In early May 2021, two more NEUROLITH systems were installed in Germany. Both the renowned Klinikum Wahrendorff in Sehnde near Hanover and the private practice of Prof. Dr Musa Citak in Hamburg are expanding their range of therapies with Transcranial Pulse Stimulation (TPS).
Prof. Dr Marc Ziegenbein, Medical Director and Chief Physician (right) &
Oliver Rosenthal, Senior Physician
The Klinikum Wahrendorff, led by chief physician Prof. Dr Marc Ziegenbein opened in May 2021 a new, modern treatment centre specifically for the early stimulation/maintenance of the mental abilities of people with Alzheimer’s disease. Transcranial Pulse Stimulation (TPS) with the NEUROLITH is part of the special therapy offer.
In addition, patients with Alzheimer’s dementia can now also be treated with the NEUROLITH system in Hamburg. Prof. Dr Citak was one of the first doctors in northern Germany to opt for the TPS system. »The first few patients are making very good progress. Relatives are very surprised and pleased by the positive effect,« says Prof. Dr Citak. In his private practice, the shock wave expert also uses various shock wave systems as well as a system for Extracorporeal Magnetotransduction Therapy (EMTT) from STORZ MEDICAL.
About TPS treatment
In 2018, Transcranial Pulse Stimulation (TPS) with the NEUROLITH system was the first, and hitherto only, procedure of its kind to obtain market authorization for the »treatment of the central nervous system of patients with Alzheimer’s disease«. TPS can stimulate deep cerebral regions, reaching as much as 8 cm into the brain.
Studies conducted at the University of Vienna under the direction of Prof. Dr Roland Beisteiner demonstrated a significant increase in cognitive performance in the CERAD test and a decrease in the Becks Depression Index in patients with mild to moderate dementia.(1) In addition, a significant correlation between neuropsychological improvement and cortical thickness increase in AD-critical brain areas was found after TPS treatment.(2)
In an ongoing study, Prof. Dr Beisteiner is investigating the effect of TPS therapy on the course of the disease in patients with Parkinson’s.
Transcranial Pulse Stimulation (TPS®) for the treatment of Alzheimer’s patients is now also available for patients in Switzerland. In early February 2021, the first NEUROLITH® system was successfully installed in the Praxis Alexander Russ in Zurich.
The NEUROLITH® practice A. Russ has already treated the first patients and reports that TPS® is in high demand: »We have numerous appointment requests from patients from the greater Zurich area, but also from the entire Lake Constance region and neighbouring southern Germany.«
In addition to Switzerland, TPS® is already available in Germany, Austria, Spain, France, Denmark, Portugal, England, Kuwait, Hong Kong, China and Canada. Another 15 installations are firmly planed until the middle of this year.
About TPS® treatment
In 2018, Transcranial Pulse Stimulation (TPS®) with the NEUROLITH® system was the first, and hitherto only, procedure of its kind to obtain market authorization for the »treatment of the central nervous system of patients with Alzheimer’s disease«.
TPS® can stimulate deep cerebral regions, reaching as much as 8 cm into the brain. Owing to the short duration of the TPS® stimulation, tissue heating is avoided. The pulses applied to the treatment area thus develop their maximum clinical effectiveness. TPS® treatment is performed through the closed skull. In studies, TPS® treatment has been shown to significantly improve CERAD test performance and to reduce Beck’s depression index in patients with mild to moderate dementia.
Thermal taster status (TTS) is a phenomenon in which thermal stimulation of specific areas of the tongue, causes a sensation of a distinct taste in the absence of a gustatory stimulus. Reports vary on what percentage of the general population is a thermal taster, occurrence of thermal tasters in research cohorts of between 20% and 50% has been reported.
Even within the group of thermal tasters, there are subgroups. These groups differ from one another in responsiveness to thermal stimuli in different areas of the tongue and the phantom taste that each type of stimulation arouses. Green and George report that “thermal sweetness” is a common taste occurring in half the thermal tasters in response to warming after the tongue was cooled, while Skinner et al. reported 25% of tasters tasting “bitter” while another 25% tasting “sour” in cooling trials.
In general, TTS is assessed by applying a thermode with a warming and a cooling stimulus, as each temperature change direction and specific temperatures elicits a different taste sensation in thermal tasters. Thermal taste is classically tested on the tip of the tongue, and some studies report findings from areas lateral of the tip or the back of the tongue. Several studies on thermal tasters have used Medoc’s Pathway 16*16 mm thermode or the Intra-oral thermode. An example of a testing protocol for TTS could be found in Eldeghaidy et al.’s study in which both warming trials and cooling trials were applied. A warming trial would start at 35°C, cooled down to 15°C and go up to 40°C, and held there for 10 sec., with a ramp of 1 °C/sec.
