Neuromodulation

Neuromodulation in Bonn:
TPS (Neurolith), tDCS & Vagus Nerve Stimulation

Summary: Gentle, non-invasive, outpatient. In my practice, I combine modern neuromodulatory procedures based on the approach of SOZOBRAINCENTER.COM to specifically influence dysregulated networks of the central and peripheral nervous system—with the goal of reducing symptoms and improving everyday function.

Typical indications (selection):

  • Parkinson's disease
  • Alzheimer’s disease and other dementias
  • Amyotrophic lateral sclerosis (ALS)
  • Epilepsy
  • Depression (unipolar)
  • Sleep disorders/insomnia
  • Autism spectrum disorder
  • Inflammatory bowel disease (IBD; Crohn’s disease, ulcerative colitis)
  • Multiple sclerosis (MS)
  • Tic disorders (incl. Tourette syndrome)
  • (e.g., with central sensitization)

Why neuromodulation?

Neurological and psychiatric conditions are network dysfunctions—not just lesions of single areas. Neuromodulation uses electrical, pulsed-ultrasonic, or vagal stimuli to modulate neuronal excitability, synaptic plasticity (incl. meta-/homeostatic plasticity) and functional connectivity. This can lessen symptoms, open rehabilitation windows, and complement pharmacotherapy.

Our procedures

1) Transcranial Pulse Stimulation (TPS) with Neurolith® (Storz Medical)

Principle: Ultrashort acoustic pulses (pulsed ultrasound, non-thermal) are applied in a navigation-guided manner to cortical target regions. Mechanistic targets:

  • neurovascular coupling
  • BDNF-mediated plasticity
  • network reconnection

Process:

– Precise target planning (history, findings, optionally imaging)
– 6–8 sessions of 30–45 min, typically 2×/week
– Monitoring: clinical assessment and standardized scales

Use cases:

– cognitive impairment/dementia
– Parkinson’s disease (akinesia/freezing, executive functions)
– depression
– chronic pain
– autism

Adverse effects: usually mild (brief head pressure, fatigue). No radiation exposure.

Evidence base: growing yet heterogeneous; biologically plausible, long-term data limited (emerging evidence).

2) Transcranial Direct Current Stimulation (tDCS, if needed HD-tDCS)

Principle: Weak direct currents (typically 1–2 mA) modulate cortical excitability (anodal, cathodal) and metaplasticity.

Process:

– Montage according to target network (e.g., DLPFC for depression, M1/S1 for pain, temporo-parietal for epilepsy/tics)
– 20–30 min per session; home-use devices after instruction; typically 2×/day per protocol
– Synergy with cognitive-motor training (state-dependency) recommended

Use cases:

– depression
– chronic (low back) pain
– epilepsy (add-on)
– Parkinson’s (motor/FoG)
– sleep regulation
– executive functions in autism

Adverse effects: tingling/itching under electrodes, rarely headache; no downtime.

Evidence base: moderate for some indications (depression/pain), exploratory for others. Protocoland outcome-driven.

3) Transcutaneous Vagus Nerve Stimulation (taVNS)

Principle: Activation of vagal afferents modulates LC-noradrenergic and cholinergic anti-inflammatory pathways (the inflammatory reflex).

Process:
– Individual parameterization (frequency, pulse width, duty cycle)
– 15–30 min, 3–7×/week, home protocols after instruction
– Monitoring: symptom scales, HRV, optionally inflammatory markers

Use cases:

– depression/anxiety
– sleep disorders
– IBD
– epilepsy (add-on)
– autonomic imbalance
– pain

Adverse effects: usually mild (skin irritation, tingling, rarely cough/throat irritation). Not with implanted stimulators/pacemakers without prior clearance.

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How we work

1. Medical evaluation (medication, comorbidities, contraindications, goal setting)
2. Network targeting (clinical, optionally EEG/functional measures)
3. Therapy plan (TPS, tDCS/HD-tDCS, taVNS—alone or combined)
4. Objective outcomes (e.g., UPDRS, MoCA, BDI-II, PSQI, HRV, pain NRS)
5. Follow-up & boosters depending on response pattern

Who is not a good candidate?

– Pregnancy (relative, depending on procedure)
– Uncontrolled epilepsy for certain protocols, acute psychosis
– Active skin inflammation at electrode sites
– Implanted electronic devices (e.g., pacemaker), case-by-case clearance

Frequently asked questions (FAQ)

How quickly does treatment work?
First effects often after 3–6 sessions; consolidation with full cycles and adjunct training.

 

Can it be combined with medication?
Yes—dose adjustments are medically supervised.

 

Is it painful?
Generally no—occasional transient sensations may occur.

 

Will insurance cover it?
Mostly self-pay/private. Case-by-case reimbursement may be possible.

 

How do we measure success?
Standardized scales (UPDRS, MoCA, BDI-II, PSQI), HRV, pain NRS, and functional goals.

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