Transcranial pulse stimulation (TPS)

What is Transcranial Pulse Stimulation?

TPS uses ultra-short, low-energy pulses (similar to shock waves) that are focused through the skull into specific brain regions. Unlike electromagnetic processes (e.g. TMS), TPS works acoustic-mechanically. The impulses are intended to improve microcirculation, stimulate the release of messenger substances and thereby support neuronal connectivity.

TPS is being discussed in specialized centers particularly as a complementary treatment for mild to moderate cognitive impairments (e.g. Alzheimer's dementia). There are also initial indications of other neuropsychiatric symptoms (e.g. depression, long-COVID-associated brain fog, Parkinson's symptoms), but overall the evidence is heterogeneous and still developing.

How it works: How should TPS work in the brain?

• Microcirculation: Mechanical microstimulation can promote local blood circulation and microvascular function.
• Neuroplasticity: Stimuli release growth factors (e.g. BDNF) that could support synaptic plasticity.
• Network modulation: Targeted stimulation of certain areas can influence functional brain networks.
• Neuroinflammation: There is evidence of modulation of inflammatory processes; However, an established clinical relevance is still the subject of research.

Important: The effects described are derived from preclinical data and smaller clinical studies. Whether and to what extent an individual patient will benefit cannot be predicted with certainty.

Possible indications and clear limits

We only recommend TPS after careful clarification and if a conservative, non-invasive supplement seems sensible. Classically discussed areas of application - usually as an add-on to standard therapies - are:

• Mild to moderate Alzheimer's dementia: in addition to guideline-based therapy and cognitive support.
• Mild cognitive impairment (MCI): in individual cases, after differential diagnostic clarification.
• Depressive symptoms: selective and as part of a multimodal treatment concept.
• Long COVID-associated cognitive complaints (“brain fog”): individual decision on a case-by-case basis.
• Parkinson's-associated symptoms: only in selected cases and always in addition.

Limitations: We generally advise against TPS if dementia is in advanced stages, the diagnosis is unclear or expectations are unrealistic. TPS does not replace standard medication or rehabilitative therapy and is not a healing procedure.

Evidence: What is scientifically proven?

There are clinical studies for TPS with small to medium numbers of cases, particularly in Alzheimer's dementia. Short-term improvements in neuropsychological tests and functional imaging have been described in some cases. However, the data is not yet robust enough to make general recommendations. Long-term effects, optimal protocols and predictors of benefit are the subject of ongoing research.

Our approach: We provide transparent advice about the current state of knowledge, only offer TPS if there is a plausible indication and accompany the therapy with standardized assessments (e.g. cognitive tests, scales) in order to document developments in a comprehensible manner.

Process of treatment in our practice

The treatment is non-invasive. During the session you sit comfortably; the target areas are stimulated one after the other. An accompanying person is possible if required.

Preparation and aftercare

• Medication: Please bring a current list of medications with you (especially anticoagulants, antiepileptics).
• Images/Findings: Current imaging (MRI/CT) and neuropsychological findings are helpful for goal planning.
• Everyday life: After the session you will usually be able to go back to everyday life straight away. However, plan for some rest on the first day.
• Accompanying therapies: Cognitive exercises, exercise therapy, sleep and nutritional strategies remain important and are tailored to the individual.

Safety, side effects and contraindications

TPS is considered well tolerated when used correctly. However, side effects are possible - usually mild and temporary.

• Common: Mild headache, fatigue, short-term hypersensitivity, feeling of pressure on the scalp.
• Uncommon: nausea, dizziness, changes in concentration.
• Rare: More severe headaches or vegetative symptoms; very rarely unexpected reactions.

Possible contraindications (are checked individually):

• Active epilepsy or recent seizures without adequate control.
• Metallic or electronic implants in the head area (e.g. aneurysm clips, shunts, neurostimulators) depending on the material/location.
• Fresh intracranial hemorrhage, brain tumor, skull defects.
• Severe uncontrolled coagulation disorders.
• Pregnancy: Caution, individual risk-benefit assessment.

Specific suitability is decided after reviewing all findings. If there are warning signs (acute confusion, focal deficits, severe headaches), immediate medical attention is required.

TPS compared to other neuromodulatory procedures

Neuromodulation includes various technologies. The choice depends on the symptoms, evidence and individual tolerability.

• Transcranial magnetic stimulation (TMS): electromagnetic, well studied for depression; different objectives and evidence profiles compared to TPS.
• tDCS/tACS: weak direct/alternating current via electrodes; Low-threshold option in studies/programs, different mechanism of action.
• Axomera therapy: peripheral targeted neurostimulation for pain modulation, relevant for musculoskeletal complaints.
• PRP neuromodulation: combination of autologous plasma and nerve modulation in the periphery; discussed in orthopedics for certain pain syndromes.

For central cognitive disorders, TPS may be an option; For peripheral pain syndromes, procedures such as Axomera or PRP neuromodulation are often more appropriate. We provide individual advice based on guidelines.

Costs and reimbursement

TPS is not yet a standard service provided by statutory health insurance companies. As a rule, this is a self-pay service; Reimbursement through private health insurance is possible, but depends on the individual case. Before you start, you will receive a transparent cost breakdown.

We recommend that you obtain a written confirmation of costs from your insurance company before starting treatment. We are happy to provide support with medical documents regarding the indication.

Your location advantage: Hamburg-Winterhude

Our practice is centrally located in 22301 Hamburg, Dorotheenstraße 48. We work in an interdisciplinary and conservative manner. We only use TPS if it suits your goals and security is guaranteed.

Would you like an assessment of whether TPS is an option for you? Bring any existing doctor's notes, imaging and medication list with you to the appointment. We take the time to provide honest, pressure-free advice.