In Thermal tasters, the anterior part of the tongue, innervated by the chorda tympani nerve, shows a typical reaction to heating and to cooling, while the posterior part of the tongue, innervated by the glossopharyngeal nerve, reacts less typically, Cruz and Green found. Thermal taster status, along with another measure, 6-npropylthiouracil (PROP) taster status, form the taste phenotype.
A hypothesis existed that the fungiform papillae of the tongue would be responsible for thermal taste because of their high density at the tip of the tongue, and their dual role: as they contain both taste buds and mechanoreceptors that are innervated by gustatory and trigeminal nerve fibers. Eldeghaidy et al. found that TTS did not seem to be correlated to fungiform papillae density in contrast to PROP taster status, and thus must have a different mechanism. The taste phenotype as a whole, and the thermal taster status specifically, increasingly allure both neurology researchers and the food and beverage industry alike. Temperature may be actively integrated as a contributor in the totality of the gustatory experience when new taste product are planned to be released to market.
FDA has cleared MagVenture TMS Therapy® for adjunct treatment of Obsessive-Compulsive Disorder (OCD). This marks MagVenture’s second indication in the US. MagVenture TMS Therapy is already FDA cleared for the treatment of major depressive disorder.
MagVenture TMS Therapy is an adjunct treatment to existing OCD therapies which may involve pharmaceutical and behavioral therapy. It is an out-patient procedure with no systemic side effects. The treatment specifically targets the networks in the brain which are known to be particularly affected by OCD, including the deeper-lying structures.
“We have worked closely with brain researchers for well over 25 years, providing numerous TMS solutions to help advance the field of neuroscience – both basic and applied. Expanding the treatment options to include other indications than major depressive disorder, such as OCD, is one more important step towards helping more adult patients improve their mental health,” says VP of Sales, MagVenture Inc, Kerry Rome.
MagVenture TMS Therapy for OCD
What is OCD?
OCD is a mental health disorder characterized by unreasonable thoughts and fears (obsessions) which lead to repetitive behavior (compulsions). OCD can severely affect one’s daily life and routines and cause distress or even functional impairment. Although pharmaceutical and psychological interventions are available, some OCD patients experience limited results from these and need more therapeutic options.
Please note, the OCD treatment is currently only approved in the US by the FDA. The usage of TMS for any other purpose than the cleared indication, in the country in which the product is intended to be used, is considered investigational.
We are often asked by our customers: “what thermode should I use?” Our answer is usually: “it depends”.
This is one of the most common questions we are asked when a customer approaches us, intending to buy a thermal quantitative sensory testing (QST) device.
The thermode is the probe that is attached to the participants’ skin, that on command of the computer program changes its temperature to hot or cold.
There are several types of thermodes; which one fits you best, depends mostly on your intended use.
Let’s start with the basics:
The classic thermode size is the 30mm by 30mm contact surface thermode, or for short: the 30*30. This thermode size has been around for decades and has therefor gathered quite the following.
Most of the normative data that has been gathered with Medoc devices around the world, and specifically by the German Research Network on Neuropathic Pain, the DFNS, has been gathered with this 30*30 thermode,,. If you intend to compare your QST results to normative values that have been collected from healthy participants, you may want to consider using the 30*30.
Another quite common thermode size is the 16*16. This thermode has been in use with researchers and clinicians who wish to stimulate smaller areas, like the face or the tongue, or perform QST on children.
One of the most asked-about thermodes is the CHEPS thermode. This thermode is special, because its technology allows working at very high speeds, for both heat and cold stimulation.
These high speeds are especially important for researchers who want to use a fast thermal stimulation in order to record Contact Heat Evoked Potentials (CHEPs),, or Cold Evoked Potentials (CEPs). Others may be interested in an application called: phasic heat temporal summation, in which very fast noxious heat pulses are applied in order to test for the wind-up phenomenon,.
The above thermode types (30*30, 16*16, CHEPS) are also available in fMRI versions. fMRI thermodes are different from normal thermodes for having additional 10 meters cable length, allowing the device to be placed outside the magnetic chamber and only the thermode to pass through the waveguide, reducing noise artifacts and insuring safety. These thermodes have undergone thorough testing and validation in different MRI environments.
Then there are the specialized thermodes. Some quantitative sensory testing has been conducted on the most uncommon places in the body, to elucidate specific issues.
Intra-oral testing is conducted with a small diameter Intraoral thermode for varying purposes like; tooth sensitivity,, pain disorders involving the mouth or the faceand thermal taster status.
Medoc’s Intravaginal thermode, formerly known as the Genito-sensory-analyzer (GSA) is utilized in studies which seek to assess somatosensory function and pain of the genital area in women,, and men.
