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Cox SS, Connolly DJ, Peng X, Badran BW. A Comprehensive Review of Low-Intensity Focused Ultrasound Parameters and Applications in Neurologic and Psychiatric Disorders. Neuromodulation 2024:S1094-7159(24)00662-7. [PMID: 39230530 DOI: 10.1016/j.neurom.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/25/2024] [Accepted: 07/19/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVES Low-intensity focused ultrasound (LIFU) is gaining increased interest as a potential therapeutic modality for a range of neuropsychiatric diseases. Current neuromodulation modalities often require a choice between high spatial fidelity or invasiveness. LIFU is unique in this regard because it provides high spatial acuity of both superficial and deep neural structures while remaining noninvasive. This new form of noninvasive brain stimulation may provide exciting potential treatment options for a variety of neuropsychiatric disorders involving aberrant neurocircuitry within deep brain structures, including pain and substance use disorders. Furthermore, LIFU is compatible with noninvasive neuroimaging techniques, such as functional magnetic resonance imaging and electroencephalography, making it a useful tool for more precise clinical neuroscience research to further understand the central nervous system. MATERIALS AND METHODS In this study, we provide a review of the most recent LIFU literature covering three key domains: 1) the history of focused ultrasound technology, comparing it with other forms of neuromodulation, 2) the parameters and most up-to-date proposed mechanisms of LIFU, and finally, 3) a consolidation of the current literature to date surrounding the clinical research that has used LIFU for the modification or amelioration of several neuropsychiatric conditions. RESULTS The impact of LIFU including poststroke motor changes, pain, mood disorders, disorders of consciousness, dementia, and substance abuse is discussed. CONCLUSIONS Although still in its infancy, LIFU is a promising tool that has the potential to change the way we approach and treat neuropsychiatric disorders. In this quickly evolving field, this review serves as a snapshot of the current understanding of LIFU in neuropsychiatric research.
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Affiliation(s)
- Stewart S Cox
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA.
| | - Dillon J Connolly
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
| | - Xiaolong Peng
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
| | - Bashar W Badran
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA
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2
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Kop BR, Shamli Oghli Y, Grippe TC, Nandi T, Lefkes J, Meijer SW, Farboud S, Engels M, Hamani M, Null M, Radetz A, Hassan U, Darmani G, Chetverikov A, den Ouden HEM, Bergmann TO, Chen R, Verhagen L. Auditory confounds can drive online effects of transcranial ultrasonic stimulation in humans. eLife 2024; 12:RP88762. [PMID: 39190585 PMCID: PMC11349300 DOI: 10.7554/elife.88762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
Transcranial ultrasonic stimulation (TUS) is rapidly emerging as a promising non-invasive neuromodulation technique. TUS is already well-established in animal models, providing foundations to now optimize neuromodulatory efficacy for human applications. Across multiple studies, one promising protocol, pulsed at 1000 Hz, has consistently resulted in motor cortical inhibition in humans (Fomenko et al., 2020). At the same time, a parallel research line has highlighted the potentially confounding influence of peripheral auditory stimulation arising from TUS pulsing at audible frequencies. In this study, we disentangle direct neuromodulatory and indirect auditory contributions to motor inhibitory effects of TUS. To this end, we include tightly matched control conditions across four experiments, one preregistered, conducted independently at three institutions. We employed a combined transcranial ultrasonic and magnetic stimulation paradigm, where TMS-elicited motor-evoked potentials (MEPs) served as an index of corticospinal excitability. First, we replicated motor inhibitory effects of TUS but showed through both tight controls and manipulation of stimulation intensity, duration, and auditory masking conditions that this inhibition was driven by peripheral auditory stimulation, not direct neuromodulation. Furthermore, we consider neuromodulation beyond driving overall excitation/inhibition and show preliminary evidence of how TUS might interact with ongoing neural dynamics instead. Primarily, this study highlights the substantial shortcomings in accounting for the auditory confound in prior TUS-TMS work where only a flip-over sham and no active control was used. The field must critically reevaluate previous findings given the demonstrated impact of peripheral confounds. Furthermore, rigorous experimental design via (in)active control conditions is required to make substantiated claims in future TUS studies. Only when direct effects are disentangled from those driven by peripheral confounds can TUS fully realize its potential for research and clinical applications.
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Affiliation(s)
- Benjamin R Kop
- Donders Institute for Brain, Cognition, and Behaviour; Radboud University NijmegenNijmegenNetherlands
| | - Yazan Shamli Oghli
- Krembil Research Institute, University Health Network; University of TorontoTorontoCanada
| | - Talyta C Grippe
- Krembil Research Institute, University Health Network; University of TorontoTorontoCanada
| | - Tulika Nandi
- Neuroimaging Center; Johannes-Gutenberg University Medical Center MainzMainzGermany
| | - Judith Lefkes
- Donders Institute for Brain, Cognition, and Behaviour; Radboud University NijmegenNijmegenNetherlands
| | - Sjoerd W Meijer
- Donders Institute for Brain, Cognition, and Behaviour; Radboud University NijmegenNijmegenNetherlands
| | - Soha Farboud
- Donders Institute for Brain, Cognition, and Behaviour; Radboud University NijmegenNijmegenNetherlands
| | - Marwan Engels
- Donders Institute for Brain, Cognition, and Behaviour; Radboud University NijmegenNijmegenNetherlands
| | - Michelle Hamani
- Krembil Research Institute, University Health Network; University of TorontoTorontoCanada
| | - Melissa Null
- Neuroimaging Center; Johannes-Gutenberg University Medical Center MainzMainzGermany
| | - Angela Radetz
- Neuroimaging Center; Johannes-Gutenberg University Medical Center MainzMainzGermany
| | - Umair Hassan
- Neuroimaging Center; Johannes-Gutenberg University Medical Center MainzMainzGermany
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network; University of TorontoTorontoCanada
| | - Andrey Chetverikov
- Donders Institute for Brain, Cognition, and Behaviour; Radboud University NijmegenNijmegenNetherlands
- Department of Psychosocial Science, Faculty of Psychology, University of BergenBergenNorway
| | - Hanneke EM den Ouden
- Department of Psychosocial Science, Faculty of Psychology, University of BergenBergenNorway
| | - Til Ole Bergmann
- Neuroimaging Center; Johannes-Gutenberg University Medical Center MainzMainzGermany
- Leibniz Institute for Resilience Research MainzMainzGermany
| | - Robert Chen
- Krembil Research Institute, University Health Network; University of TorontoTorontoCanada
| | - Lennart Verhagen
- Donders Institute for Brain, Cognition, and Behaviour; Radboud University NijmegenNijmegenNetherlands
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3
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Lefaucheur JP, Moro E, Shirota Y, Ugawa Y, Grippe T, Chen R, Benninger DH, Jabbari B, Attaripour S, Hallett M, Paulus W. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter. Clin Neurophysiol 2024; 164:57-99. [PMID: 38852434 DOI: 10.1016/j.clinph.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/02/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
In this review, different aspects of the use of clinical neurophysiology techniques for the treatment of movement disorders are addressed. First of all, these techniques can be used to guide neuromodulation techniques or to perform therapeutic neuromodulation as such. Neuromodulation includes invasive techniques based on the surgical implantation of electrodes and a pulse generator, such as deep brain stimulation (DBS) or spinal cord stimulation (SCS) on the one hand, and non-invasive techniques aimed at modulating or even lesioning neural structures by transcranial application. Movement disorders are one of the main areas of indication for the various neuromodulation techniques. This review focuses on the following techniques: DBS, repetitive transcranial magnetic stimulation (rTMS), low-intensity transcranial electrical stimulation, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), and focused ultrasound (FUS), including high-intensity magnetic resonance-guided FUS (MRgFUS), and pulsed mode low-intensity transcranial FUS stimulation (TUS). The main clinical conditions in which neuromodulation has proven its efficacy are Parkinson's disease, dystonia, and essential tremor, mainly using DBS or MRgFUS. There is also some evidence for Tourette syndrome (DBS), Huntington's disease (DBS), cerebellar ataxia (tDCS), and axial signs (SCS) and depression (rTMS) in PD. The development of non-invasive transcranial neuromodulation techniques is limited by the short-term clinical impact of these techniques, especially rTMS, in the context of very chronic diseases. However, at-home use (tDCS) or current advances in the design of closed-loop stimulation (tACS) may open new perspectives for the application of these techniques in patients, favored by their easier use and lower rate of adverse effects compared to invasive or lesioning methods. Finally, this review summarizes the evidence for keeping the use of electromyography to optimize the identification of muscles to be treated with botulinum toxin injection, which is indicated and widely performed for the treatment of various movement disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA 4391, ENT Team, Paris-Est Créteil University, Créteil, France.
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Yuichiro Shirota
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Talyta Grippe
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanaz Attaripour
- Department of Neurology, University of California, Irvine, CA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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4
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Grippe T, Shamli-Oghli Y, Darmani G, Nankoo JF, Raies N, Sarica C, Arora T, Gunraj C, Ding MYR, Rinchon C, DiLuca DG, Pichardo S, Cardoso F, Lozano AM, Chen R. Plasticity-Induced Effects of Theta Burst Transcranial Ultrasound Stimulation in Parkinson's Disease. Mov Disord 2024; 39:1364-1374. [PMID: 38787806 DOI: 10.1002/mds.29836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Low-intensity transcranial ultrasound stimulation (TUS) is a noninvasive brain stimulation (NIBS) technique with high spatial specificity. Previous studies showed that TUS delivered in a theta burst pattern (tbTUS) increased motor cortex (MI) excitability up to 30 minutes due to long-term potentiation (LTP)-like plasticity. Studies using other forms of NIBS suggested that cortical plasticity may be impaired in patients with Parkinson's disease (PD). OBJECTIVE The aim was to investigate the neurophysiological effects of tbTUS in PD patients off and on dopaminergic medications compared to healthy controls. METHODS We studied 20 moderately affected PD patients in on and off dopaminergic medication states (7 with and 13 without dyskinesia) and 17 age-matched healthy controls in a case-controlled study. tbTUS was applied for 80 seconds to the MI. Motor-evoked potentials (MEP), short-interval intracortical inhibition (SICI), and short-interval intracortical facilitation (SICF) were recorded at baseline, and at 5 minutes (T5), T30, and T60 after tbTUS. Motor Unified Parkinson's Disease Rating Scale (mUPDRS) was measured at baseline and T60. RESULTS tbTUS significantly increased MEP amplitude at T30 compared to baseline in controls and in PD patients on but not in PD patients off medications. SICI was reduced in PD off medications compared to controls. tbTUS did not change in SICI or SICF. The bradykinesia subscore of mUPDRS was reduced at T60 compared to baseline in PD on but not in the off medication state. The presence of dyskinesia did not affect tbTUS-induced plasticity. CONCLUSIONS tbTUS-induced LTP plasticity is impaired in PD patients off medications and is restored by dopaminergic medications. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Talyta Grippe
- Department of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Canada
- Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil
- University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | | | | | - Can Sarica
- University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Tarun Arora
- University Health Network, Toronto, Canada
- Division of Clinical Neuroscience, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Mandy Yi Rong Ding
- University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Cricia Rinchon
- University Health Network, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Daniel G DiLuca
- Department of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Canada
- University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Samuel Pichardo
- Cumming School of Medicine, Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Francisco Cardoso
- Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Andres M Lozano
- University Health Network, Toronto, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Robert Chen
- Department of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Canada
- University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
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5
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Murphy KR, Farrell JS, Bendig J, Mitra A, Luff C, Stelzer IA, Yamaguchi H, Angelakos CC, Choi M, Bian W, DiIanni T, Pujol EM, Matosevich N, Airan R, Gaudillière B, Konofagou EE, Butts-Pauly K, Soltesz I, de Lecea L. Optimized ultrasound neuromodulation for non-invasive control of behavior and physiology. Neuron 2024:S0896-6273(24)00493-8. [PMID: 39079529 DOI: 10.1016/j.neuron.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/09/2024] [Accepted: 07/02/2024] [Indexed: 08/09/2024]
Abstract
Focused ultrasound can non-invasively modulate neural activity, but whether effective stimulation parameters generalize across brain regions and cell types remains unknown. We used focused ultrasound coupled with fiber photometry to identify optimal neuromodulation parameters for four different arousal centers of the brain in an effort to yield overt changes in behavior. Applying coordinate descent, we found that optimal parameters for excitation or inhibition are highly distinct, the effects of which are generally conserved across brain regions and cell types. Optimized stimulations induced clear, target-specific behavioral effects, whereas non-optimized protocols of equivalent energy resulted in substantially less or no change in behavior. These outcomes were independent of auditory confounds and, contrary to expectation, accompanied by a cyclooxygenase-dependent and prolonged reduction in local blood flow and temperature with brain-region-specific scaling. These findings demonstrate that carefully tuned and targeted ultrasound can exhibit powerful effects on complex behavior and physiology.
