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Title: Transcranial Pulse Stimulation (TPS) With Shockwaves Differs Significantly From Transcranial Focused Ultrasound (TFUS)
e-poster Number: INSIM27
Category: Neurology
Author Name: Pavel Novak
Institute: Storz Medical AG
Co-Author Name:
Abstract :
Low-intensity shockwaves (ESWT) are used in orthopedic, cardiology, urology, dermatology, and aesthetics since 1990. Brain stimulation with shockwaves (Transcranial Pulse Stimulation, TPS) was first applied in 2005.
Another focal, mechanical stimulation tool in medicine is the focused ultrasound. It is used for tissue ablation and drug delivery. Low intensity transcranial Focused Ultrasound (tFUS) is an emerging option for neuromodulation.
Shockwaves are single pulses(1µs) with high pressure amplitude, Fig.1. The asymmetrical pulse shape results in broad frequency spectrum. The average power density is less than 0.1 W/cm2. TPS uses Energy Flux Density (EFD) of up to 0.25 mJ/mm2, only 0.04mJ/mm2 reaches the brain.
Ultrasound is a continuous train of sinusoidal pressure oscillations, Fig.2 with frequency of 0.5 to 5MHz. The frequency spectrum is narrow (main frequency and its harmonics). The average power density is up to 25W/cm2. The skull attenuates transcranial FUS in a similar way like shockwaves. For minimizing the tissue heating, the continuous ultrasound train is applied intermittently with repeated bursts.
The TPS is approved (Europe) for the treatment of Alzheimer’s disease. The treatment of further neurological disorders is under clinical evaluation. TPS/shockwaves working principle is mechanotransduction, which describes the interactions between the mechanical stimulus and the resulting biological reactions.
tFUS applications are still experimental. The working principle resulting in neuromodulation is not yet fully understood.
TPS/shockwaves is long term evaluated stimulation method, which influences the tissue in multiple way. There is no tissue heating. tFUS results only in neuromodulation and is not yet approved.