References: Hafner, J., Lee, G., Joester, J., Lynch, M., Barnes, E. H., Wrigley, P. J., & Ng, K. (2015). Thermal quantitative sensory testing: a study of 101 control subjects. Journal of Clinical Neuroscience, 22(3), 588-591.  Blankenburg, M., Boekens, H., Hechler, T., Maier, C., Krumova, E., Scherens, A., … & Zernikow, B. (2010). Reference values for quantitative sensory testing in children and adolescents: developmental and gender differences of somatosensory perception. PAIN®, 149(1), 76-88. Yarnitsky, D., & Sprecher, E. (1994). Thermal testing: normative data and repeatability for various test algorithms. Journal of the neurological sciences, 125(1), 39-45.  Sampaio, F. A., Sampaio, C. R., Cunha, C. O., Costa, Y. M., Alencar, P. N., Bonjardim, L. R., … & Conti, P. C. (2019). The effect of orthodontic separator and short‐term fixed orthodontic appliance on inflammatory mediators and somatosensory function. Journal of oral rehabilitation, 46(3), 257-267.  Yang, Q., Dorado, R., Chaya, C., & Hort, J. (2018). The impact of PROP and thermal taster status on the emotional response to beer. Food Quality and Preference, 68, 420-430.  Hainsworth, K. R., Simpson, P. M., Ali, O., Varadarajan, J., Rusy, L., & Weisman, S. J. (2020). Quantitative Sensory Testing in Adolescents with Co-occurring Chronic Pain and Obesity: A Pilot Study. Children, 7(6), 55.  Rosner, J., Hostettler, P., Scheuren, P. S., Sirucek, L., Rinert, J., Curt, A., … & Hubli, M. (2018). Normative data of contact heat evoked potentials from the lower extremities. Scientific reports, 8(1), 1-9.  Jutzeler, C. R., Rosner, J., Rinert, J., Kramer, J. L., & Curt, A. (2016). Normative data for the segmental acquisition of contact heat evoked potentials in cervical dermatomes. Scientific reports, 6, 34660.  Granovsky, Y., Anand, P., Nakae, A., Nascimento, O., Smith, B., Sprecher, E., & Valls-Solé, J. (2016). Normative data for Aδ contact heat evoked potentials in adult population: a multicenter study. Pain, 157(5), 1156-1163. Hüllemann, P., Nerdal, A., Binder, A., Helfert, S., Reimer, M., & Baron, R. (2016). Cold‐evoked potentials–Ready for clinical use?. European Journal of Pain, 20(10), 1730-1740. Staud, R., Weyl, E. E., Riley III, J. L., & Fillingim, R. B. (2014). Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients. PloS one, 9(2), e89086. Bar-Shalita, T., Vatine, J. J., Yarnitsky, D., Parush, S., & Weissman-Fogel, I. (2014). Atypical central pain processing in sensory modulation disorder: absence of temporal summation and higher after-sensation. Experimental brain research, 232(2), 587-595.  Elman, I., Upadhyay, J., Langleben, D. D., Albanese, M., Becerra, L., & Borsook, D. (2018). Reward and aversion processing in patients with post-traumatic stress disorder: functional neuroimaging with visual and thermal stimuli. Translational psychiatry, 8(1), 1-15.  Harrison, R., Zeidan, F., Kitsaras, G., Ozcelik, D., & Salomons, T. V. (2019). Trait mindfulness is associated with lower pain reactivity and connectivity of the default mode network. The Journal of Pain, 20(6), 645-654. Russo, A., Tessitore, A., Esposito, F., Di Nardo, F., Silvestro, M., Trojsi, F., … & Tedeschi, G. (2017). Functional changes of the perigenual part of the anterior cingulate cortex after external trigeminal neurostimulation in migraine patients. Frontiers in neurology, 8, 282.  Grahl, A., Onat, S., & Büchel, C. (2018). The periaqueductal gray and Bayesian integration in placebo analgesia. Elife, 7, e32930  Baad-Hansen, L., Lu, S., Kemppainen, P., List, T., Zhang, Z., & Svensson, P. (2015). Differential changes in gingival somatosensory sensitivity after painful electrical tooth stimulation. Experimental Brain Research, 233(4), 1109-1118  Rahal, V., Gallinari, M. D. O., Barbosa, J. S., Martins-Junior, R. L., Santos, P. H. D., Cintra, L. T. A., & Briso, A. L. F. (2018). Influence of skin cold sensation threshold in the occurrence of dental sensitivity during dental bleaching: a placebo controlled clinical trial. Journal of Applied Oral Science, 26.  Mo, X., Zhang, J., Fan, Y., Svensson, P., & Wang, K. (2015). Thermal and mechanical quantitative sensory testing in chinese patients with burning mouth syndrome–a probable neuropathic pain condition?. The journal of headache and pain, 16(1), 84.  Gruenwald, I., Mustafa, S., Gartman, I., & Lowenstein, L. (2015). Genital sensation in women with pelvic organ prolapse. International urogynecology journal, 26(7), 981-984. Reed, B. D., Sen, A., Harlow, S. D., Haefner, H. K., & Gracely, R. H. (2017). Multimodal vulvar and peripheral sensitivity among women with vulvodynia: a case-control study. Journal of lower genital tract disease, 21(1), 78.  Lesma, A., Bocciardi, A., Corti, S., Chiumello, G., Rigatti, P., & Montorsi, F. (2014). Sexual function in adult life following Passerini-Glazel feminizing genitoplasty in patients with congenital adrenal hyperplasia. The Journal of urology, 191(1), 206-211.  Chen, X., Wang, F. X., Hu, C., Yang, N. Q., & Dai, J. C. (2018). Penile sensory thresholds in subtypes of premature ejaculation: implications of comorbid erectile dysfunction. Asian journal of andrology, 20(4), 330.