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Affiliation(s)
- Keith R Murphy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jordan S Farrell
- Department of Neurosurgery, Stanford University, Stanford, CA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, Boston, MA, USA; F.M. Kirby Neurobiology Center, Harvard Medical School, Boston, MA, USA
| | - Jonas Bendig
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Anish Mitra
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Charlotte Luff
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Ina A Stelzer
- Department of Anesthesia, Stanford University, Stanford, CA, USA
| | - Hiroshi Yamaguchi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Department of Neuroscience, Nagoya University, Nagoya, Japan
| | | | - Mihyun Choi
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Wenjie Bian
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, China; School of Life Sciences, Westlake University, Hangzhou, Zhejiang, China
| | - Tommaso DiIanni
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Esther Martinez Pujol
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Noa Matosevich
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Raag Airan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Brice Gaudillière
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Elisa E Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Kim Butts-Pauly
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Ivan Soltesz
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Luis de Lecea
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
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6
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Nandi T, Kop BR, Butts Pauly K, Stagg CJ, Verhagen L. The relationship between parameters and effects in transcranial ultrasonic stimulation. ARXIV 2024:arXiv:2407.01232v2. [PMID: 39010874 PMCID: PMC11247914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Transcranial ultrasonic stimulation (TUS) is rapidly gaining traction for non-invasive human neuromodulation, with a pressing need to establish protocols that maximise neuromodulatory efficacy. In this review, we aggregate and examine empirical evidence for the relationship between tunable TUS parameters and in vitro and in vivo outcomes. Based on this multiscale approach, TUS researchers can make better informed decisions about optimal parameter settings. Importantly, we also discuss the challenges involved in extrapolating results from prior empirical work to future interventions, including the translation of protocols between models and the complex interaction between TUS protocols and the brain. A synthesis of the empirical evidence suggests that larger effects will be observed at lower frequencies within the sub-MHz range, higher intensities and pressures than commonly administered thus far, and longer pulses and pulse train durations. Nevertheless, we emphasise the need for cautious interpretation of empirical data from different experimental paradigms when basing protocols on prior work as we advance towards refined TUS parameters for human neuromodulation.
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Affiliation(s)
- Tulika Nandi
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Benjamin R Kop
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Kim Butts Pauly
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lennart Verhagen
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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7
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In A, Strohman A, Payne B, Legon W. Low-intensity focused ultrasound to the posterior insula reduces temporal summation of pain. Brain Stimul 2024; 17:911-924. [PMID: 39089647 DOI: 10.1016/j.brs.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The insula and dorsal anterior cingulate cortex (dACC) are core brain regions involved in pain processing and central sensitization, a shared mechanism across various chronic pain conditions. Methods to modulate these regions may serve to reduce central sensitization, though it is unclear which target may be most efficacious for different measures of central sensitization. OBJECTIVE/HYPOTHESIS Investigate the effect of low-intensity focused ultrasound (LIFU) to the anterior insula (AI), posterior insula (PI), or dACC on conditioned pain modulation (CPM) and temporal summation of pain (TSP). METHODS N = 16 volunteers underwent TSP and CPM pain tasks pre/post a 10 min LIFU intervention to either the AI, PI, dACC or Sham stimulation. Pain ratings were collected pre/post LIFU. RESULTS Only LIFU to the PI significantly attenuated pain ratings during the TSP protocol. No effects were found for the CPM task for any of the LIFU targets. LIFU pressure modulated group means but did not affect overall group differences. CONCLUSIONS LIFU to the PI reduced temporal summation of pain. This may, in part, be due to dosing (pressure) of LIFU. Inhibition of the PI with LIFU may be a future potential therapy in chronic pain populations demonstrating central sensitization. The minimal effective dose of LIFU for efficacious neuromodulation will help to translate LIFU for therapeutic options.
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Affiliation(s)
- Alexander In
- Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA
| | - Andrew Strohman
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, 24016, USA
| | - Brighton Payne
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
| | - Wynn Legon
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA; Center for Human Neuroscience Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA; Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24016, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, 24016, USA; Department of Neurosurgery, Carilion Clinic, Roanoke, VA, 24016, USA.
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8
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Pellow C, Pichardo S, Pike GB. A systematic review of preclinical and clinical transcranial ultrasound neuromodulation and opportunities for functional connectomics. Brain Stimul 2024; 17:734-751. [PMID: 38880207 DOI: 10.1016/j.brs.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024] Open
Abstract
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.
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Affiliation(s)
- Carly Pellow
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Alberta, T2N 4N1, Canada.
| | - Samuel Pichardo
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Alberta, T2N 4N1, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada
| | - G Bruce Pike
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Alberta, T2N 4N1, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada
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9
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Legon W, Strohman A, In A, Payne B. Noninvasive neuromodulation of subregions of the human insula differentially affect pain processing and heart-rate variability: a within-subjects pseudo-randomized trial. Pain 2024; 165:1625-1641. [PMID: 38314779 PMCID: PMC11189760 DOI: 10.1097/j.pain.0000000000003171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 02/07/2024]
Abstract
ABSTRACT The insula is an intriguing target for pain modulation. Unfortunately, it lies deep to the cortex making spatially specific noninvasive access difficult. Here, we leverage the high spatial resolution and deep penetration depth of low-intensity focused ultrasound (LIFU) to nonsurgically modulate the anterior insula (AI) or posterior insula (PI) in humans for effect on subjective pain ratings, electroencephalographic (EEG) contact heat-evoked potentials, as well as autonomic measures including heart-rate variability (HRV). In a within-subjects, repeated-measures, pseudo-randomized trial design, 23 healthy volunteers received brief noxious heat pain stimuli to the dorsum of their right hand during continuous heart-rate, electrodermal, electrocardiography and EEG recording. Low-intensity focused ultrasound was delivered to the AI (anterior short gyrus), PI (posterior longus gyrus), or under an inert Sham condition. The primary outcome measure was pain rating. Low-intensity focused ultrasound to both AI and PI similarly reduced pain ratings but had differential effects on EEG activity. Low-intensity focused ultrasound to PI affected earlier EEG amplitudes, whereas LIFU to AI affected later EEG amplitudes. Only LIFU to the AI affected HRV as indexed by an increase in SD of N-N intervals and mean HRV low-frequency power. Taken together, LIFU is an effective noninvasive method to individually target subregions of the insula in humans for site-specific effects on brain biomarkers of pain processing and autonomic reactivity that translates to reduced perceived pain to a transient heat stimulus.
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Affiliation(s)
- Wynn Legon
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
- Center for Human Neuroscience Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
| | - Andrew Strohman
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, United States
| | - Alexander In
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Brighton Payne
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
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10
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Wilson MG, Riis TS, Kubanek J. Controlled ultrasonic interventions through the human skull. Front Hum Neurosci 2024; 18:1412921. [PMID: 38979100 PMCID: PMC11228146 DOI: 10.3389/fnhum.2024.1412921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/03/2024] [Indexed: 07/10/2024] Open
Abstract
Transcranial focused ultrasound enables precise and non-invasive manipulations of deep brain circuits in humans, promising to provide safe and effective treatments of various neurological and mental health conditions. Ultrasound focused to deep brain targets can be used to modulate neural activity directly or localize the release of psychoactive drugs. However, these applications have been impeded by a key barrier-the human skull, which attenuates ultrasound strongly and unpredictably. To address this issue, we have developed an ultrasound-based approach that directly measures and compensates for the ultrasound attenuation by the skull. No additional skull imaging, simulations, assumptions, or free parameters are necessary; the method measures the attenuation directly by emitting a pulse of ultrasound from an array on one side of the head and measuring with an array on the opposite side. Here, we apply this emerging method to two primary future uses-neuromodulation and local drug release. Specifically, we show that the correction enables effective stimulation of peripheral nerves and effective release of propofol from nanoparticle carriers through an ex vivo human skull. Neither application was effective without the correction. Moreover, the effects show the expected dose-response relationship and targeting specificity. This article highlights the need for precise control of ultrasound intensity within the skull and provides a direct and practical approach for addressing this lingering barrier.
