TPS useful for concussions, says a study

Transcranial Pulse Stimulation (TPS) in football-related concussions – Pilot Study

by Prof. Karsten Knobloch – here the original study

Background

Concussions frequently occur in contact sports such as soccer, American football, rugby, or ice hockey.

They are caused by a blow or impact to the head, neck, or body that transmits a sudden force to the brain. This can trigger a temporary dysfunction – often without visible changes on CT or MRI. Symptoms include headaches, dizziness, difficulty concentrating, memory problems, or delayed reactions.

Returning to sports too early increases the risk of re-injury and can lead to chronic changes in the brain in the long term.

What is TPS?

Transcranial Pulse Stimulation (TPS) is a novel, MRI-guided method in which focused, electromagnetically generated shock waves are directed specifically into the brain. These impulses stimulate nerve cells and can promote neuroplasticity—the brain’s ability to regenerate and form new connections. TPS is already being used successfully in Alzheimer’s disease to improve memory and mood.

The Pilot Study

The pilot study was conducted in Prof. Dr. Karsten Knobloch’s practice. Five male amateur soccer players (average age 25) with recent concussions were treated. TPS therapy began an average of 48 hours after the injury and consisted of three sessions spaced two days apart. 6,000 pulses with an energy of 0.2 mJ/mm² were applied over 30 minutes per treatment – the entire cerebrum was stimulated under MRI navigation.

Results

• No side effects in all participants
• Significant symptom improvement: According to the SCAT6 test, the number of complaints decreased from an average of 13 to 4 within 7 days, and the severity from 24 to 9 points.

• Memory, concentration, and orientation performance were good from the start and remained stable.
• Rapid return to sport: on average after 7 days (comparison with professional football: approx. 8–9 Days)

Significance

The results suggest that TPS could be a safe and well-tolerated adjunctive therapy for sports concussions to accelerate recovery. However, the observations are preliminary – larger, controlled studies are needed for a firm recommendation.

Conclusion

Typically cautiously worded so as not to suggest any promises: TPS could help shorten recovery time after a sports concussion and relieve symptoms more quickly. The method is painless, non-invasive, and showed no side effects in this first small study. Especially for sports with a high risk of head injuries, TPS could become an important component of rehabilitation in the future.

Comparison of TPS with other treatment approaches for concussion

Classical approach

The standard treatment for a concussion has so far primarily consisted of rest, observation, and a gradual increase in exercise intensity:

• Physical rest for several days
• Cognitive rest (no screens, no studying)
• Gradual return to sports and school/work
• Symptom-oriented measures (e.g., painkillers for headaches)

This strategy leads to improvement in most athletes within 7–14 days. However, in some patients, it can lead to prolonged symptoms.> occur (weeks to months, so-called “post-concussion syndrome”).

Other modern approaches

• Physiotherapy / vestibular therapy: Useful for dizziness and balance disorders, but often requires several weeks.
• Medicinal approaches: Only supportive; no medication can cure a concussion itself.
• Aerobic exercise (e.g., cycling): Increasingly recommended in recent years, it accelerates recovery, but only in the subacute stage.

How does TPS perform?

Knobloch’s pilot study shows that TPS leads to improvement very quickly – after just one week, the players were almost symptom-free and were able to return to play after an average of seven days. This puts TPS at the lower end of the usual recovery time, possibly even slightly faster than the traditional approach (approximately 8–10 days in professional football).

• Advantages of TPS
  • Faster symptom reduction (SCAT6 scale: -70% in 7 days)
  • No side effects
  • Non-invasive, painless
  • Could also be useful for longer-lasting symptoms (not yet studied here)
• Disadvantages / Open Questions
  • Only a small pilot study (5 patients)
  • No direct comparison studies with standard therapy or placebo yet
  • Cost and availability currently limited

Summary

While conventional treatment primarily relies on rest and time, TPS could actively accelerate the recovery process. Compared to other additional measures (physiotherapy, endurance training), TPS has a significantly faster and more comprehensive effect on symptoms – at least according to the data available so far. Logically, however, larger studies are needed for a definitive evaluation, as this five-patient study is not randomized.

EBM Level 4
The present study by Knobloch (2025) is a pilot study with five patients without a control group.

According to the criteria of Evidence-Based Medicine (EBM), the evidence is divided into levels:

• Level 1a: Systematic reviews and meta-analyses of RCTs
• Level 1b: Individual randomized controlled trials (RCTs) with narrow confidence intervals
• Level 2a/2b: Cohort studies or individual cohort studies or RCTs with methodological weaknesses
• Level 3a/3b: Case-control studies
• Level 4: Case series or observational studies without a control group
• Level 5: Expert opinions, pathophysiological considerations

Since this is a case series with Since there are only 5 patients without a comparison group, the study is Level 4 (case series evidence) according to EBM criteria.

This means:

• Very early level of evidence, well suited for hypothesis generation and for testing feasibility and safety.
• No basis for guideline recommendations yet.
• Next steps would be controlled randomized trials (Level 2–1b) to test efficacy and superiority over standard therapy.