Transcranial Pulse Stimulation | TPS

Transcranial Pulse Stimulation (TPS) is stimulation of the brain with pulsed ultrasound waves that can be targeted to a particular position, without surgery, without a general anaesthetic, and usually taking about 30–45 minutes per session. The present evidence indicates that TPS may help memory, attention, and mood in some patients with Alzheimer's, when used as part of holistic care and followed up closely by a doctor. It is an option of interest for those wanting a non-surgical approach to reinforce the rehabilitation of the brain.

At PYONG Rehabilitation Penthouse Clinic (Gaysorn Tower, floor 11, BTS Chidlom) you will be assessed and have the goals of your rehabilitation set by a rehabilitation physician, coordinating a multidisciplinary team (physiotherapist/occupational therapist/speech therapist/clinical psychologist/dietitian) in order to plan for the individual, with safety cared for at every step, in a location in the heart of the city convenient to reach (tps-neuro.com (opens in a new tab))

What is TPS?

TPS (Transcranial Pulse Stimulation) is a technology of stimulating the brain with ultrasound waves in very short pulses, sent through the skull to the target area of the brain specifically. What is particular about TPS is that it uses "short rhythmic pulses" rather than a continuous wave, which reduces the arising of heat in the tissue of the brain and allows the physician carrying out the procedure to set the path of brain stimulation by reference to the brain image of the individual patient (such as an MRI). During the procedure the person receiving the service can sit or lie comfortably, needs no anaesthetic, and can go home immediately afterwards.

In patients with Alzheimer's, it is reported that the scores of tests of memory and cognition may improve temporarily after receiving TPS as an initial course, and some plans of treatment use TPS as booster stimulation at intervals to sustain the result. However, the result of using TPS depends on the severity of the condition, the underlying structure of the brain, and the overall rehabilitation programme received alongside (such as memory training/daily activities/nutrition/sleep) (PMC (opens in a new tab), Wiley Online Library (opens in a new tab), MDPI (opens in a new tab))

Why have TPS at PYONG Rehabilitation

Transcranial Pulse Stimulation (TPS) is an advanced non-invasive medical technology designed for treating patients with Alzheimer's disease, particularly at the early to moderate stage. PYONG Rehabilitation Penthouse is one of the few leading medical establishments in Thailand to have brought this technology into service, using the most modern model of TPS device, accepted at international level, from Switzerland, certified for use with patients with Alzheimer's.

The TPS device PYONG Rehabilitation has chosen uses an acoustic pulse focused as deep as 8 cm into the brain, which is deeper than most methods of brain stimulation that need no surgery.
It has a BodyTrack® system connected with MRI data and tracking the position in real time, so that the doctor knows exactly where the wave is being sent. This allows the TPS device at PYONG Rehabilitation to send the wave into treatment precisely and in a shorter time than other methods of treatment, taking only about 30 minutes of treatment per session and using a low-energy wave (≈ 0.25 mJ/mm²), so that no heat arises in the tissue, reducing the risk and increasing the comfort of the patient.

• The rehabilitation physician oversees every step, from the assessment and the choice of protocol through to following up the actual result
• A multidisciplinary team in the neurological and older-adult line (Penthouse Clinic) combines TPS with programmes of memory/routine training, physiotherapy, occupational therapy, nutrition, and sleep hygiene
• There is technology referencing the individual brain image (MRI) and standard tests, so that the follow-up has clear indicators
• A convenient location in the heart of Bangkok, Gaysorn Tower, floor 11, next to BTS Chidlom, easy to reach for the family and carers
  because our goal is "a better quality of life for the patient and the family"

How does TPS work?

TPS uses mechanical stimulation of the nervous system (mechanotransduction) from short pulsed ultrasound waves that affect the working of the neural networks in the areas of memory and attention. TPS may promote microcirculation and the plasticity of the brain. During it the person receiving the service feels only the movement of the probe head and the cool gel on the head; there is no wound and no needle. The steps in treatment with TPS consist of:

1. Assessment by the doctor and tests of memory (MoCA/MMSE/ADAS-Cog)
2. Planning the positions from the MRI of the brain of the person receiving the service
3. Stimulating the brain with TPS at various points, totalling about 6,000 pulses per session, taking about 30–45 minutes
4. Going home and making an appointment according to the programme of treatment
   The plan of treatment with TPS most often met is to receive treatment with TPS at least 6 times within 2 weeks, after which booster stimulation with the TPS device every 4–6 weeks sustains the result. The doctor, however, will adjust this according to the symptoms and the response of each person (there may be other approaches to treatment, such as stimulation with the TPS device 10 times in 5 weeks) (tps-neuro.com (opens in a new tab), Frontiers (opens in a new tab), PubMed (opens in a new tab))