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Affiliation(s)
- Matthew G Wilson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Thomas S Riis
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Jan Kubanek
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
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11
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Matt E, Radjenovic S, Mitterwallner M, Beisteiner R. Current state of clinical ultrasound neuromodulation. Front Neurosci 2024; 18:1420255. [PMID: 38962179 PMCID: PMC11219564 DOI: 10.3389/fnins.2024.1420255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
Unmatched by other non-invasive brain stimulation techniques, transcranial ultrasound (TUS) offers highly focal stimulation not only on the cortical surface but also in deep brain structures. These unique attributes are invaluable in both basic and clinical research and might open new avenues for treating neurological and psychiatric diseases. Here, we provide a concise overview of the expanding volume of clinical investigations in recent years and upcoming research initiatives concerning focused ultrasound neuromodulation. Currently, clinical TUS research addresses a variety of neuropsychiatric conditions, such as pain, dementia, movement disorders, psychiatric conditions, epilepsy, disorders of consciousness, and developmental disorders. As demonstrated in sham-controlled randomized studies, TUS neuromodulation improved cognitive functions and mood, and alleviated symptoms in schizophrenia and autism. Further, preliminary uncontrolled evidence suggests relieved anxiety, enhanced motor functions in movement disorders, reduced epileptic seizure frequency, improved responsiveness in patients with minimally conscious state, as well as pain reduction after neuromodulatory TUS. While constrained by the relatively modest number of investigations, primarily consisting of uncontrolled feasibility trials with small sample sizes, TUS holds encouraging prospects for treating neuropsychiatric disorders. Larger sham-controlled randomized trials, alongside further basic research into the mechanisms of action and optimal sonication parameters, are inevitably needed to unfold the full potential of TUS neuromodulation.
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Affiliation(s)
| | | | | | - Roland Beisteiner
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
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12
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Caffaratti H, Slater B, Shaheen N, Rhone A, Calmus R, Kritikos M, Kumar S, Dlouhy B, Oya H, Griffiths T, Boes AD, Trapp N, Kaiser M, Sallet J, Banks MI, Howard MA, Zanaty M, Petkov CI. Neuromodulation with Ultrasound: Hypotheses on the Directionality of Effects and a Community Resource. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.14.24308829. [PMID: 38947047 PMCID: PMC11213082 DOI: 10.1101/2024.06.14.24308829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Low-intensity Transcranial Ultrasound Stimulation (TUS) is a promising non-invasive technique for deep-brain stimulation and focal neuromodulation. Research with animal models and computational modelling has raised the possibility that TUS can be biased towards enhancing or suppressing neural function. Here, we first conduct a systematic review of human TUS studies for perturbing neural function and alleviating brain disorders. We then collate a set of hypotheses on the directionality of TUS effects and conduct an initial meta-analysis on the human TUS study reported outcomes to date (n = 32 studies, 37 experiments). We find that parameters such as the duty cycle show some predictability regarding whether the targeted area's function is likely to be enhanced or suppressed. Given that human TUS sample sizes are exponentially increasing, we recognize that results can stabilize or change as further studies are reported. Therefore, we conclude by establishing an Iowa-Newcastle (inTUS) resource for the systematic reporting of TUS parameters and outcomes to support further hypothesis testing for greater precision in brain stimulation and neuromodulation with TUS.
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Affiliation(s)
- Hugo Caffaratti
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Ben Slater
- Biosciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Nour Shaheen
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Ariane Rhone
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Ryan Calmus
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Michael Kritikos
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Sukhbinder Kumar
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Brian Dlouhy
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Hiroyuki Oya
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Tim Griffiths
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
- Biosciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Aaron D Boes
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Nicholas Trapp
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Marcus Kaiser
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Rui Jin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jérôme Sallet
- Stem Cell and Brain Research Institute, INSERM U1208, University of Lyon, Lyon, France
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Matthew I Banks
- Department of Anesthesiology, University of Wisconsin at Madison, WI, USA
| | - Matthew A Howard
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Mario Zanaty
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Christopher I Petkov
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
- Biosciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
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13
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Xia X, Wang Z, Zeng K, Nankoo JF, Darmani G, Tran S, Ding MYR, Chen R. Effects of the motor cortical theta-burst transcranial-focused ultrasound stimulation on the contralateral motor cortex. J Physiol 2024; 602:2931-2943. [PMID: 38872383 DOI: 10.1113/jp285139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/15/2024] [Indexed: 06/15/2024] Open
Abstract
Theta-burst transcranial ultrasound stimulation (tbTUS) increases primary motor cortex (M1) excitability for at least 30 min. However, the remote effects of focal M1 tbTUS on the excitability of other cortical areas are unknown. Here, we examined the effects of left M1 tbTUS on right M1 excitability. An 80 s train of active or sham tbTUS was delivered to the left M1 in 20 healthy subjects. Before and after the tbTUS, we measured: (1) corticospinal excitability using motor-evoked potential (MEP) amplitudes from single-pulse transcranial magnetic stimulation (TMS) of left and right M1; (2) interhemispheric inhibition (IHI) from left to right M1 and from right to left M1 using a dual-site paired-pulse TMS paradigm; and (3) intracortical circuits of the right M1 with short-interval intracortical inhibition and intracortical facilitation (ICF) using paired-pulse TMS. Left M1 tbTUS decreased right M1 excitability as shown by decreased MEP amplitudes, increased right M1 ICF and decreased short-interval IHI from left to right hemisphere at interstimulus interval (ISI) of 10 ms but not long-interval IHI at interstimulus interval of 40 ms. The study showed that left M1 tbTUS can change the excitability of remote cortical areas with decreased right M1 excitability and interhemispheric inhibition. The remote effects of tbTUS should be considered when it is used in neuroscience research and as a potential neuromodulation treatment for brain disorders. KEY POINTS: Transcranial ultrasound stimulation (TUS) is a novel non-invasive brain stimulation technique for neuromodulation with the advantages of being able to achieve high spatial resolution and target deep brain structures. A repetitive TUS protocol, with an 80 s train of theta burst patterned TUS (tbTUS), has been shown to increase primary motor cortex (M1) excitability, as well as increase alpha and beta movement-related spectral power in distinct brain regions. In this study, we examined on the effects of the motor cortical tbTUS on the excitability of contralateral M1 measured with MEPs elicited by transcranial magnetic stimulation. We showed that left M1 tbTUS decreased right M1 excitability and left-to-right M1 interhemispheric inhibition, and increased intracortical facilitation of right M1. These results lead to better understand the effects of tbTUS and can help the development of tbTUS for the treatment of neurological and psychiatric disorders and in neuroscience research.
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Affiliation(s)
- Xue Xia
- School of Social Development and Health Management, University of Health and Rehabilitation Sciences, Qingdao, China
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Zhen Wang
- Krembil Research Institute, University Health Network, Toronto, Canada
- School of Sport and Health Science, Xi'an Physical Education University, Xi'an, China
| | - Ke Zeng
- Krembil Research Institute, University Health Network, Toronto, Canada
- Department of Psychology, Faculty of Arts and Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | | | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Stephanie Tran
- Krembil Research Institute, University Health Network, Toronto, Canada
| | | | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
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14
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Song W, Jayaprakash N, Saleknezhad N, Puleo C, Al-Abed Y, Martin JH, Zanos S. Transspinal Focused Ultrasound Suppresses Spinal Reflexes in Healthy Rats. Neuromodulation 2024; 27:614-624. [PMID: 37530695 DOI: 10.1016/j.neurom.2023.04.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Low-intensity, focused ultrasound (FUS) is an emerging noninvasive neuromodulation approach, with improved spatial and temporal resolution and penetration depth compared to other noninvasive electrical stimulation strategies. FUS has been used to modulate circuits in the brain and the peripheral nervous system, however, its potential to modulate spinal circuits is unclear. In this study, we assessed the effect of trans-spinal FUS (tsFUS) on spinal reflexes in healthy rats. MATERIALS AND METHODS tsFUS targeting different spinal segments was delivered for 1 minute, under anesthesia. Monosynaptic H-reflex of the sciatic nerve, polysynaptic flexor reflex of the sural nerve, and withdrawal reflex tested with a hot plate were measured before, during, and after tsFUS. RESULTS tsFUS reversibly suppresses the H-reflex in a spinal segment-, acoustic pressure- and pulse-repetition frequency (PRF)-dependent manner. tsFUS with high PRF augments the degree of homosynaptic depression of the H-reflex observed with paired stimuli. It suppresses the windup of components of the flexor reflex associated with slower, C-afferent, but not faster, A- afferent fibers. Finally, it increases the latency of the withdrawal reflex. tsFUS does not elicit neuronal loss in the spinal cord. CONCLUSIONS Our study provides evidence that tsFUS reversibly suppresses spinal reflexes and suggests that tsFUS could be a safe and effective strategy for spinal cord neuromodulation in disorders associated with hyperreflexia, including spasticity after spinal cord injury and painful syndromes.
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Affiliation(s)
- Weiguo Song
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Nafiseh Saleknezhad
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Chris Puleo
- General Electric Research, Niskayuna, NY, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - John H Martin
- Department of Molecular, Cellular, and Biomedical Sciences, Center for Discovery and Innovation, City University of New York School of Medicine, New York, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY.
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15
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Tanaka M, Battaglia S, Giménez-Llort L, Chen C, Hepsomali P, Avenanti A, Vécsei L. Innovation at the Intersection: Emerging Translational Research in Neurology and Psychiatry. Cells 2024; 13:790. [PMID: 38786014 PMCID: PMC11120114 DOI: 10.3390/cells13100790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Translational research in neurological and psychiatric diseases is a rapidly advancing field that promises to redefine our approach to these complex conditions [...].
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Affiliation(s)
- Masaru Tanaka
- HUN-REN-SZTE Neuroscience Research Group, Hungarian Research Network, University of Szeged (HUN-REN-SZTE), Danube Neuroscience Research Laboratory, Tisza Lajos krt. 113, H-6725 Szeged, Hungary;
| | - Simone Battaglia
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology “Renzo Canestrari”, Cesena Campus, Alma Mater Studiorum Università di Bologna, 47521 Cesena, Italy;
- Department of Psychology, University of Turin, 10124 Turin, Italy
| | - Lydia Giménez-Llort
- Institut de Neurociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain;
- Department of Psychiatry & Forensic Medicine, Faculty of Medicine, Campus Bellaterra, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193 Barcelona, Spain
| | - Chong Chen
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan;
| | - Piril Hepsomali
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6ET, UK;
| | - Alessio Avenanti
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology “Renzo Canestrari”, Cesena Campus, Alma Mater Studiorum Università di Bologna, 47521 Cesena, Italy;
- Neuropsychology and Cognitive Neuroscience Research Center (CINPSI Neurocog), Universidad Católica del Maule, Talca 3460000, Chile
| | - László Vécsei
- HUN-REN-SZTE Neuroscience Research Group, Hungarian Research Network, University of Szeged (HUN-REN-SZTE), Danube Neuroscience Research Laboratory, Tisza Lajos krt. 113, H-6725 Szeged, Hungary;
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
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16
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Osada T, Konishi S. Noninvasive intervention by transcranial ultrasound stimulation: Modulation of neural circuits and its clinical perspectives. Psychiatry Clin Neurosci 2024; 78:273-281. [PMID: 38505983 DOI: 10.1111/pcn.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/12/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
Low-intensity focused transcranial ultrasound stimulation (TUS) is an emerging noninvasive technique capable of stimulating both the cerebral cortex and deep brain structures with high spatial precision. This method is recognized for its potential to comprehensively perturb various brain regions, enabling the modulation of neural circuits, in a manner not achievable through conventional magnetic or electrical brain stimulation techniques. The underlying mechanisms of neuromodulation are based on a phenomenon where mechanical waves of ultrasound kinetically interact with neurons, specifically affecting neuronal membranes and mechanosensitive channels. This interaction induces alterations in the excitability of neurons within the stimulated region. In this review, we briefly present the fundamental principles of ultrasound physics and the physiological mechanisms of TUS neuromodulation. We explain the experimental apparatus and procedures for TUS in humans. Due to the focality, the integration of various methods, including magnetic resonance imaging and magnetic resonance-guided neuronavigation systems, is important to perform TUS experiments for precise targeting. We then review the current state of the literature on TUS neuromodulation, with a particular focus on human subjects, targeting both the cerebral cortex and deep subcortical structures. Finally, we outline future perspectives of TUS in clinical applications in psychiatric and neurological fields.
