Shock wave stimulation, new hope against Alzheimer's

Absences, gradual memory loss, insomnia, disorientation, apathy, depression, lack of concentration…. They are small clues that can make us glimpse the tip of the iceberg that is hidden behind a neurodegenerative disease. And if this happens, Alzheimer's usually has the majority of ballots to give it a title, since it is the most frequent form of dementia (it accounts for at least 60% of cases), as well as the main cause of cognitive deterioration in the world that, according to experts, will increase in the coming decades, due to the aging of the population, according to data from the Spanish Society of Neurology (SEN).

With that black horizon as a backdrop, and knowing that Alzheimer's currently has no cure, it is essential to look for new alternatives that allow us to face the advance of the disease and, at least, slow down its progression.. And this is where transcranial stimulation with shock waves comes into play, a pioneering alternative in our country but which has extensive experience in other European countries, such as Austria or Germany.

«Transcranial stimulation with mechanoacoustic shock waves improves communication between neurons and the passage of molecules. In addition, it generates an opening of the blood-brain barrier, optimizing the exchange of substances between the brain and the rest of the body.. Thus, it increases the levels of brain growth factor and endothelial growth factor, with the consequent increase in vascularization and cell proliferation.. It also acts on neurotransmitters, increasing serotonin and dopamine levels,” explains Dr. Karin Freitag, director of Clínica DKF in Madrid, a pioneer in Alzheimer's treatment in Spain with Neurolith, the first procedure based on transcranial stimulation with shock waves and, at the moment, the only one approved in 2018 by the CE for its application in the field of Neurology.

initial stages

As Freitag details, “Neurolith is particularly indicated for the treatment of cognitive impairment in the mild and moderate stages of Alzheimer's, as it promotes cerebral vascularization and improves performance and connections between neurons.”. The more neurons are preserved, the more substrate exists to stimulate. Therefore, the sooner it is treated, the better.. Early intervention in the initial stages of the disease helps delay its progression, maintaining the functionality of patients for longer, improving their quality of life and avoiding the overload of caregivers.. It would even be the best preventive treatment option in mental health.”

And that is precisely what the patients and relatives of those who have tried this pioneering technique report.. «At the last International Congress on Alzheimer's and Parkinson's, which took place in Gothenburg, Sweden, we shared with the scientific community the results of our latest study in patients diagnosed with Alzheimer's.. In said work we observed a global cognitive improvement three months after the treatment. The main improvements were especially in apathy, initiative and mood. We also saw great results in the overall cognitive performance of those affected and, specifically, in cognitive functions such as attention, orientation and immediate memory”, says Miguel Ángel Fernández, neuropsychologist at the Cognitive Impairment Unit of Clínica DKF. These observations are “in line with scientific studies published to date reporting a benefit in cognitive performance in patients.”. Among these publications, we can cite the works of the Cont group or those of Beisteiner”, points out Freitag.

To achieve this promising effect that seems to slow down Alzheimer's, the treatment carried out at Clínica DKF consists of “six sessions of 30 minutes each that are carried out on alternate days for two weeks. Likewise, a seventh reinforcement session is applied a month after it has finished”, details Fernández.

Scientific evidence

In order to give consistency to this promising use of shock waves and to better understand its great potential, Clínica DKF works tenaciously to scientifically demonstrate the advantages achieved with this procedure.. «In May our publication in the prestigious journal ''Current Alzheimer Research'' comes out with an exhaustive review of the Neurolith evidence carried out by our team of professionals. As the most relevant conclusions, we can advance this previously mentioned improvement in the cognitive and affective sphere”, advances Freitag, who acknowledges that “Alzheimer's currently has no cure and, until that moment arrives, we must rely on all the therapies and treatments that help us improve the quality of life of our patients. To do this, we must be very involved in research and in the most innovative techniques that emerge outside our borders”.

The next step in this long journey will be to present at the Congress of the International Society for Shock Waves (ISMT), to be held in July in South Korea, “the preliminary data of our study with more than 20 patients treated with Neurolith. Based on these initial data, we hope to subsequently publish the results in a prestigious peer-reviewed scientific journal, which means that there are external and international reviewers who are experts in the subject who act as an objective filter of the suitability of the article content.. This is very important, because people have to know that the publications have an important scientific endorsement behind them”, highlights Freitag. In fact, as the specialist adds, “one of the particularities of our study, which makes it distinctive and innovative, is that we are going to compare the data of our patients treated with Neurolith with a control group of patients who have not undergone to treatment. This will contrast the benefits of the technique with the natural course of the disease.. So far this has never been published. We see the improvements, we see it every day in our patients, but it is essential to carry out this study in this way for its scientific endorsement”.

And this evidence is necessary, since the most classical neurologists are still reticent about these alternatives, which are unknown in routine clinical practice.. «More studies would be needed to be able to comment on this. It is necessary to carry out studies with a larger number of patients, prospectively and with greater methodological control.. To this day, this type of procedure is not included in any clinical guide,” says Raquel Sánchez del Valle, coordinator of the SEN's Behavior and Dementia Study Group.. Faced with this, Freitag emphasizes that she is “convinced that this is the right path. I opted for transcranial shock waves because I strongly believe in the potential they have, because of their great effect of neovascularization with the “stem cell call” effect and because I know that it is a path that still has a lot to offer us in other fields».

Magnetic stimulation, another way to investigate

Repetitive transcranial magnetic stimulation is being explored as a therapeutic procedure for pathologies of the nervous system, including Alzheimer's and mild cognitive impairment.. «It consists of applying a pulsed magnetic field on certain brain areas. To date, no level of evidence has been demonstrated. This does not imply that it is ruled out as a therapeutic weapon in these pathologies.. There are many works that seem to show some improvement, but do not have enough consistency to be considered effective.. Therefore, more studies are required”, affirms José Luis Relova, head of the Neurophysiology Service of the Hospital Clínico Universitario de Santiago and vice president of the Spanish Society of Clinical Neurophysiology, who stresses that “clinical neurophysiology in patients with dementia can help to establish a correct diagnosis of the process, which is an essential step to select the most appropriate therapeutic approach».

While these innovations are gaining ground, this week, for the first time, a drug approved by the US Food and Drug Administration has been shown to be capable of “slowing down cognitive decline and memory loss”, which is why Sánchez del Valle put all your hopes “in two new treatments, based on the use of monoclonal antibodies, which allow the pathophysiological processes of the disease to be modified. Although their effects may be moderate and one of them falls by the wayside, at least they will open the door to great advances that could change the course of the approach to the disease.