Indications
Non-invasive neurostimulation procedures are being investigated and used for a number of neurological and psychiatric conditions. Below you will find an overview of the indications we treat at our Berlin practice.
Alzheimer's Dementia
Alzheimer's disease is the most common form of dementia and progressively leads to memory impairment, loss of orientation and limitations in daily life. It primarily affects short-term memory and cognitive functions such as language, planning and spatial thinking.
Background
At the cellular level, deposits of beta-amyloid plaques and tau fibrils occur, which are associated with progressive loss of synapses and nerve cells. The hippocampus and temporo-parietal cortex areas are particularly affected.
Accompanying symptoms such as depressive symptoms, apathy and sleep disorders frequently occur. Established medication therapy can so far only limitedly influence the course of the disease - this is where non-invasive neurostimulation procedures come in.
Prevalence
In Germany, around 1.8 million people live with a dementia condition, approximately two thirds of them with Alzheimer's. With rising life expectancy, the number is expected to continue increasing in the coming decades.
Neurostimulation for Alzheimer's Dementia
The NEUROLITH® system used for TPS has been CE-approved in the EU for the treatment of Alzheimer's dementia since 2018. Clinical studies show improvements in standardised cognition tests (CERAD, ADAS-Cog) as well as a reduction in accompanying depressive symptoms. The effects vary individually.
In our practice we treat with:
Parkinson's Disease
Parkinson's disease is a progressive neurodegenerative condition that typically involves movement disorders such as tremor, muscle rigidity and slowed movements (bradykinesia). Non-motor symptoms such as sleep disorders, depression and cognitive decline also occur.
Background
The cause is a progressive loss of dopamine-producing nerve cells in the substantia nigra. The resulting dopamine deficiency disrupts signal processing in the basal ganglia and leads to the typical movement symptoms.
Medication therapy - usually with L-Dopa - can alleviate symptoms but loses effectiveness over time and is associated with side effects. Neurostimulation is increasingly being investigated as a complementary therapeutic approach.
Prevalence
In Germany, approximately 400,000 people have Parkinson's disease. The average age of onset is between 50 and 60 years, and men are slightly more frequently affected than women.
Neurostimulation for Parkinson's Disease
In an analysis of 20 randomised trials, magnetic stimulation improved the motor symptoms of patients with Parkinson's disease. The best evidence is for high-frequency stimulation of the motor cortex on both sides; the European guideline on the therapeutic use of magnetic stimulation lists it at evidence level B. The device we use is intended for the treatment of depression, so for Parkinson's disease we treat as an individual treatment attempt.
In our practice we treat with:
Depression
Depression is one of the most common mental health conditions. It manifests as persistent low mood, lack of drive, loss of interest and enjoyment, sleep and appetite disorders, and a significant reduction in quality of life.
Background
Neurobiologically, depression is associated with an imbalance of neurotransmitters such as serotonin, dopamine and noradrenaline, as well as altered activity in prefrontal and limbic brain regions. Reduced neuroplasticity also plays a role.
Approximately one third of patients respond insufficiently to standard medication and psychotherapy treatments. In these cases, neurostimulation procedures can represent a complementary option.
Prevalence
Around 8.2 million people in Germany are affected by a depressive condition within a year. The lifetime prevalence is approximately 16-20 percent. Women are affected about twice as frequently as men.
Neurostimulation for Depression
Repetitive Transcranial Magnetic Stimulation (rTMS) is an established procedure for treatment-resistant depression and is recommended in clinical guidelines. Transcranial Direct Current Stimulation (tDCS) also shows antidepressant effects in studies. Application is outpatient, medication-free and with a good tolerability profile.
Long Covid / Post-COVID Syndrome
Post-COVID Syndrome is characterised by persistent symptoms following a COVID-19 infection - most commonly brain fog, cognitive fatigue and concentration problems, fatigue and autonomic complaints.
Background
Neurobiologically, these symptoms are associated with persistent neuroinflammation, altered microcirculation disorders, and dysregulated neural networks.