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Affiliation(s)
- Takahiro Osada
- Department of Neurophysiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Seiki Konishi
- Department of Neurophysiology, Juntendo University School of Medicine, Tokyo, Japan
- Research Institute for Diseases of Old Age, Juntendo University School of Medicine, Tokyo, Japan
- Sportology Center, Juntendo University School of Medicine, Tokyo, Japan
- Advanced Research Institute for Health Science, Juntendo University School of Medicine, Tokyo, Japan
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17
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Lee K, Park TY, Lee W, Kim H. A review of functional neuromodulation in humans using low-intensity transcranial focused ultrasound. Biomed Eng Lett 2024; 14:407-438. [PMID: 38645585 PMCID: PMC11026350 DOI: 10.1007/s13534-024-00369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Transcranial ultrasonic neuromodulation is a rapidly burgeoning field where low-intensity transcranial focused ultrasound (tFUS), with exquisite spatial resolution and deep tissue penetration, is used to non-invasively activate or suppress neural activity in specific brain regions. Over the past decade, there has been a rapid increase of tFUS neuromodulation studies in healthy humans and subjects with central nervous system (CNS) disease conditions, including a recent surge of clinical investigations in patients. This narrative review summarized the findings of human neuromodulation studies using either tFUS or unfocused transcranial ultrasound (TUS) reported from 2013 to 2023. The studies were categorized into two separate sections: healthy human research and clinical studies. A total of 42 healthy human investigations were reviewed as grouped by targeted brain regions, including various cortical, subcortical, and deep brain areas including the thalamus. For clinical research, a total of 22 articles were reviewed for each studied CNS disease condition, including chronic pain, disorder of consciousness, Alzheimer's disease, Parkinson's disease, depression, schizophrenia, anxiety disorders, substance use disorder, drug-resistant epilepsy, and stroke. Detailed information on subjects/cohorts, target brain regions, sonication parameters, outcome readouts, and stimulatory efficacies were tabulated for each study. In later sections, considerations for planning tFUS neuromodulation in humans were also concisely discussed. With an excellent safety profile to date, the rapid growth of human tFUS research underscores the increasing interest and recognition of its significant potential in the field of non-invasive brain stimulation (NIBS), offering theranostic potential for neurological and psychiatric disease conditions and neuroscientific tools for functional brain mapping.
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Affiliation(s)
- Kyuheon Lee
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, 5 Hwarangro 14-gil, Seongbuk-gu, Seoul, 02792 South Korea
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Tae Young Park
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, 5 Hwarangro 14-gil, Seongbuk-gu, Seoul, 02792 South Korea
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, South Korea
| | - Wonhye Lee
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, 5 Hwarangro 14-gil, Seongbuk-gu, Seoul, 02792 South Korea
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Hyungmin Kim
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, 5 Hwarangro 14-gil, Seongbuk-gu, Seoul, 02792 South Korea
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, South Korea
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18
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Davidson B, Bhattacharya A, Sarica C, Darmani G, Raies N, Chen R, Lozano AM. Neuromodulation techniques - From non-invasive brain stimulation to deep brain stimulation. Neurotherapeutics 2024; 21:e00330. [PMID: 38340524 PMCID: PMC11103220 DOI: 10.1016/j.neurot.2024.e00330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/14/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Over the past 30 years, the field of neuromodulation has witnessed remarkable advancements. These developments encompass a spectrum of techniques, both non-invasive and invasive, that possess the ability to both probe and influence the central nervous system. In many cases neuromodulation therapies have been adopted into standard care treatments. Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial ultrasound stimulation (TUS) are the most common non-invasive methods in use today. Deep brain stimulation (DBS), spinal cord stimulation (SCS), and vagus nerve stimulation (VNS), are leading surgical methods for neuromodulation. Ongoing active clinical trials using are uncovering novel applications and paradigms for these interventions.
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Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Nasem Raies
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada.
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19
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Zadeh AK, Raghuram H, Shrestha S, Kibreab M, Kathol I, Martino D, Pike GB, Pichardo S, Monchi O. The effect of transcranial ultrasound pulse repetition frequency on sustained inhibition in the human primary motor cortex: A double-blind, sham-controlled study. Brain Stimul 2024; 17:476-484. [PMID: 38621645 DOI: 10.1016/j.brs.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Non-invasive brain stimulation techniques such as transcranial magnetic stimulation and transcranial direct current stimulation hold promise for inducing brain plasticity. However, their limited precision may hamper certain applications. In contrast, Transcranial Ultrasound Stimulation (TUS), known for its precision and deep brain targeting capabilities, requires further investigation to establish its efficacy in producing enduring effects for treating neurological and psychiatric disorders. OBJECTIVE To investigate the enduring effects of different pulse repetition frequencies (PRF) of TUS on motor corticospinal excitability. METHODS T1-, T2-weighted, and zero echo time magnetic resonance imaging scans were acquired from 21 neurologically healthy participants for neuronavigation, skull reconstruction, and the performance of transcranial ultrasound and thermal modelling. The effects of three different TUS PRFs (10, 100, and 1000 Hz) with a constant duty cycle of 10 % on corticospinal excitability in the primary motor cortex were assessed using TMS-induced motor evoked potentials (MEPs). Each PRF and sham condition was evaluated on separate days, with measurements taken 5-, 30-, and 60-min post-TUS. RESULTS A significant decrease in MEP amplitude was observed with a PRF of 10 Hz (p = 0.007), which persisted for at least 30 min, and with a PRF of 100 Hz (p = 0.001), lasting over 60 min. However, no significant changes were found for the PRF of 1000 Hz and the sham conditions. CONCLUSION This study highlights the significance of PRF selection in TUS and underscores its potential as a non-invasive approach to reduce corticospinal excitability, offering valuable insights for future clinical applications.
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Affiliation(s)
- Ali K Zadeh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | | | - Shirshak Shrestha
- Department of Biomedical Engineering, University of Calgary, Calgary, AB, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Iris Kathol
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - G Bruce Pike
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Samuel Pichardo
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montreal, QC, Canada; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
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Zeng K, Li Z, Xia X, Wang Z, Darmani G, Li X, Chen R. Effects of different sonication parameters of theta burst transcranial ultrasound stimulation on human motor cortex. Brain Stimul 2024; 17:258-268. [PMID: 38442800 DOI: 10.1016/j.brs.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Theta burst TUS (tbTUS) can induce increased cortical excitability in human, but how different sonication parameters influence the effects are still unknown. OBJECTIVE To examine how a range of sonication parameters, including acoustic intensity, pulse repetition frequency, duty cycle and sonication duration, influence the effects of tbTUS on human motor cortical excitability. METHODS 14 right-handed healthy subjects underwent 8 sessions with different tbTUS parameters in a randomized, cross-over design on separate days. The original tbTUS protocol was studied in one session and one parameter was changed in each of the seven sessions. To examine changes in cortical excitability induced by tbTUS, we measured the motor-evoked potential (MEP) amplitude, resting motor threshold, short-interval intracortical inhibition and intracortical facilitation, as well as short-interval intracortical facilitation before and up to 90 min after tbTUS. RESULTS All conditions increased MEP amplitudes except the condition with low acoustic intensity of 10 W/cm2. Pulse repetition frequency of 5 Hz produced higher MEP amplitudes compared to pulse repetition frequencies of 2 and 10 Hz. In addition, higher duty cycles (5%, 10%, and 15%) and longer sonication durations (40, 80, and 120 s) were associated with longer duration of increased MEP amplitudes. Resting motor threshold remained stable in all conditions. For paired-pulse TMS measures, tbTUS reduced short-interval intracortical inhibition and enhanced short-interval intracortical facilitation, but had no effect on intracortical facilitation. CONCLUSIONS Ultrasound bursts repeated at theta (∼5 Hz) frequency is optimal to produce increased cortical excitability with the range of 2-10 Hz. Furthermore, there was a dose-response effect regarding duty cycle and sonication duration in tbTUS for plasticity induction. The aftereffects of tbTUS were associated with a shift of the inhibition/excitation balance toward less inhibition and more excitation in the motor cortex. These findings can be used to determine the optimal tbTUS parameters in neuroscience research and treatment of neurological and psychiatric disorders.
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Affiliation(s)
- Ke Zeng
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Zhuhai, Guangdong, China; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Zhiwei Li
- School of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Xue Xia
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; School of Social Development and Health Management, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Zhen Wang
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; School of Sport and Health Science, Xi'an Physical Education University, Xi'an, China
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Xiaoli Li
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Zhuhai, Guangdong, China
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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21
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Riis TS, Losser AJ, Kassavetis P, Moretti P, Kubanek J. Noninvasive modulation of essential tremor with focused ultrasonic waves. J Neural Eng 2024; 21:016033. [PMID: 38335553 DOI: 10.1088/1741-2552/ad27ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/09/2024] [Indexed: 02/12/2024]
Abstract
Objective: Transcranial focused low-intensity ultrasound has the potential to noninvasively modulate confined regions deep inside the human brain, which could provide a new tool for causal interrogation of circuit function in humans. However, it has been unclear whether the approach is potent enough to modulate behavior.Approach: To test this, we applied low-intensity ultrasound to a deep brain thalamic target, the ventral intermediate nucleus, in three patients with essential tremor.Main results: Brief, 15 s stimulations of the target at 10% duty cycle with low-intensity ultrasound, repeated less than 30 times over a period of 90 min, nearly abolished tremor (98% and 97% tremor amplitude reduction) in 2 out of 3 patients. The effect was observed within seconds of the stimulation onset and increased with ultrasound exposure time. The effect gradually vanished following the stimulation, suggesting that the stimulation was safe with no harmful long-term consequences detected.Significance: This result demonstrates that low-intensity focused ultrasound can robustly modulate deep brain regions in humans with notable effects on overt motor behavior.
