Shock waves are acoustic pulses that have been successfully used since the end of the 1980s to treat various clinical symptoms, such as extracorporeal treatment of kidney stones, diseases of the locomotor system, as well as pseudo-joints, to stimulate angiogenesis, in the case of abnormal wound healing and the treatment of angina. In the mid-1990s, the effectiveness of shock waves in neurological disorders such as post-traumatic contractions and spastic paralysis was recognized. In 2015, the first treatments were performed on patients with Alzheimer's disease at the University of Vienna. In 2018, transcranial impulse stimulation (TPS®) using the NEUROLITH® system received, as the only method of this kind, approval for the treatment of the central nervous system in patients with Alzheimer's disease. Other neurological conditions, such as Parkinson's disease, and psychiatric disorders, such as depression, are undergoing further clinical trials, research, and development.

Shock waves and ultrasounds

Both shock and ultrasonic waves are acoustic waves that occur in a similar frequency range. Nevertheless, they differ significantly from each other. While a continuous wave with numerous oscillations characterizes ultrasound, a shock wave is characterized by a single shock pulse followed by a stretching wave with a smaller amplitude. In addition, due to the fluctuating high-frequency exposure, the energy of the ultrasound waves is absorbed by the tissue and can heat it - an effect that is not observed with shock waves. Thus, TPS stimulation does not cause tissue overheating.

With the TPS® method, areas of the brain can be stimulated up to a depth of 8 cm. The properties of shock waves enable the effective use of physical energy in locally limited areas of tissues. Through mechanotransduction the release of growth factors and nitric oxide is being stimulated. The biological effect of the TPS method is:

• Modulation of neuronal responses
• Reduction of cerebral cortex atrophy
• Stimulation of neuroplasticity
• Improving the blood supply to the brain, creating new blood vessels (neoangiogenesis)
• Nerve regeneration
• Improvement of the axonal state in the stimulated area
• Improving brain function in dementia caused by Alzheimer's disease
• Normalization of the so-called functional connectivity between brain circuits important for mood regulation (potential antidepressant effect).

• 6 TPS® treatments (sessions) in 2 weeks
• the duration of the procedure is about 30 minutes
• treatments are non-invasive, safe, and uncomplicated
• no need to shave the head
• significant neuropsychological improvement
• antidepressant effect

Potential side effects (usually disappear after about five days):

• swelling, redness, hematoma
• petechiae
• slight soreness/discomfort in the stimulated area

Contraindications to TPS® Therapy:

• hemorrhagic diathesis
• thrombosis
• pregnancy
• a brain tumor
• cortisone therapy up to 6 weeks before the first treatment
• presence of metal foreign bodies in the skull (e.g., stents, fragments)
• pacemaker

Alzheimer's disease is the most common form of dementia. It cannot be cured. The number of people with Alzheimer's disease continues to grow - currently, it affects approximately 33 million people worldwide. Patients suffer from memory lapses, have problems with orientation, and can no longer function independently in everyday life. Many patients, especially in the early stages of dementia, also struggle with depression. This significantly reduces the quality of life of those affected and their relatives. The progressive loss of neurons triggers the clinical symptoms of Alzheimer's disease. As a result, the brain shrinks, especially the cerebral cortex. As a result of the loss of neurons, the information transmission and processing points located between the nerves are also degraded. These disorders cause memory loss. According to current knowledge, the causative agent of Alzheimer's disease is harmful protein molecules that arise outside nerve cells and impair their work. One of these molecules, beta-amyloid, builds up and builds up in the brain of an Alzheimer's patient. The so-called amyloid plaques, as a result of which there is a deterioration of blood circulation and, as a consequence, disturbances in the supply of oxygen and energy to the brain.

Based on efficacy data, a follow-up study published in 2021 investigated the potential benefit of TPS® treatment on cortical atrophy characteristic of Alzheimer's disease, including data from 17 patients in the pre/post analysis. The study's authors showed a correlation between neuropsychological improvement and an increase in cortical thickness in dementia-critical brain regions. Alzheimer's disease patients who benefit from TPS® treatment appear to have reduced cortical atrophy. In 2022, a clinical trial was published on 18 patients with Alzheimer's disease and accompanying depression. Again, confirmation of a significant improvement in well-being was obtained, confirmed by the BDI-II scale and the normalization of the so-called functional connectivity (FC) between the brain's critical mood circuits.

• d’Agostino, M. C. et al.: International Journal of Surgery, 24(Pt B):147-153, 2015.
• Yahata, K. et al.: Journal of Neurosurgery, 25(6):745-755, 2016.
• Hatanaka, K. et al.: American Journal of Physiology-Cell Physiology, 311(3):C378-85, 2016.
• Mariotto, S. et al.: Nitric Oxide, 12(2):89-96, 2005.
• Lohse-Busch, H. et al.: NeuroRehabilitation, 35(2):227-233, 235-244, 2014
• Beisteiner, R. et al.: Advanced Science, 7(3):1902583, 2020.
• Popescu, T. et al.: Alzheimer’s & Dementia, 7(1):e12121, 2021.
• Van Hoesen, G. W. et al.: Hippocampus, 1(1):1-8, 1991.
• Van Hoesen, G. W. et al.: Cerebral Cortex, 10(3):243-251, 2000.
• Bush, A. I.: Trends in Neurosciences, 26(4): 207-214, 2003.
• Beisteiner, R. (Uniwersytet Medyczny w Wiedniu): Transcranial Pulse Stimulation (TPS) as a revolutionary new brain therapy, 46. Polski Kongres Psychiatryczny, Szczecin, 2021.
• Matt, E. et al.: Journal of Translational Medicine, 20(1):26, 2022.
• Lohse-Busch, H.: Neurologie & Rehabilitation, S2:KV4–05, 2019.