The 5Th National CME and 2nd Hands-on-Training workshop is one of its kind in India delivering hands-on training in administration of rTMS Therapy. This year we welcome practitioners and researchers from across the country and world-wide to enlighten using the field of Transcranial Magnetic Stimulation.
This workshop creates a diverse platform for novel and keen individuals as well as
renowned national and international experts to collaborate together to further their knowledge.
Thus, this program not only sets up a platform to acquire skills evaluating TMS from
both clinical and research perspectives, but also sets an opportunity for networking.
The didactic sessions in program tend to cover series of topic relevant to running a
TMS clinical service or rTMS based research project, including:
Stimulation of the brain with magnetic pulses while depicting what happens in the brain at the same time with functional magnetic resonance imaging (functional MRI) That is the essense of interleaved TMS/fMRI.
With this complete turnkey TMS/fMRI research solution, it is possible to induce neural activity safely into targeted cortical regions, directly in the MRI scanner. Features of the MagVenture TMS/fMRI solution further include: The integration of TMS with functional MRI provides researchers with a unique tool to study human brain functional connectivity in real-time and assess how it can be altered by certain interventions, behaviour, or pathologies.
The small geometry of the B35 coil enables you to place multiple coils simultaneously on the head providing a focal, yet powerful stimulation. The B35 coil comes in different versions to suit your specific needs:
Another option is the D-shaped Cool-D50 coil with the stimulation center being placed at the edge of the coil. This allows for alternating stimulation of two centers in the brain only 2-3 cm apart.
Head motion compensation monitors the coil’s position, orientation and contact to the head at all times and actively follows any possible head movement during TMS. It ensures a high level of repeatability between TMS sessions, is integrable with MagVenture stimulators and coils and may be piloted by a neuronavigation system from Localite.
MagVenture offers a highly flexible solution which addresses all your requirements for accuracy, reliability and consistency in clinical research and thus, ultimately, help facilitate new treatment options. This even includes the possibility to perform true randomized, double-blinded, multi-center studies.A robotic solution and/or neuronavigation may easily be added to further enhance the reproducibility of your research.
MagVenture offers a number of coils with both an active and a placebo side for true double-blinded TMS studies: Cool D-B80 A/P, MMC-140 A/P, Cool-B65 A/P and Cool-B70 A/P.
MagVenture also offers a number of placebo coils for single-blinded research: MC-P-B70, MCF-P-B70 and MCF-P-B65
Plan stimulation areas, visualise the stimulation spot, and monitor and record the precise position of the research subject and coil with complete replicabibility. The turnkey solution provides full integration with MagVenture stimulators, allowing for automatic and easy exchange of all the needed information such as intensity, coil and stimulator type, MEPs, and temperature.
MagVenture offers a specifically dedicated coil for animal model research. It provides a unique opportunity to study the effects of TMS within a wide range of fields including behavioural, metabolic, (epi) genetics, molecular, and biochemical pathways. This research solution overcomes previously known challenges pertaining to focality, overheating, shape, and size. It provides complete replicability and reliability and, due to the small coil size, it will even fit inside a PET or SPECT imaging scanner with a minimum ø120mm bore which for some research purposes is important.
The number of stimuli available in small coils like the Cool-40 Rat Coil is a huge barrier for performing real TMS due to the heating of the TMS coil. The Cool-40 Rat coil overcomes this barrier as it operates with the special High-Performance Cooling System. This will allow for a high number of stimuli before overheating.
The small dimensions of the rat brain compared to the human brain makes it very challenging to provide efficient TMS stimulation using human coils, as they typically lack focus of the magnetic fields and largely out-limit the dimensions of the rat’s head. Further, the smaller coils that are currently available do not induce electrical fields in the brain that are comparable to the electrical fields elicited with human coils in the patient’s brain. All of these issues have been solved with the Cool-40 Rat coil due to the special design of the windings, the High-Performance Cooling System, and the bended shape.