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Affiliation(s)
- Thomas S Riis
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, United States of America
| | - Adam J Losser
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, United States of America
| | - Panagiotis Kassavetis
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, United States of America
| | - Paolo Moretti
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, United States of America
- George E. Wahlen, VA, Salt Lake City Health Care System, Salt Lake City, UT 84148, United States of America
| | - Jan Kubanek
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, United States of America
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22
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Samuel N, Ding MYR, Sarica C, Darmani G, Harmsen IE, Grippe T, Chen X, Yang A, Nasrkhani N, Zeng K, Chen R, Lozano AM. Accelerated Transcranial Ultrasound Neuromodulation in Parkinson's Disease: A Pilot Study. Mov Disord 2023; 38:2209-2216. [PMID: 37811802 DOI: 10.1002/mds.29622] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Low-intensity transcranial focused ultrasound (TUS) is a novel method for neuromodulation. We aimed to study the feasibility of stimulating the bilateral primary motor cortices (M1) with accelerated theta-burst TUS (a-tbTUS) on neurophysiologic and clinical outcomes in Parkinson's disease (PD). METHODS Patients were randomly assigned to receive active or sham a-tbTUS for the first visit and the alternate condition on the second visit, at least 10 days apart. a-tbTUS was administered in three consecutive sonications at 30-minute intervals. We used an accelerated protocol to produce an additive effect of stimulation. Patients were studied in the OFF-medication state. Transcranial magnetic stimulation (TMS)-elicited motor-evoked potentials (MEPs) were used to assess motor cortical excitability before and after TUS. Clinical outcomes after a-tbTUS administration were assessed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS)-III. RESULTS A total of 20 visits were conducted in 10 PD patients. Compared to the baseline, TMS-elicited MEP amplitudes significantly increased following active but not sham sonication (P = 0.0057). MEP amplitudes were also higher following a-tbTUS than sham sonication (P = 0.0064). There were no statistically significant changes in MDS-UPDRS-III scores with active or sham a-tbTUS. CONCLUSIONS a-tbTUS increases motor cortex excitability and is a feasible non-invasive neuromodulation strategy in PD. Future studies should determine optimal dosing parameters and the durability of neurophysiologic and clinical outcomes in PD patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nardin Samuel
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Mandy Yi Rong Ding
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Can Sarica
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Irene E Harmsen
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Talyta Grippe
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease and The Morton & Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Xingyu Chen
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Andrew Yang
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Negar Nasrkhani
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Ke Zeng
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease and The Morton & Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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23
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Badawe HM, El Hassan RH, Khraiche ML. Modeling ultrasound modulation of neural function in a single cell. Heliyon 2023; 9:e22522. [PMID: 38046165 PMCID: PMC10686887 DOI: 10.1016/j.heliyon.2023.e22522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/10/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023] Open
Abstract
Background Low intensity ultrasound stimulation has been shown to non-invasively modulate neural function in the central nervous system (CNS) and peripheral nervous system (PNS) with high precision. Ultrasound sonication is capable of either excitation or inhibition, depending on the ultrasound parameters used. On the other hand, the mode of interaction of ultrasonic waves with the neural tissue for effective neuromodulation remains ambiguous. New method Here within we propose a numerical model that incorporates the mechanical effects of ultrasound stimulation on the Hodgkin-Huxley (HH) neuron by incorporating the relation between increased external pressure and the membrane induced tension, with a stress on the flexoelectric effect on the neural membrane. The external pressure causes an increase in the total tension of the membrane thus affecting the probability of the ion channels being open after the conformational changes that those channels undergo. Results The interplay between varying the acoustic intensities and frequencies depicts different action potential suppression rates, whereby a combination of low intensity and low frequency ultrasound sonication proved to be the most effective in modulating neural function.Comparison with Existing Methods: Our method solely depends on the HH model of a single neuron and the linear flexoelectric effect of the dielectric neural membrane, when under an ultrasound-induced mechanical strain, while varying the ion-channels conductances based on different sonication frequencies and intensities. We study the effect of ultrasound parameters on the firing rate, latency, and action potential amplitude of a HH neuron for a better understanding of the neuromodulation modality of ultrasound stimulation (in the continuous and pulsed modes). Conclusions This simulation work confirms the published experimental data that low intensity and low frequency ultrasound sonication has a higher success rate of modulating neural firing.
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Affiliation(s)
- Heba M. Badawe
- Neural Engineering and Nanobiosensors Group, Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
| | - Rima H. El Hassan
- Neural Engineering and Nanobiosensors Group, Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
| | - Massoud L. Khraiche
- Neural Engineering and Nanobiosensors Group, Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
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24
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Ziebell P, Rodrigues J, Forster A, Sanguinetti JL, Allen JJ, Hewig J. Inhibition of midfrontal theta with transcranial ultrasound explains greater approach versus withdrawal behavior in humans. Brain Stimul 2023; 16:1278-1288. [PMID: 37611659 DOI: 10.1016/j.brs.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/11/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
Recent reviews highlighted low-intensity transcranial focused ultrasound (TUS) as a promising new tool for non-invasive neuromodulation in basic and applied sciences. Our preregistered double-blind within-subjects study (N = 152) utilized TUS targeting the right prefrontal cortex, which, in earlier work, was found to positively enhance self-reported global mood, decrease negative states of self-reported emotional conflict (anxiety/worrying), and modulate related midfrontal functional magnetic resonance imaging activity in affect regulation brain networks. To further explore TUS effects on objective physiological and behavioral variables, we used a virtual T-maze task that has been established in prior studies to measure motivational conflicts regarding whether participants execute approach versus withdrawal behavior (with free-choice responses via continuous joystick movements) while allowing to record related electroencephalographic data such as midfrontal theta activity (MFT). MFT, a reliable marker of conflict representation on a neuronal level, was of particular interest to us since it has repeatedly been shown to explain related behavior, with relatively low MFT typically preceding approach-like risky behavior and relatively high MFT typically preceding withdrawal-like risk aversion. Our central hypothesis is that TUS decreases MFT in T-maze conflict situations and thereby increases approach and reduces withdrawal. Results indicate that TUS led to significant MFT decreases, which significantly explained increases in approach behavior and decreases in withdrawal behavior. This study expands TUS evidence on a physiological and behavioral level with a large sample size of human subjects, suggesting the promise of further research based on this distinct TUS-MFT-behavior link to influence conflict monitoring and its behavioral consequences. Ultimately, this can serve as a foundation for future clinical work to establish TUS interventions for emotional and motivational mental health.
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Affiliation(s)
- Philipp Ziebell
- University of Würzburg, Department of Psychology I, Marcusstr. 9-11, 97070 Würzburg, Germany.
| | - Johannes Rodrigues
- University of Würzburg, Department of Psychology I, Marcusstr. 9-11, 97070 Würzburg, Germany.
| | - André Forster
- University of Würzburg, Department of Psychology I, Marcusstr. 9-11, 97070 Würzburg, Germany.
| | - Joseph L Sanguinetti
- University of Arizona, Department of Psychology, 1503 E. University Blvd. (Building 68), Tucson (AZ) 85721, USA.
| | - John Jb Allen
- University of Arizona, Department of Psychology, 1503 E. University Blvd. (Building 68), Tucson (AZ) 85721, USA.
| | - Johannes Hewig
- University of Würzburg, Department of Psychology I, Marcusstr. 9-11, 97070 Würzburg, Germany.
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25
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Choi MH, Li N, Popelka G, Butts Pauly K. Development and validation of a computational method to predict unintended auditory brainstem response during transcranial ultrasound neuromodulation in mice. Brain Stimul 2023; 16:1362-1370. [PMID: 37690602 DOI: 10.1016/j.brs.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/03/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Transcranial ultrasound stimulation (TUS) is a promising noninvasive neuromodulation modality. The inadvertent and unpredictable activation of the auditory system in response to TUS obfuscates the interpretation of non-auditory neuromodulatory responses. OBJECTIVE The objective was to develop and validate a computational metric to quantify the susceptibility to unintended auditory brainstem response (ABR) in mice premised on time frequency analyses of TUS signals and auditory sensitivity. METHODS Ultrasound pulses with varying amplitudes, pulse repetition frequencies (PRFs), envelope smoothing profiles, and sinusoidal modulation frequencies were selected. Each pulse's time-varying frequency spectrum was differentiated across time, weighted by the mouse hearing sensitivity, then summed across frequencies. The resulting time-varying function, computationally predicting the ABR, was validated against experimental ABR in mice during TUS with the corresponding pulse. RESULTS There was a significant correlation between experimental ABRs and the computational predictions for 19 TUS signals (R2 = 0.97). CONCLUSIONS To reduce ABR in mice during in vivo TUS studies, 1) reduce the amplitude of a rectangular continuous wave envelope, 2) increase the rise/fall times of a smoothed continuous wave envelope, and/or 3) change the PRF and/or duty cycle of a rectangular or sinusoidal pulsed wave to reduce the gap between pulses and increase the rise/fall time of the overall envelope. This metric can aid researchers performing in vivo mouse studies in selecting TUS signal parameters that minimize unintended ABR. The methods for developing this metric can be adapted to other animal models.
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Affiliation(s)
- Mi Hyun Choi
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA.
| | - Ningrui Li
- Department of Electrical Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Gerald Popelka
- Department of Otolaryngology, Stanford School of Medicine, Stanford, CA, 94305, USA; Department of Radiology, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Kim Butts Pauly
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA; Department of Electrical Engineering, Stanford University, Stanford, CA, 94305, USA; Department of Radiology, Stanford School of Medicine, Stanford, CA, 94305, USA.
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26
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Kim HC, Lee W, Weisholtz DS, Yoo SS. Transcranial focused ultrasound stimulation of cortical and thalamic somatosensory areas in human. PLoS One 2023; 18:e0288654. [PMID: 37478086 PMCID: PMC10361523 DOI: 10.1371/journal.pone.0288654] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023] Open
Abstract
The effects of transcranial focused ultrasound (FUS) stimulation of the primary somatosensory cortex and its thalamic projection (i.e., ventral posterolateral nucleus) on the generation of electroencephalographic (EEG) responses were evaluated in healthy human volunteers. Stimulation of the unilateral somatosensory circuits corresponding to the non-dominant hand generated EEG evoked potentials across all participants; however, not all perceived stimulation-mediated tactile sensations of the hand. These FUS-evoked EEG potentials (FEP) were observed from both brain hemispheres and shared similarities with somatosensory evoked potentials (SSEP) from median nerve stimulation. Use of a 0.5 ms pulse duration (PD) sonication given at 70% duty cycle, compared to the use of 1 and 2 ms PD, elicited more distinctive FEP peak features from the hemisphere ipsilateral to sonication. Although several participants reported hearing tones associated with FUS stimulation, the observed FEP were not likely to be confounded by the auditory sensation based on a separate measurement of auditory evoked potentials (AEP) to tonal stimulation (mimicking the same repetition frequency as the FUS stimulation). Off-line changes in resting-state functional connectivity (FC) associated with thalamic stimulation revealed that the FUS stimulation enhanced connectivity in a network of sensorimotor and sensory integration areas, which lasted for at least more than an hour. Clinical neurological evaluations, EEG, and neuroanatomical MRI did not reveal any adverse or unintended effects of sonication, attesting its safety. These results suggest that FUS stimulation may induce long-term neuroplasticity in humans, indicating its neurotherapeutic potential for various neurological and neuropsychiatric conditions.
