Parkinson’s disease treatment with shockwaves

Abstract

Abstract Shockwaves have been first successfully used for extracorporeal kidney stone disintegration in 1980. Meanwhile, low intensity shockwaves proved to be efficient for the treatment of non-unions, tendon- and muscular pain, wound healing, heart insufficiency, erectile dysfunction and aesthetics. Spasticity is treated since 1990, followed by the treatment of spinal cord injuries and unresponsive wakefulness. The working principle is the mechanical activation of biological processes called mechanotransduction resulting in anti-inflammatory effect, increased cell metabolism, release of nitric oxide (eNO) and of numerous growth factors. From 2010 to 2013, 18 patients with Parkinson’s disease were off-label treated. First, in order to determine an appropriate treatment rhythm and the energy dosage. A further 3 patients followed in 2017. The treatment was performed with focused shockwave generator and consisted of 6 approximately 30 minutes sessions within two weeks. 6000 pulses with energy flux density of 0.2mJ/mm2 at 5Hz were applied during each session in the region of interest of the brain. After the initial treatment block, the disease symptoms assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) improved by over 50%. The symptomatic improvements remained stable to date by regular monthly re-treatments (1 session) in one of the patients for 8 years and in the 3 other patients over 3 years. The UPDRS, motoric part decreased by more than 50% within the treatment period. The UPDRS, all 3 items, was reduced by 44%. There were no negative side effects. Parkinson’s disease treatment with shockwaves is safe and effective. The broad scope of shockwave stimulated biological effects in the brain seems to be an interesting and promising option as an extension to the established treatments. Further clinical trials with larger number of patients are necessary for regulatory clearance. A placebo controlled, randomized trial is ongoing. Keywords: Parkinson' disease, shockwaves, mechanotransduction, brain