Modulation effect of low-intensity transcranial ultrasound stimulation on REM and NREM sleep

Ultrasound Neuromodulation for Sleep and Neurological Disorder Therapy: A Path to Clinical Translation

Ultrasound neuromodulation is a promising noninvasive technique capable of penetrating the skull and precisely targeting deep brain regions with millimeter accuracy. Recent studies have demonstrated that transcranial ultrasound stimulation (TUS) of sleep-related brain areas can induce sleep in mice and even trigger a reversible, hibernation-like state without causing damage. Beyond its utility in preclinical models of central nervous system diseases, such as epilepsy, tremors, Alzheimer's disease, and depression, TUS holds significant potential for clinical translation. Given that many neurological disorders, including Alzheimer's and Parkinson's disease, are associated with sleep abnormalities, leveraging clinical TUS applications for these diseases also creates a pathway for translating this technology to sleep modulation in human use. These findings highlight the potential for ultrasound neuromodulation to advance neuroscience research and clinical applications in sleep control.

Ambient chemical and physical approaches for the modulation of sleep and wakefulness

Humans spend a third of their lives asleep. While the sleep-wake behaviors are primarily modulated by homeostasis and circadian rhythm, several ambient chemical and physical factors, including light, sound, odor, vibration, temperature, electromagnetic radiation, and ultrasound, also affect sleep and wakefulness. Light at different wavelengths has different effects on sleep and wakefulness. Sound not only promotes but also suppresses sleep; this effect is mediated by certain nuclei, including the pedunculopontine nucleus and inferior colliculus. Certain sleep-promoting odorants regulate sleep through the involvement of the olfactory bulb and olfactory tubercle. In addition, vibrations may induce sleep through the vestibular system. A modest increase in ambient temperature leads to an increase in sleep duration through the involvement of the preoptic area. Electromagnetic radiation has a dual effect on sleep-wake behaviors. The stimulation produced by the ambient chemical and physical factors activates the peripheral sensory system, which converts the chemical and physical stimuli into nerve impulses. This signal is then transmitted to the central nervous system, including several nuclei associated with the modulation of sleep-wake behaviors. This review summarizes the effects of ambient chemical and physical factors on the regulation of sleep and wakefulness, as well as the underlying neurobiological mechanisms.

A systematic review of preclinical and clinical transcranial ultrasound neuromodulation and opportunities for functional connectomics

BACKGROUND

Low-intensity transcranial ultrasound has surged forward as a non-invasive and disruptive tool for neuromodulation with applications in basic neuroscience research and the treatment of neurological and psychiatric conditions.

OBJECTIVE

To provide a comprehensive overview and update of preclinical and clinical transcranial low intensity ultrasound for neuromodulation and emphasize the emerging role of functional brain mapping to guide, better understand, and predict responses.

METHODS

A systematic review was conducted by searching the Web of Science and Scopus databases for studies on transcranial ultrasound neuromodulation, both in humans and animals.

RESULTS

187 relevant studies were identified and reviewed, including 116 preclinical and 71 clinical reports with subjects belonging to diverse cohorts. Milestones of ultrasound neuromodulation are described within an overview of the broader landscape. General neural readouts and outcome measures are discussed, potential confounds are noted, and the emerging use of functional magnetic resonance imaging is highlighted.

CONCLUSION

Ultrasound neuromodulation has emerged as a powerful tool to study and treat a range of conditions and its combination with various neural readouts has significantly advanced this platform. In particular, the use of functional magnetic resonance imaging has yielded exciting inferences into ultrasound neuromodulation and has the potential to advance our understanding of brain function, neuromodulatory mechanisms, and ultimately clinical outcomes. It is anticipated that these preclinical and clinical trials are the first of many; that transcranial low intensity focused ultrasound, particularly in combination with functional magnetic resonance imaging, has the potential to enhance treatment for a spectrum of neurological conditions.

Modulatory effects of low-intensity retinal ultrasound stimulation on rapid and non-rapid eye movement sleep

Prior investigations have established that the manipulation of neural activity has the potential to influence both rapid eye movement and non-rapid eye movement sleep. Low-intensity retinal ultrasound stimulation has shown effectiveness in the modulation of neural activity. Nevertheless, the specific effects of retinal ultrasound stimulation on rapid eye movement and non-rapid eye movement sleep, as well as its potential to enhance overall sleep quality, remain to be elucidated. Here, we found that: In healthy mice, retinal ultrasound stimulation: (i) reduced total sleep time and non-rapid eye movement sleep ratio; (ii) changed relative power and sample entropy of the delta (0.5-4 Hz) in non-rapid eye movement sleep; and (iii) enhanced relative power of the theta (4-8 Hz) and reduced theta-gamma coupling strength in rapid eye movement sleep. In Alzheimer's disease mice with sleep disturbances, retinal ultrasound stimulation: (i) reduced the total sleep time; (ii) altered the relative power of the gamma band during rapid eye movement sleep; and (iii) enhanced the coupling strength of delta-gamma in non-rapid eye movement sleep and weakened the coupling strength of theta-fast gamma. The results indicate that retinal ultrasound stimulation can modulate rapid eye movement and non-rapid eye movement-related neural activity; however, it is not beneficial to the sleep quality of healthy and Alzheimer's disease mice.

The effectiveness and safety of low-intensity transcranial ultrasound stimulation: A systematic review of human and animal studies

Low-intensity transcranial ultrasound stimulation (LITUS) is a novel non-invasive neuromodulation technique. We conducted a systematic review to evaluate current evidence on the efficacy and safety of LITUS neuromodulation. Five databases were searched from inception to May 31, 2023. Randomized controlled human trials and controlled animal studies were included. The neuromodulation effects of LITUS on clinical or pre-clinical, neurophysiological, neuroimaging, histological and biochemical outcomes, and adverse events were summarized. In total, 11 human studies and 44 animal studies were identified. LITUS demonstrated therapeutic efficacy in neurological disorders, psychiatric disorders, pain, sleep disorders and hypertension. LITUS-related changes in neuronal structure and cortical activity were found. From histological and biochemical perspectives, prominent findings included suppressing the inflammatory response and facilitating neurogenesis. No adverse effects were reported in controlled animal studies included in our review, while reversible headache, nausea, and vomiting were reported in a few human subjects. Overall, LITUS alleviates various symptoms and modulates associated brain circuits without major side effects. Future research needs to establish a solid therapeutic framework for LITUS.