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Affiliation(s)
- Hyun-Chul Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Wonhye Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel S Weisholtz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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27
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Shamli Oghli Y, Grippe T, Arora T, Hoque T, Darmani G, Chen R. Mechanisms of theta burst transcranial ultrasound induced plasticity in the human motor cortex. Brain Stimul 2023; 16:1135-1143. [PMID: 37524296 DOI: 10.1016/j.brs.2023.07.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Transcranial ultrasound stimulation (TUS) is a novel non-invasive brain stimulation technique with high depth penetrance and spatial resolution. Theta-burst TUS (tbTUS) is a plasticity-inducing protocol which increases motor cortical excitability for up to 30 min following 80s of sonication. While this protocol may have therapeutic potential for the treatment of psychiatric and neurological disorders, the mechanisms of action of TUS remain unclear. OBJECTIVE We conducted the first pharmacological study to examine the mechanisms of TUS in human primary motor cortex. By administering brain-active drugs with known mechanisms of action, we aimed to elucidate the mechanisms of tbTUS. METHODS Fourteen healthy subjects participated in a within-subjects randomized, double-blind, cross-over study with five visits. At each visit, one of four study drugs (carbamazepine - Na+ channel blocker, nimodipine - L-type Ca2+ channel blocker, lorazepam - positive allosteric modulator of gamma-aminobutyric acid (GABA) type A receptor, dextromethorphan - N-methyl-d-aspartate receptor antagonist) or placebo was administered in random order, followed by tbTUS. RESULTS The plasticity effects of tbTUS on motor cortex excitability measured by motor-evoked potential amplitudes elicited by transcranial magnetic stimulation were reduced by all study drugs compared to placebo. CONCLUSION tbTUS may induce NMDA-dependent synaptic plasticity since the effects are blocked by increased GABAA receptor activities and voltage-gated Na+ and Ca2+ channels blockers. These results are consistent with the hypotheses that tbTUS induced long-term potentiation-like mechanisms and that TUS involves activation of mechanosensitive Na+ and Ca2+ channels. Alternatively, non-specific pharmacologically induced changes in excitatory/inhibitory balance might have interfered with the effects of tbTUS.
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Affiliation(s)
- Yazan Shamli Oghli
- Institute of Medical Science, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, United States
| | - Talyta Grippe
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Tarun Arora
- Krembil Research Institute, University Health Network, Toronto, Canada; Division of Clinical Neuroscience, Department of Neurology, Section for Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Tasnuva Hoque
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Robert Chen
- Institute of Medical Science, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada.
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Tsehay Y, Zeng Y, Weber-Levine C, Awosika T, Kerensky M, Hersh AM, Ou Z, Jiang K, Bhimreddy M, Bauer SJ, Theodore JN, Quiroz VM, Suk I, Alomari S, Sun J, Tong S, Thakor N, Doloff JC, Theodore N, Manbachi A. Low-Intensity Pulsed Ultrasound Neuromodulation of a Rodent's Spinal Cord Suppresses Motor Evoked Potentials. IEEE Trans Biomed Eng 2023; 70:1992-2001. [PMID: 37018313 PMCID: PMC10510849 DOI: 10.1109/tbme.2022.3233345] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Here we investigate the ability of low-intensity ultrasound (LIUS) applied to the spinal cord to modulate the transmission of motor signals. METHODS Male adult Sprague-Dawley rats (n = 10, 250-300 g, 15 weeks old) were used in this study. Anesthesia was initially induced with 2% isoflurane carried by oxygen at 4 L/min via a nose cone. Cranial, upper extremity, and lower extremity electrodes were placed. A thoracic laminectomy was performed to expose the spinal cord at the T11 and T12 vertebral levels. A LIUS transducer was coupled to the exposed spinal cord, and motor evoked potentials (MEPs) were acquired each minute for either 5- or 10-minutes of sonication. Following the sonication period, the ultrasound was turned off and post-sonication MEPs were acquired for an additional 5 minutes. RESULTS Hindlimb MEP amplitude significantly decreased during sonication in both the 5- (p < 0.001) and 10-min (p = 0.004) cohorts with a corresponding gradual recovery to baseline. Forelimb MEP amplitude did not demonstrate any statistically significant changes during sonication in either the 5- (p = 0.46) or 10-min (p = 0.80) trials. CONCLUSION LIUS applied to the spinal cord suppresses MEP signals caudal to the site of sonication, with recovery of MEPs to baseline after sonication. SIGNIFICANCE LIUS can suppress motor signals in the spinal cord and may be useful in treating movement disorders driven by excessive excitation of spinal neurons.
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29
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Strohman A, In A, Stebbins K, Legon W. Evaluation of a Novel Acoustic Coupling Medium for Human Low-Intensity Focused Ultrasound Neuromodulation Applications. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1422-1430. [PMID: 36889994 DOI: 10.1016/j.ultrasmedbio.2023.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Single-element low-intensity focused ultrasound (LIFU) is an emerging form of human neuromodulation. Current coupling methods are impractical for clinical bedside use. Here, we evaluate commercially available high-viscosity gel polymer matrices as couplants for human LIFU neuromodulation applications. METHODS We first empirically tested the acoustic transmission of three densities at 500 kHz and then subjected the gel with the least acoustic attenuation to further tests of the effect of thickness, frequency, de-gassing and production variability. RESULTS The highest-density gel had the lowest acoustic attenuation (3.3%) with low lateral (<0.5 mm) and axial (<2 mm) beam distortion. Different thicknesses of the gel up to 10 mm did not appreciably affect results. The gel polymers exhibited frequency-dependent attenuation at 1 and 3 MHz up to 86.6%, as well as significant beam distortion >4 mm. Poor de-gassing methods also increased pressure attenuation at 500 kHz up to 59.6%. Standardized methods of making these gels should be established to reduce variability. CONCLUSION Commercially available de-gassed, high-density gel matrices are a low-cost, easily malleable, low-attenuation and distortion medium for the coupling of single-element LIFU transducers for human neuromodulation applications at 500 kHz.
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Affiliation(s)
- Andrew Strohman
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, USA.
| | - Alexander In
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Katelyn Stebbins
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, USA
| | - Wynn Legon
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Center for Human Neuroscience Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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30
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Legon W, Strohman A, In A, Stebbins K, Payne B. Non-invasive neuromodulation of sub-regions of the human insula differentially affect pain processing and heart-rate variability. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.05.539593. [PMID: 37205396 PMCID: PMC10187309 DOI: 10.1101/2023.05.05.539593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The insula is a portion of the cerebral cortex folded deep within the lateral sulcus covered by the overlying opercula of the inferior frontal lobe and superior portion of the temporal lobe. The insula has been parsed into sub-regions based upon cytoarchitectonics and structural and functional connectivity with multiple lines of evidence supporting specific roles for each of these sub-regions in pain processing and interoception. In the past, causal interrogation of the insula was only possible in patients with surgically implanted electrodes. Here, we leverage the high spatial resolution combined with the deep penetration depth of low-intensity focused ultrasound (LIFU) to non-surgically modulate either the anterior insula (AI) or posterior insula (PI) in humans for effect on subjective pain ratings, electroencephalographic (EEG) contact head evoked potentials (CHEPs) and time-frequency power as well as autonomic measures including heart-rate variability (HRV) and electrodermal response (EDR). N = 23 healthy volunteers received brief noxious heat pain stimuli to the dorsum of their right hand during continuous heart-rate, EDR and EEG recording. LIFU was delivered to either the AI (anterior short gyrus), PI (posterior longus gyrus) or under an inert sham condition time-locked to the heat stimulus. Results demonstrate that single-element 500 kHz LIFU is capable of individually targeting specific gyri of the insula. LIFU to both AI and PI similarly reduced perceived pain ratings but had differential effects on EEG activity. LIFU to PI affected earlier EEG amplitudes around 300 milliseconds whereas LIFU to AI affected EEG amplitudes around 500 milliseconds. In addition, only LIFU to the AI affected HRV as indexed by an increase in standard deviation of N-N intervals (SDNN) and mean HRV low frequency power. There was no effect of LIFU to either AI or PI on EDR or blood pressure. Taken together, LIFU looks to be an effective method to individually target sub-regions of the insula in humans for site-specific effects on brain biomarkers of pain processing and autonomic reactivity that translates to reduced perceived pain to a transient heat stimulus. These data have implications for the treatment of chronic pain and several neuropsychological diseases like anxiety, depression and addiction that all demonstrate abnormal activity in the insula concomitant with dysregulated autonomic function.
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Affiliation(s)
- Wynn Legon
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA
- Center for Human Neuroscience Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
| | - Andrew Strohman
- Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, 24016, USA
| | - Alexander In
- Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA
| | - Katelyn Stebbins
- Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA, 24016, USA
| | - Brighton Payne
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
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Yang Y, Yuan J, Field RL, Ye D, Hu Z, Xu K, Xu L, Gong Y, Yue Y, Kravitz AV, Bruchas MR, Cui J, Brestoff JR, Chen H. Induction of a torpor-like hypothermic and hypometabolic state in rodents by ultrasound. Nat Metab 2023; 5:789-803. [PMID: 37231250 PMCID: PMC10229429 DOI: 10.1038/s42255-023-00804-z,] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/11/2023] [Indexed: 08/22/2023]
Abstract
Torpor is an energy-conserving state in which animals dramatically decrease their metabolic rate and body temperature to survive harsh environmental conditions. Here, we report the noninvasive, precise and safe induction of a torpor-like hypothermic and hypometabolic state in rodents by remote transcranial ultrasound stimulation at the hypothalamus preoptic area (POA). We achieve a long-lasting (>24 h) torpor-like state in mice via closed-loop feedback control of ultrasound stimulation with automated detection of body temperature. Ultrasound-induced hypothermia and hypometabolism (UIH) is triggered by activation of POA neurons, involves the dorsomedial hypothalamus as a downstream brain region and subsequent inhibition of thermogenic brown adipose tissue. Single-nucleus RNA-sequencing of POA neurons reveals TRPM2 as an ultrasound-sensitive ion channel, the knockdown of which suppresses UIH. We also demonstrate that UIH is feasible in a non-torpid animal, the rat. Our findings establish UIH as a promising technology for the noninvasive and safe induction of a torpor-like state.
