Abstract

Background: With transcranial pulse stimulation (TPS), a new non-invasive CE-certified and MR-tracked brain stimulation method based on ultra-short ultrasound waves has recently become available, which can achieve a functional improvement in cognitive performance through mechanical transduction, especially in Alzheimer's disease.

Methods: In this case series we share our experience about safety and effectiveness of TPS-treatment in patients with AD ranging from mild to severe stages of the disease, as well as off-label indications such as depression and atypical dementia. The principle of TPS is based on ultrashort ultrasound pulses in the microsecond range, which act on mechano-sensitive channels of the nerve cell membrane by means of mechanical effects and lead to a change in transmitters and the release of growth factors by stimulating neuronal networks. Animal experiments have shown that this leads to microglia activation and plaque reduction. All patients in our case series received six therapy sessions within two weeks and a further therapy session after six weeks with an energy quantity of 0.2 mJ/mm² per individual pulse with a total number of pulses of 6000/session and a frequency of 4 Hz. Thanks to 3D navigation based on MRI images of the patient, an individual pulse application was carried out using the Neurolith device from Storz Medical. The color-word interference (Stroop) test was used to test executive function.

Results: About 2/3 of our patients with AD were able to maintain or even improve their pre-test level, and a complete remission could be achieved in therapy-resistant depressive patients. Long-term side effects were observed in none of our patients.

Conclusion: With the help of TPS, an improvement in cognitive deficits in patients with AD as well as depression and atypical dementia is possible without any long-term side effects so far. Further studies with larger samples are necessary to confirm these results.