (DGN), November 8-11, 2023, in Berlin, and the DGPPN Congress (German Society for Psychiatry and Psychotherapy, Psychosomatics, and Neurology), November 29-December 02, 2023, also in Berlin, among other events. The DGN congress is the largest specialist neurology meeting in Europe and the DGPPN brings together the expertise of over 11,000 specialists and scientists on mental illness.

TPS will be present at both congresses and further work on TPS research on various indications will be presented.

All posters presented in this review can be viewed in detail in the “Studies, Posters, and Literature” section at:.