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Affiliation(s)
- Yaoheng Yang
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Jinyun Yuan
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Rachael L Field
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Dezhuang Ye
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Zhongtao Hu
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Kevin Xu
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Lu Xu
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Yan Gong
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Yimei Yue
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Alexxai V Kravitz
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Michael R Bruchas
- Departments of Anesthesiology and Pain Medicine, Pharmacology, and Bioengineering, Center for Neurobiology of Addiction, Pain, and Emotion, University of Washington, Seattle, WA, USA
| | - Jianmin Cui
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Jonathan R Brestoff
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Hong Chen
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA.
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA.
- Division of Neurotechnology, Washington University School of Medicine, Saint Louis, MO, USA.
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32
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Beisteiner R, Hallett M, Lozano AM. Ultrasound Neuromodulation as a New Brain Therapy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2205634. [PMID: 36961104 PMCID: PMC10190662 DOI: 10.1002/advs.202205634] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/03/2023] [Indexed: 05/18/2023]
Abstract
Within the last decade, ultrasound has been "rediscovered" as a technique for brain therapies. Modern technologies allow focusing ultrasound through the human skull for highly focal tissue ablation, clinical neuromodulatory brain stimulation, and targeted focal blood-brain-barrier opening. This article gives an overview on the state-of-the-art of the most recent application: ultrasound neuromodulation as a new brain therapy. Although research centers have existed for decades, the first treatment centers were not established until 2020, and clinical applications are spreading rapidly.
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Affiliation(s)
- Roland Beisteiner
- Department of NeurologyFunctional Brain Diagnostics and TherapyHigh Field MR CenterMedical University of ViennaSpitalgasse 23Vienna1090Austria
| | - Mark Hallett
- Human Motor Control SectionNational Institute of Neurological Disorders and StrokeNational Institutes of Health10 Center DriveBethesdaMD20892–1428USA
| | - Andres M. Lozano
- Division of NeurosurgeryDepartment of SurgeryUniversity of TorontoTorontoONM5T 2S8Canada
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33
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Zanos S, Ntiloudi D, Pellerito J, Ramdeo R, Graf J, Wallace K, Cotero V, Ashe J, Moon J, Addorisio M, Shoudy D, Coleman TR, Brines M, Puleo C, Tracey KJ, Chavan SS. Focused ultrasound neuromodulation of the spleen activates an anti-inflammatory response in humans. Brain Stimul 2023; 16:703-711. [PMID: 37055009 PMCID: PMC10330863 DOI: 10.1016/j.brs.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
Focused ultrasound stimulation (FUS) activates mechanosensitive ion channels and is emerging as a method of noninvasive neuromodulation. In preclinical studies, FUS of the spleen (sFUS) activates an anti-inflammatory neural pathway which suppresses acute and chronic inflammation. However, the relevance of sFUS for regulating inflammatory responses in humans is unknown. Here, we used a modified diagnostic ultrasound imaging system to target the spleen of healthy human subjects with 3 min of continuously swept or stationary focused pulsed ultrasound, delivered at three different energy levels within allowable safety exposure limits. Potential anti-inflammatory effects of sFUS were assessed by measuring sFUS-elicited changes in endotoxin-induced tumor necrosis factor (TNF) production in whole blood samples from insonified subjects. We found that stimulation with either continuously swept or focused pulsed ultrasound has an anti-inflammatory effect: sFUS lowers TNF production for >2 h, with TNF returning to baseline by 24 h following sFUS. This response is independent of anatomical target (i.e., spleen hilum or parenchyma) or ultrasound energy level. No clinical, biochemical, or hematological parameters are adversely impacted. This is the first demonstration that sFUS suppresses the normal inflammatory response in humans, with potential implications for noninvasive bioelectronic therapy of inflammatory disorders.
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Affiliation(s)
- Stavros Zanos
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Despoina Ntiloudi
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - John Pellerito
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Radiology, Northwell Health, Manhasset, NY, 11030, USA
| | - Richard Ramdeo
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - John Graf
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Kirk Wallace
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | | | - Jeff Ashe
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Jessica Moon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Meghan Addorisio
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - David Shoudy
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Thomas R Coleman
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Michael Brines
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Chris Puleo
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Kevin J Tracey
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sangeeta S Chavan
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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34
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Yang Y, Yuan J, Field RL, Ye D, Hu Z, Xu K, Xu L, Gong Y, Yue Y, Kravitz AV, Bruchas MR, Cui J, Brestoff JR, Chen H. Induction of a torpor-like hypothermic and hypometabolic state in rodents by ultrasound. Nat Metab 2023; 5:789-803. [PMID: 37231250 PMCID: PMC10229429 DOI: 10.1038/s42255-023-00804-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
Torpor is an energy-conserving state in which animals dramatically decrease their metabolic rate and body temperature to survive harsh environmental conditions. Here, we report the noninvasive, precise and safe induction of a torpor-like hypothermic and hypometabolic state in rodents by remote transcranial ultrasound stimulation at the hypothalamus preoptic area (POA). We achieve a long-lasting (>24 h) torpor-like state in mice via closed-loop feedback control of ultrasound stimulation with automated detection of body temperature. Ultrasound-induced hypothermia and hypometabolism (UIH) is triggered by activation of POA neurons, involves the dorsomedial hypothalamus as a downstream brain region and subsequent inhibition of thermogenic brown adipose tissue. Single-nucleus RNA-sequencing of POA neurons reveals TRPM2 as an ultrasound-sensitive ion channel, the knockdown of which suppresses UIH. We also demonstrate that UIH is feasible in a non-torpid animal, the rat. Our findings establish UIH as a promising technology for the noninvasive and safe induction of a torpor-like state.
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Affiliation(s)
- Yaoheng Yang
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Jinyun Yuan
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Rachael L Field
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Dezhuang Ye
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Zhongtao Hu
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Kevin Xu
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Lu Xu
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Yan Gong
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Yimei Yue
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Alexxai V Kravitz
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Michael R Bruchas
- Departments of Anesthesiology and Pain Medicine, Pharmacology, and Bioengineering, Center for Neurobiology of Addiction, Pain, and Emotion, University of Washington, Seattle, WA, USA
| | - Jianmin Cui
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Jonathan R Brestoff
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Hong Chen
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA.
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA.
- Division of Neurotechnology, Washington University School of Medicine, Saint Louis, MO, USA.
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35
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Yüksel MM, Sun S, Latchoumane C, Bloch J, Courtine G, Raffin EE, Hummel FC. Low-Intensity Focused Ultrasound Neuromodulation for Stroke Recovery: A Novel Deep Brain Stimulation Approach for Neurorehabilitation? IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:300-318. [PMID: 38196977 PMCID: PMC10776095 DOI: 10.1109/ojemb.2023.3263690] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 01/11/2024] Open
Abstract
Stroke as the leading cause of adult long-term disability and has a significant impact on patients, society and socio-economics. Non-invasive brain stimulation (NIBS) approaches such as transcranial magnetic stimulation (TMS) or transcranial electrical stimulation (tES) are considered as potential therapeutic options to enhance functional reorganization and augment the effects of neurorehabilitation. However, non-invasive electrical and magnetic stimulation paradigms are limited by their depth focality trade-off function that does not allow to target deep key brain structures critically important for recovery processes. Transcranial ultrasound stimulation (TUS) is an emerging approach for non-invasive deep brain neuromodulation. Using non-ionizing, ultrasonic waves with millimeter-accuracy spatial resolution, excellent steering capacity and long penetration depth, TUS has the potential to serve as a novel non-invasive deep brain stimulation method to establish unprecedented neuromodulation and novel neurorehabilitation protocols. The purpose of the present review is to provide an overview on the current knowledge about the neuromodulatory effects of TUS while discussing the potential of TUS in the field of stroke recovery, with respect to existing NIBS methods. We will address and discuss critically crucial open questions and remaining challenges that need to be addressed before establishing TUS as a new clinical neurorehabilitation approach for motor stroke recovery.
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Affiliation(s)
- Mahmut Martin Yüksel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1201Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
| | - Shiqi Sun
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1011Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1011Switzerland
| | - Charles Latchoumane
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1011Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1011Switzerland
| | - Jocelyne Bloch
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1015Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1015Switzerland
- Department of NeurosurgeryLausanne University HospitalLausanne1011Switzerland
| | - Gregoire Courtine
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1015Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1015Switzerland
- Department of NeurosurgeryLausanne University HospitalLausanne1011Switzerland
| | - Estelle Emeline Raffin
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1201Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
| | - Friedhelm Christoph Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1202Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
- Clinical NeuroscienceUniversity of Geneva Medical SchoolGeneva1211Switzerland
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36
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Blackmore DG, Razansky D, Götz J. Ultrasound as a versatile tool for short- and long-term improvement and monitoring of brain function. Neuron 2023; 111:1174-1190. [PMID: 36917978 DOI: 10.1016/j.neuron.2023.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 03/15/2023]
Abstract
Treating the brain with focused ultrasound (FUS) at low intensities elicits diverse responses in neurons, astroglia, and the extracellular matrix. In combination with intravenously injected microbubbles, FUS also opens the blood-brain barrier (BBB) and facilitates focal drug delivery. However, an incompletely understood cellular specificity and a wide parameter space currently limit the optimal application of FUS in preclinical and human studies. In this perspective, we discuss how different FUS modalities can be utilized to achieve short- and long-term improvements, thereby potentially treating brain disorders. We review the ongoing efforts to determine which parameters induce neuronal inhibition versus activation and how mechanoreceptors and signaling cascades are activated to induce long-term changes, including memory improvements. We suggest that optimal FUS treatments may require different FUS modalities and devices, depending on the targeted brain area or local pathology, and will be greatly enhanced by new techniques for monitoring FUS efficacy.
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Affiliation(s)
- Daniel G Blackmore
- Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Daniel Razansky
- Institute for Biomedical Engineering, Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, 8057 Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, 8093 Zurich, Switzerland
| | - Jürgen Götz
- Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia.
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37
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Weak Ultrasound Contributes to Neuromodulatory Effects in the Rat Motor Cortex. Int J Mol Sci 2023; 24:ijms24032578. [PMID: 36768901 PMCID: PMC9917173 DOI: 10.3390/ijms24032578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Transcranial focused ultrasound (tFUS) is a novel neuromodulating technique. It has been demonstrated that the neuromodulatory effects can be induced by weak ultrasound exposure levels (spatial-peak temporal average intensity, ISPTA < 10 mW/cm2) in vitro. However, fewer studies have examined the use of weak tFUS to potentially induce long-lasting neuromodulatory responses in vivo. The purpose of this study was to determine the lower-bound threshold of tFUS stimulation for inducing neuromodulation in the motor cortex of rats. A total of 94 Sprague-Dawley rats were used. The sonication region aimed at the motor cortex under weak tFUS exposure (ISPTA of 0.338-12.15 mW/cm2). The neuromodulatory effects of tFUS on the motor cortex were evaluated by the changes in motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS). In addition to histology analysis, the in vitro cell culture was used to confirm the neuromodulatory mechanisms following tFUS stimulation. In the results, the dose-dependent inhibitory effects of tFUS were found, showing increased intensities of tFUS suppressed MEPs and lasted for 30 min. Weak tFUS significantly decreased the expression of excitatory neurons and increased the expression of inhibitory GABAergic neurons. The PIEZO-1 proteins of GABAergic neurons were found to involve in the inhibitory neuromodulation. In conclusion, we show the use of weak ultrasound to induce long-lasting neuromodulatory effects and explore the potential use of weak ultrasound for future clinical neuromodulatory applications.
