Focused Ultrasound Therapy
Focused ultrasound is an early-stage, non-invasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with epilepsy. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue. Where the beams converge, the ultrasound produces a variety of therapeutic effects without incisions or radiation.
Current treatments for epilepsy include medication, surgery, radiofrequency or laser ablation, deep brain stimulation, and stereotactic radiosurgery, all of which have limitations and side effects. Focused ultrasound has the potential to provide an alternative to invasive surgery or to replace or augment radiosurgery for treatment of tumors in the brain. There are no incisions, no ionizing radiation and no damage to surrounding healthy tissue. Focused ultrasound may also be able to enhance delivery of drug therapies, reducing toxicity and side-effects.
- Focused ultrasound is non-invasive – no incisions, holes in the skull, electrodes in the brain – and therefore has reduced risk for infection, blood clots, and mechanical tissue damage.
- Precise targeting minimizes damage to non-targeted healthy brain.
- Treatment can be a complement to drug therapy, enabling enhanced delivery into the brain via temporary opening of the blood-brain barrier.
A current clinical trial at Taipei Veteran’s General Hospital is using neuro-navigation to treat patients with refractory epilepsy.
A current clinical trial is underway at the University of Virginia, for patients with medication-refractory epilepsy with subcortical focal lesions.
Another clinical trial at the Brigham and Women’s University is enrolling patients with drug resistant temporal lobe epilepsy.
The Ohio State University has a current clinical trial for patients to prevent the secondary generalization from focal onset epilepsy.
A current clinical trial is underway at the University of California Los Angeles for medication-refractory epilepsy in patients with subcortical lesions.
Regulatory Approval and Reimbursement
Focused ultrasound is not approved by any regulatory bodies worldwide as a treatment for epilepsy, nor is the treatment reimbursed by medical insurance providers.
Preclinical Laboratory Studies
Preclinical studies are underway to investigate the use of various mechanisms of focused ultrasound in the treatment of epilepsy. Examples of these studies include:
- Focused ultrasound to temporarily disrupt the BBB and deliver promising drug therapies, including the dosing and timing (e.g. frequency) of drug administration.
- Focused ultrasound to induce neuromodulation, to stimulate or block signals in a specific area of the brain that are causing symptoms such as seizure.
Chen SG, Tsai CH, Lin CJ, Lee CC, Yu HY, Hsieh TH, Liu HL.Transcranial focused ultrasound pulsation suppresses pentylenetetrazol induced epilepsy in vivo. Brain Stimul. 2019 Sep 24. pii: S1935-861X(19)30374-2. doi: 10.1016/j.brs.2019.09.011.
Agnese V, Costa V, Scoarughi GL, Corso C, Carina V, De Luca A, Bellavia D, Raimondi L, Pagani S, Midiri M, Stassi G, Alessandro R, Fini M, Barbato G, Giavaresi G. Focused Ultrasound Effects on Osteosarcoma Cell Lines. Biomed Res Int. 2019 May 19;2019:6082304. doi: 10.1155/2019/6082304. eCollection 2019.
Parker WE, Weidman EK, Chazen JL, Niogi SN, Uribe-Cardenas R, Kaplitt MG, Hoffman CE. Magnetic resonance-guided focused ultrasound for ablation of mesial temporal epilepsy circuits: modeling and theoretical feasibility of a novel noninvasive approach. J Neurosurg. 2019 Jun 14:1-8. doi: 10.3171/2019.4.JNS182694. [Epub ahead of print] PMID: 31200385
Vejay N. Vakharia, MRCS , John S. Duncan, FRCP, Juri-Alexander Witt, PhD, Christian E. Elger, FRCP, Richard Staba, PhD, and Jerome Engel Jr, PhD. Getting the Best Outcomes from Epilepsy Surgery. ANN NEUROL 2018;83:676–690
Piper RJ, Hughes MA, Moran CM, Kandasamy J. Focused ultrasound as a non-invasive intervention for neurological disease: a review. Br J Neurosurg. 2016 Jun;30(3):286-93. doi: 10.3109/02688697.2016.1173189. Epub 2016 Apr 22.
Monteith S, Snell J, Eames M, Kassell NF, Kelly E, Gwinn R. Transcranial magnetic resonance-guided focused ultrasound for temporal lobe epilepsy: a laboratory feasibility study. J Neurosurg. 2016 Feb 12:1-8.
Kang JY, Wu C, Tracy J, Lorenzo M, Evans J, Nei M, Skidmore C, Mintzer S, Sharan AD, Sperling MR. Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy. Epilepsia. 2016 Feb;57(2):325-34. doi: 10.1111/epi.13284. Epub 2015 Dec 24.
Quigg M, Harden C. Minimally invasive techniques for epilepsy surgery: stereotactic radiosurgery and other technologies. J Neurosurg. 2014 Dec;121 Suppl:232-40. doi: 10.3171/2014.8.GKS141608. Review.
Wynn Legon, Tomokazu F Sato, Alexander Opitz, Jerel Mueller, Aaron Barbour, Amanda Williams & William J Tyler. Transcranial focused ultrasound modulates the activity of primary somatosensory cortex in humans. Nature Neuroscience (2014).
Jolesz FA, McDannold NJ. Magnetic resonance-guided focused ultrasound: a new technology for clinical neurosciences. Neurol Clin. 2014 Feb;32(1):253-69.
Dallapiazza R, McKisic MS, Shah B, Elias WJ. Neuromodulation for movement disorders. Neurosurg Clin N Am. 2014 Jan;25(1):47-58.
Click here for additional references from PubMed.
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