TPS Centre Ulm

Transcraneal Pulse Stimulation

New Treatment Option for Neuronal Diseases

Transcraneal pulse stimulation (TPS) is a relatively new method for treating neuronal disorders. It was approved in 2018 for the treatment of Alzheimer's dementia.

But the roots of this treatment reach several decades back. It is based on experience with shock waves for the treatment of orthopedic diseases. In these area of application, shock waves were able to activate healing processes in the stimulated cells. Due to the scientifically proven effectiveness, health insurance companies nowadays cover the costs of treatment for various orthopedic indications.

Based on this positive experience, grew the hope that shock waves could also initiate repair processes in the brain. And in fact, it showed up that it TPS is a safe and effective treatment for Alzheimers disease. But not just that. It soon became apparent that this method can also be helpful for other neuronal diseases.

In addition to Alzheimer it is now applied as "Off Label" therapy for medical conditions like Parkinson, stroke, depression, ADHS, locked in syndrome, and for severely impaired persons (wheelchair).

The mode of action of TPS is mechanical stimulation the brain. To achieve this, focussed pulse waves are applied to the surface of the head.

Each wave causes a slight compression and then expansion of the tissue. This activates a mechanism called mechanotransduction. It means that the mechanical stimulation of the tissue triggers a biological response. Clinical studies have shown that the shock waves can stimulate growth factors, vasodilation and even formation of stem cells in neuronal tissue, with the potential to cause increased blood flow, the formation of new blood vessels and nerve regeneration.

The released growth factors and vascular–active substances then circulate throughout the brain. They can still be detected several weeks after the treatment. As a result of this and the improved blood flow, deeper regions of the brain also benefit from TPS.

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What Happens During a Treatment?

The patient sits in a comfortable chair while the therapist passes the pulse wave transmitter over his/her head.

At the beginning of each treatment, the therapist calibates the system to the patient, passing a calibration pen over the patient's head. This allows the system to "recognize" the size, shape and position of the head.

The therapist then applies ultrasound gel to the scalp in the areas to be treated. This is necessary for the transmission of the pulse waves. The different areas are stimulated one after the other. To cover each area, the therapist moves the transmitter manually over the scalp.

The monitor of the system shows in real time where the transmitter is currently and how many pulses have already been applied to which area. This allows for precise treatment control.

The treatment lasts around half an hour and is painless. During the treatment, the patient can move the head and have a chat or rest. There are no restrictions for the patient before and after the treatment. He/she can eat and drink normally etc. Eventually ongoing parallel therapies and medications do not need to be paused.

Click on red circle in the image to start the video (in German language)

Real Time Controlled Stimulation

The stimulation system shows in real time which area is getting stimulated. This allows for pricise activation of target areas.

Indications suited for TPS

TPS treatment can be used for a range of neuronal diseases. Currently we focus on:

Dementia

To improve memory, orientation, activation, mood and communication

-> Alzheimer

Severely disabled persons*

For restoration of basic capabilities like chewing, swallowing, body stability,...

-> Disabled

Parkinson*

To improve muscular coodination, gait, sensibility, tremor, rigor

-> Parkinson

Depression*

For reduction of therapy resistant depression symptoms

-> Depression

Post / Long Covid*

To overcome cronic fatigue, lack of concentration, loss of senses

-> P/L Covid

Special applications*

Neuronal diseases like stroke, ADHS, locked in syndrome, ALS

-> Others

* TPS treatment is not yet approved in the EU for the indications marked with a star. Nonetheless, it can be applied in these cases as an individual healing attempt after a thorough individual medical evaluation.

Results

With many thousand TPS treatments performed, there exists extensive experience in the treatment of dementia. The majority of patients improve in cognitive comparative studies (MMST, DemTect, etc.), their mood brightens, they become more active again, word-finding difficulties decrease, etc.

For the treatment of other neuronal diseases such as Parkinson's disease, only case studies are available so far. In these, improvement of muscular symptoms is a frequently observed as treatment result. For example: tense facial structures relax, chewing and swallowing become easier, muscular control improves, walking becomes more stable, fluid and faster.

Incidentally, age is not important. Our oldest patient was 97 years old and responded well to the therapy.

When we look at the patients with Alzheimer's dementia that we have treated at our center we see an improvement in symptoms in about 2/3 of the cases. In some patients the difference is very pronounced, but most of the time the changes are mild to moderate:

For example, after TPS the persons are often less passive. It is easier to motivate them to go for a walk, they may start playing their musical instrument again or they do more housework. You could say they are more open to life again. Their mood often improves and becomes more balanced. This can mean, for example, that the person is happy to have their grandchildren come for a visit.

We also quite frequently observe a reduction of muscular symptoms. The posture is more stable, the grip of the hands gets stronger, the range of motion increases, swallowing and chewing eases, the gait gets more secure and facial muscles relax. This is especially true for Patients with Parkinson's disease, ALS or severe limitations (wheelchair patients).

