Recent Advances in the Use of Focused Ultrasound as a Treatment for Epilepsy.
Authors: Lescrauwaet E, Vonck K, Sprengers M, Raedt R, Klooster D, Carrette E, Boon P
Epilepsy affects about 1% of the population. Approximately one third of patients with epilepsy are drug-resistant (DRE). Resective surgery is an effective treatment for DRE, yet invasive, and not all DRE patients are suitable resective surgery candidates. Focused ultrasound, a novel non-invasive neurointerventional method is currently under investigation as a treatment alternative for DRE. By emitting one or more ultrasound waves, FUS can target structures in the brain at millimeter resolution. High intensity focused ultrasound (HIFU) leads to ablation of tissue and could therefore serve as a non-invasive alternative for resective surgery. It is currently under investigation in clinical trials following the approval of HIFU for essential tremor and Parkinson's disease. Low intensity focused ultrasound (LIFU) can modulate neuronal activity and could be used to lower cortical neuronal hyper-excitability in epilepsy patients in a non-invasive manner. The seizure-suppressive effect of LIFU has been studied in several preclinical trials, showing promising results. Further investigations are required to demonstrate translation of preclinical results to human subjects.
Introduction
Purpose
Transcranial ultrasound stimulation
Study Objective
To review published studies investigating the effects of low- and high-intensity focused ultrasound as potential treatments for epilepsy.
Animal model / Human subject
None.
Disease model
Epilepsy (drug-resistant epilepsy)
MRI or image guidance method
None.
Targeted brain region(s)
Cerebral cortex
Cargo name and characteristics
Focused ultrasound (FUS) — a noninvasive physical/energy-based therapeutic modality delivering focused acoustic waves to brain targets at millimeter resolution. Includes high-intensity focused ultrasound (HIFU), which produces thermal ablation of tissue for lesioning, and low-intensity focused ultrasound (LIFU), which modulates neuronal activity/noninvasively to suppress cortical hyperexcitability in epilepsy.
Route of administration
No drug/cargo delivered; treatment was delivered non-invasively via transcranial focused ultrasound (HIFU/LIFU)
Outcomes and Safety
Summary of Outcomes
Low-intensity focused ultrasound reduces neuronal hyperexcitability and suppresses seizures in preclinical models (with preliminary limited human data), while high-intensity focused ultrasound can noninvasively ablate targeted brain tissue but currently faces technical and safety limitations.
Safety-related matter
The paper states that safety is not yet established and further preclinical and clinical research with long-term follow-up is required, explicitly highlighting skull overheating as a potential adverse event and noting concerns about attaining ablation temperatures, stimulation-parameter uncertainty, and evaluation of risks related to reversible blood–brain barrier opening.
Brain Region
Ultrasound Parameters
Ultrasound instrument
None in text.
Duration of a single FUS session
None.
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