Specific, evidence-based therapies for the neurological symptoms of Post-COVID Syndrome are still limited. Non-invasive neurostimulation procedures are currently being clinically evaluated.
Prevalence
It is estimated that 10-20% of people with COVID-19 develop persistent symptoms. This means several million people are affected in Germany alone.
Neurostimulation for Long Covid / Post-COVID Syndrome
Transcranial Pulse Stimulation (TPS) is used for Long Covid / Post-COVID Syndrome as an individual treatment attempt. Initial clinical experience reports suggest improvements in brain fog and cognitive fatigue. Controlled studies are ongoing.
In our practice we treat with:
Zwangsstörung
Zwangsgedanken und Zwangshandlungen kosten Zeit und Kraft: Kontrollieren, Waschen, Ordnen oder gedankliches Durchspielen können den Tag über Stunden bestimmen. Behandlung erster Wahl ist die Verhaltenstherapie mit Exposition und Reaktionsmanagement, ergänzt um Medikamente.
Background
Wenn diese Wege nicht ausgereicht haben, kommt die repetitive Transkranielle Magnetstimulation als ergänzender Ansatz infrage. Sie regt mit kurzen Magnetimpulsen ein umschriebenes Areal der Hirnrinde an, ambulant und ohne Narkose.
Die deutsche S3-Leitlinie hat ihre Einschätzung dazu 2022 geändert: Seither nennt sie die rTMS als mögliche Option bei unzureichendem Ansprechen auf die Verfahren der ersten Wahl, mit dem Ziel einer kurzfristigen Symptomlinderung.
Prevalence
Nach Bevölkerungsstudien erkrankt etwa 1 bis 3 % der Menschen im Lauf des Lebens an einer Zwangsstörung. Für Berlin sind das schätzungsweise 32.000 bis 115.000 Betroffene.
Neurostimulation for Zwangsstörung
Eine Netzwerk-Metaanalyse über 34 randomisierte Studien mit 1.089 Patienten fand für das Protokoll, das wir fahren, eine signifikante Verbesserung gegenüber einer Scheinstimulation. Wer davon profitiert, lässt sich vorher nicht bestimmen. Das eingesetzte Gerät ist für die Behandlung der Depression zugelassen; bei der Zwangsstörung behandeln wir im Rahmen eines individuellen Heilversuchs.
In our practice we treat with:
Chronische Schmerzen
Nervenschmerzen entstehen, wenn das schmerzleitende System selbst geschädigt ist, etwa nach einer Gürtelrose, einem Schlaganfall oder bei Multipler Sklerose. Sie sprechen auf übliche Schmerzmittel oft nur begrenzt an.
Background
Die Magnetstimulation setzt am Motorkortex an, auf der Gegenseite zum Schmerz. Von dort werden körpereigene Opioide freigesetzt und die Weiterleitung des Schmerzes gedämpft.
Anders als bei anderen Indikationen nimmt der Effekt beim Nervenschmerz mit jeder Wiederholung eher zu als ab. Dafür muss allerdings in Abständen weiterbehandelt werden.
Prevalence
Schätzungen zufolge leiden rund 5 % der Bevölkerung an neuropathischen Schmerzen. Belegt wirksam ist die Behandlung vor allem bei Schmerzen nach Gürtelrose und bei zentralem Schmerz, etwa nach einem Schlaganfall oder bei Multipler Sklerose.
Neurostimulation for Chronische Schmerzen
Die europäische Leitlinie zur therapeutischen Anwendung der Magnetstimulation bewertet die Stimulation des Motorkortex bei neuropathischem Schmerz mit Empfehlungsgrad A, ihrer höchsten Stufe. Ob ein Patient profitiert, lässt sich davor nicht sagen: etwa die Hälfte der Behandelten spricht nicht an. Das eingesetzte Gerät ist für die Behandlung der Depression zugelassen; beim Schmerz behandeln wir im Rahmen eines individuellen Heilversuchs.
In our practice we treat with:
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Suitability is assessed by a doctor in each individual case. The treatments are self-pay services; private health insurers often reimburse them.