The symptoms/conditions suited to TPS

• Alzheimer's at the early to moderate stage (with a carer following up alongside)
• Mild cognitive impairment (MCI) with problems of memory/attention
• Those who forget where they have put things, put something down and cannot find it, or find it hard to manage a task of several steps
• Those whose concentration has shortened and who are easily confused in a new environment
• Those with depressed mood/anxiety together with dementia (assessed by a doctor) (PMC (opens in a new tab))
• Those looking for a non-surgical option to reinforce the care of the brain
• Those who do not respond to certain treatments, or who bear the side effects of medicine poorly (under a doctor's care)
• Those who want an integrated rehabilitation programme together with memory training, daily routine, and nutrition

The academic evidence on TPS

• Preliminary studies report that the cognitive test scores of those receiving treatment improved after finishing treatment with TPS and were sustained for a period, together with a signal of increased working of the memory network on fMRI, with no severe harm found in the participants (PMC (opens in a new tab))
• Research reports an improved cognitive result after stimulation with TPS in some patients with Alzheimer's (the details of the plan of treatment differ from one individual to another) (JAMA Network (opens in a new tab))

In summary: TPS is a technology that is promising, but it should be used together with standard care and holistic rehabilitation under the supervision of a specialist physician in rehabilitation medicine.

How often should TPS be done?

The general approach to treatment begins with 6 sessions in 2 weeks (at least 48 hours apart), taking about 30–45 minutes per session. After the course ends, some may be advised to have booster stimulation every 4–6 weeks to help sustain the result. There are also alternative plans of treatment, such as 10 sessions in 5 weeks, which different centres choose differently according to their experience and the character of the patient.

Most importantly, the frequency and the number of sessions will be adjusted by the doctor after assessing the baseline data (cognitive scores, MRI images, co-existing conditions, medicines taken, the goals of the patient's family) and the actual response of the patient during treatment. There is no fixed plan of treatment for everyone. Our team will review the result consistently and integrate memory/routine training with the carer, so that the result helps improve the patient's quality of life as much as possible (tps-neuro.com (opens in a new tab), Frontiers (opens in a new tab), PubMed (opens in a new tab))

The result expected

• Short term (within the first week to 2 weeks after beginning treatment): some patients report feeling "clearer-headed/better focused/slightly better in mood" (PMC (opens in a new tab))
• Long term (4–6 weeks and beyond): some research reports higher cognitive scores (such as a higher ADAS-Cog) after finishing the initial treatment, which may be sustained with booster stimulation at intervals. However, Alzheimer's is a degenerative disease (Degenerative Disease), and so holistic rehabilitation should be maintained and the symptoms followed up continuously (MDPI (opens in a new tab), PMC (opens in a new tab))

Contraindications and points to be careful of in the procedure

The present data indicates that the side effects of TPS are usually slight and temporary, such as headache, tiredness, dizziness, or irritation of the skin from the gel, with no severe harm found in most reports. However, there are important contraindications, namely metal/a device in the head or a brain pacemaker, an abnormality of blood clotting (such as haemophilia), a thrombotic state, a tumour in the area of treatment, and having received corticosteroids within 6 weeks before beginning treatment. Besides this, a recent MRI is necessary to help plan the position of stimulation safely. Every case has the history taken, the body examined, and screening by a doctor beforehand, always (PMC (opens in a new tab), tps-neuro.com (opens in a new tab))

The cost

The price depends on the assessment of the plan of treatment by the doctor, in order to choose the plan of treatment suited to the level of the symptoms, in accordance with what the MRI shows and the goals of treatment of the patient's family. In general, the cost of assessment and of treatment with the TPS device by the doctor and the team of specialists is about 5,000–10,000 baht per session.

Frequently asked questions (FAQ)

1) How does TPS differ from TMS?

TPS uses "pulsed ultrasound waves" through the skull to stimulate the brain at a specific position, while TMS uses an electromagnetic field. Both are procedures that need no surgery, but their mechanisms and indications differ — the doctor will help choose the procedure suited to the patient.

2) What has to be prepared?

A recent MRI of the brain is needed, to be used in setting the position of stimulation, and the medicines you are taking/your history of co-existing conditions should be brought for the doctor to assess before beginning treatment (tps-neuro.com (opens in a new tab))

3) How does it feel during it? Is it painful?

Mostly it is not painful; you may feel the movement of the probe head. The time per session is about 30–45 minutes, and you can go home immediately after the procedure (tps-neuro.com (opens in a new tab))

4) Who should not have TPS?

Those with metal/a device in the head or a brain pacemaker, an abnormality of blood clotting, a thrombotic state, a tumour in the area of treatment, or who have received steroids in the past 6 weeks — it must be avoided or postponed, and the doctor will consider it case by case (tps-neuro.com (opens in a new tab))

5) How long will the result last? Is a booster needed?

Some receive a temporary benefit after the initial period of treatment, and booster stimulation every 4–6 weeks may be advised to sustain the result. The doctor will adjust this according to the response and the goals of the family (tps-neuro.com (opens in a new tab), MDPI (opens in a new tab))

Choosing a place to treat pain and conditions of the brain from a clinic cared for by a team of specialist physicians with expertise, such as PYONG Rehabilitation Clinic and PYONG Rehabilitation Penthouse, helps the patient receive effective and safe care, with modern technology, so that the patient has the chance to recover and return to a better quality of life quickly.