Clinical studies show an increase in cognitive ability. In the diagram you'll see the results of a study in which the reaction time of 21 patients in the Stroop test was evaluted before (blue) and after treatment (orange). Almost all patients showed a significant reduction in reaction time (clinical publication from 2023, Prof. Sprick. MRI tracked TPS..., see bibliography).

What we at our center, however, find more difficult to achieve is a significant improvement in short-term memory. Luckily, for most patients and relatives this ability is less important regarding overall quality of life.

Therapy Objective

You need to be aware of one truth: In cases of degenerative diseases (Alzheimer, Parkinson,...) the therapy does not bring back the person once was before the illness. It cannot revert the disease. Mainly because of the damage already present. In patients with Parkinson's disease for example, by the time the first symptoms appear, around 70% of the dopamine-producing nerve cells are already destroyed. Prior to this moment, the nervous system was still able to compensate for the dopamine deficiency.

With TPS therapy we help the brain to make better use of the remaining nerve cells. But our advice is that slowing down the deterioration should always be considered the principal goal of the treatment. Regaining lost capabilities is possible but not guaranteed and should be seen as add-on.

Long Term Effect

In case that an improvement is observed after TPS therapy (the majority of the patients do respond but not all), this is usually not a short-term effect, but remains for a longer period of time.

However, many neuronal indications like Alzheimer’s disease are progressive degenerative diseases. For example, in Parkinson's disease, certain nerve cells (so called grey substance) constantly perish, slowing down dopamine production in the brain. Consequently, the effect of TPS decreases over time. To prevent this, regular booster treatments have proven to be useful.

The situation is different in case of acute illnesses such as Post-Covid. Here, booster treatments are usually not necessary.

The first graph shows the progress 14 weeks after the initial set of treatments for Alzheimer. The second graph shows how the improvement achieved in Parkinson's disease was maintained over several years using booster treatments.

-> Clinical Publications on TPS

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FAQ

Here you'll find answers to the most common questions.

You require additional information? Start our interactive questionnaire or contact us via the contact form.

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The abbreviation TPS stands for Transcranial Pulse Stimulation. In this technique, mechanical impulses are applied through the skull to areas of the brain.

During the treatment the patient sits in a comfortable chair, can move the head, have a chat or rest while the therapist moves a small transmitter over his/her head until all target areas are covered. This takes about half an hour.

The initial therapy consists of 6 to 10 treatment sessions. Depending on the outcome complimentary booster treatments are applied every 3 or 6 months.

No severe adverse effects have been reported so far after many thousands of treatment sessions. Sometimes temporary adverse effects like headache, dizziness or fatigue occur.

There is no age limit. Our oldest patient was 97 years old and responded well to the treatment.

Transcranial Pulse Stimulation is an out-patient treatment. For patients living too far away to travel to each session we offer a variation of the treatment that allows them to stay in the city for the duration of the therapy.

To be able to verify if the treatment can be applied in your case we need the following:

- Medical diagnosis of the disease

- Recent MRT or CT report (Magnetic Resonance Imaging / Computer Tomography)

- Current medication

- Additional relevant medical documents that may exist

- A description of the symptoms

A referral from your medical practitioner is not required.

Normally, we have sufficient slots available to start the treatment on short term. The cases that take longer are the ones that requrie a new MRT or CT imaging.

The cost of the initial therapy depends on the amount of sessions agreed on. It is € 3,000 for 6 sessions, € 4.000 for 9 sessions, and € 4,250 € for 10 sessions. For subsequent booster treatments

Although Transcraneal Pulse Therapy is approved for the treatment of Alzheimer's disease it is not covered by the reimbursement system. This is normal for any new treatment. It typically takes many years until new therapies get covered.

Currently, the statuary health insurance companies do not provide any subsidy. Private health insurance companies sometimes subsidize up to 20% of the costs. Patients covered by the governmental health insurance (Beihilfe) may receive up to 50% of subsidies.

Can TPS be applied in my case?

With your responses to these 8 questions we can provide you with an estimation.

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About us

Dr. med. A. Schwarz

Psychiatrist

Our TPS treatment center is part of the doctor’s practice of Dr. med. A. Schwarz, a psychiatrist with more than 25 years of experience.

We are carrying out TPS treatments since the beginning of 2022. Located in the center of Ulm, the TPS-Zentrum has its own premises (suitable for wheelchairs). It is quickly accessible from various highways and there are sufficient parking spaces.

For special indications like depression we cooperate with the psychiatric hospital Dr. Schwarz located in the direct vicinity and run by Dr. med. G. Schwarz, a brother of Dr. A. Schwarz.

We are located in the old town of Ulm, a city that together with its counterpart Neu-Ulm has about 200.000 inhabitants. Our office is just a few minutes' walk from the central market place with the famous cathedral "Ulmer Münster" and also very close to the river Danube. If you come by car from outside you can reach us quickly from the motorways A8 and A7. There is a public car park directly in front of the doctor's office.

If you live too far away to travel to each treatment, there are several hotels nearby where you can stay during therapy. We are happy to help you organize your stay. Ask for our corresponding information sheet.