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38
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Wang M, Wang T, Ji H, Yan J, Wang X, Zhang X, Li X, Yuan Y. Modulation effect of non-invasive transcranial ultrasound stimulation in an ADHD rat model. J Neural Eng 2023; 20. [PMID: 36599159 DOI: 10.1088/1741-2552/acb014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/04/2023] [Indexed: 01/05/2023]
Abstract
Objective.Previous studies have demonstrated that transcranial ultrasound stimulation (TUS) with noninvasive high penetration and high spatial resolution has an effective neuromodulatory effect on neurological diseases. Attention deficit hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that severely affects child health. However, the neuromodulatory effects of TUS on ADHD have not been reported to date. This study aimed to investigate the neuromodulatory effects of TUS on ADHD.Approach.TUS was performed in ADHD model rats for two consecutive weeks, and the behavioral improvement of ADHD, neural activity of ADHD from neurons and neural oscillation levels, and the plasma membrane dopamine transporter and brain-derived neurotrophic factor (BDNF) in the brains of ADHD rats were evaluated.Main results.TUS can improve cognitive behavior in ADHD rats, and TUS altered neuronal firing patterns and modulated the relative power and sample entropy of local field potentials in the ADHD rats. In addition, TUS can also enhance BDNF expression in the brain tissues.Significance. TUS has an effective neuromodulatory effect on ADHD and thus has the potential to clinically improve cognitive dysfunction in ADHD.
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Affiliation(s)
- Mengran Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
| | - Teng Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China.,Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, People's Republic of China
| | - Hui Ji
- Department of Neurology, Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Jiaqing Yan
- College of Electrical and Control Engineering, North China University of Technology, Beijing 100041, People's Republic of China
| | - Xingran Wang
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China.,Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, People's Republic of China
| | - Xiangjian Zhang
- Department of Neurology, Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Xin Li
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
| | - Yi Yuan
- School of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China.,Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Yanshan University, Qinhuangdao 066004, People's Republic of China
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39
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Attali D, Tiennot T, Schafer M, Fouragnan E, Sallet J, Caskey CF, Chen R, Darmani G, Bubrick EJ, Butler C, Stagg CJ, Klein-Flügge M, Verhagen L, Yoo SS, Pauly KB, Aubry JF. Three-layer model with absorption for conservative estimation of the maximum acoustic transmission coefficient through the human skull for transcranial ultrasound stimulation. Brain Stimul 2023; 16:48-55. [PMID: 36549480 DOI: 10.1016/j.brs.2022.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Transcranial ultrasound stimulation (TUS) has been shown to be a safe and effective technique for non-invasive superficial and deep brain stimulation. Safe and efficient translation to humans requires estimating the acoustic attenuation of the human skull. Nevertheless, there are no international guidelines for estimating the impact of the skull bone. A tissue independent, arbitrary derating was developed by the U.S. Food and Drug Administration to take into account tissue absorption (0.3 dB/cm-MHz) for diagnostic ultrasound. However, for the case of transcranial ultrasound imaging, the FDA model does not take into account the insertion loss induced by the skull bone, nor the absorption by brain tissue. Therefore, the estimated absorption is overly conservative which could potentially limit TUS applications if the same guidelines were to be adopted. Here we propose a three-layer model including bone absorption to calculate the maximum pressure transmission through the human skull for frequencies ranging between 100 kHz and 1.5 MHz. The calculated pressure transmission decreases with the frequency and the thickness of the bone, with peaks for each thickness corresponding to a multiple of half the wavelength. The 95th percentile maximum transmission was calculated over the accessible surface of 20 human skulls for 12 typical diameters of the ultrasound beam on the skull surface, and varies between 40% and 78%. To facilitate the safe adjustment of the acoustic pressure for short ultrasound pulses, such as transcranial imaging or transcranial ultrasound stimulation, a table summarizes the maximum pressure transmission for each ultrasound beam diameter and each frequency.
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Affiliation(s)
- David Attali
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR8063, PSL University, Paris, France; Pôle Paris 16 (Secteurs 17-18) et Pôle Neuro Sainte-Anne, Centre Hospitalier Sainte-Anne, GHU Paris Psychiatrie & Neurosciences, Université Paris Cité, Paris, France
| | - Thomas Tiennot
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR8063, PSL University, Paris, France
| | - Mark Schafer
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Elsa Fouragnan
- Brain Research Imaging Center and School of Psychology, University of Plymouth, Plymouth, UK; School of Psychology, Portland Square, Plymouth PL4 8AA, UK
| | - Jérôme Sallet
- Univ Lyon, Université Lyon 1, Inserm, Stem Cell and Brain Research Institute U1208, Bron, France
| | - Charles F Caskey
- Vanderbilt University Institute of Imaging Sciences, VU Medical Center, Nashville, TN, United States
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Ellen J Bubrick
- Brigham and Women's Hospital, Harvard Medical School, Department of Neurology, 75 Francis St., Boston, MA, USA
| | - Christopher Butler
- Department of Brain Sciences, Imperial College London, 9th Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging (WIN), Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Miriam Klein-Flügge
- Wellcome Centre for Integrative Neuroimaging (WIN), Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK; Wellcome Centre for Integrative Neuroimaging (WIN), Department of Experimental Psychology, University of Oxford, Tinsley Building, Mansfield Road, Oxford OX1 3TA, UK
| | - Lennart Verhagen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, the Netherlands
| | - Seung-Schik Yoo
- Brigham and Women's Hospital, Harvard Medical School, Department of Radiology, 75 Francis St., Boston, MA, USA
| | - Kim Butts Pauly
- Stanford University, Department of Radiology, Stanford CA, 94305, USA
| | - Jean-Francois Aubry
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR8063, PSL University, Paris, France.
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Yang PF, Phipps MA, Newton AT, Jonathan S, Manuel TJ, Gore JC, Grissom WA, Caskey CF, Chen LM. Differential dose responses of transcranial focused ultrasound at brain regions indicate causal interactions. Brain Stimul 2022; 15:1552-1564. [PMID: 36496128 PMCID: PMC9806861 DOI: 10.1016/j.brs.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
We have previously shown that focused ultrasound (FUS) pulses in low pressure range exerted bidirectional and brain state-dependent neuromodulation in the nonhuman primate somatosensory cortices by fMRI. Here we aim to gain insights about the proposed neuron selective modulation of FUS and probe feedforward versus feedback interactions by simultaneously quantifying the stimulus (FUS pressures: 925, 425, 250 kPa) and response (% BOLD fMRI changes) function at the targeted area 3a/3b and off-target cortical areas at 7T. In resting-state, lowered intensities of FUS resulted in decreased fMRI signal changes at the target area 3a/3b and off-target area 1/2, S2, MCC, insula and auditory cortex, and no signal difference in thalamic VPL and MD nuclei. In activated states, concurrent high-intensity FUS significantly enhanced touch-evoked signals in area 1/2. Medium- and low-intensity FUS significantly suppressed touch-evoked BOLD signals in all areas except in the auditory cortex, VPL and MD thalamic nuclei. Distinct state dependent and dose-response curves led us to hypothesize that FUS's neuromodulatory effects may be mediated through preferential activation of different populations of neurons. Area 3a/3b may have distinct causal feedforward and feedback interactions with Area 1/2, S2, MCC, insula, and VPL. FUS offers a noninvasive neural stimulation tool for dissecting brain circuits and probing causal functional connections.
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Affiliation(s)
- Pai-Feng Yang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Anthony Phipps
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Allen T Newton
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumeeth Jonathan
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Thomas J Manuel
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - John C Gore
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - William A Grissom
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Charles F Caskey
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li Min Chen
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
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Park TY, Jeong JH, Chung YA, Yeo SH, Kim H. Application of subject-specific helmets for the study of human visuomotor behavior using transcranial focused ultrasound: a pilot study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107127. [PMID: 36126434 DOI: 10.1016/j.cmpb.2022.107127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE As a novel non-invasive human brain stimulation method, transcranial focused ultrasound (tFUS) is receiving growing attention due to its superior spatial specificity and depth penetrability. Since the focal point of tFUS needs to be fixated precisely to the target brain region during stimulation, a critical issue is to identify and maintain the accurate position and orientation of the tFUS transducer relative to the subject's head. This study aims to propose the entire framework of tFUS stimulation integrating the methods previously proposed by the authors for tFUS transducer configuration optimization and a subject-specific 3D-printed helmet, and to validate this complete setup in a human behavioral neuromodulation study. METHODS To find the optimal configuration of the tFUS transducer, a numerical method based on subject-specific tFUS beamlines simulation was used. Then, the subject-specific 3D-printed helmet has been applied to effectively secure the transducer at the estimated optimal configuration. To validate this tFUS framework, a common behavioral neuromodulation paradigm was chosen; the effect of the dorsolateral prefrontal cortex (DLPFC) stimulation on anti-saccade (AS) behavior. While human participants (n=2) were performing AS tasks, tFUS stimulations were randomly applied to the left DLPFC right after the fixation target disappeared. RESULTS The neuromodulation result strongly suggests that the cortical stimulation using the proposed tFUS setup is effective in significantly reducing the error rates of anti-saccades (about -10 %p for S1 and -16 %p for S2), whereas no significant effect was observed on their latencies. These observed behavioral effects are consistent with the previous results based on conventional brain stimulation or lesion studies. CONCLUSIONS The proposed subject-specific tFUS framework has been effectively used in human neuromodulation study. The result suggests that the tFUS stimulation targeted to the DLPFC can generate a neuromodulatory effect on AS behavior.
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Affiliation(s)
- Tae Young Park
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea; Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, 02792, Republic of Korea
| | - Ji Hyeok Jeong
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea; Department of Brain and Cognitive Engineering, Korea University, Seoul, 136-713, Republic of Korea
| | - Yong An Chung
- Incheon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Sang Hoon Yeo
- School of Sport, Exercise & Rehabilitation Sciences, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Hyungmin Kim
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea; Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, 02792, Republic of Korea.
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Remus: System for remote deep brain interventions. iScience 2022; 25:105251. [PMID: 36304108 PMCID: PMC9593303 DOI: 10.1016/j.isci.2022.105251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/17/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022] Open
Abstract
Transcranial-focused ultrasound brings personalized medicine to the human brain. Ultrasound can modulate neural activity or release drugs in specific neural circuits but this personalized approach requires a system that delivers ultrasound into specified targets flexibly and on command. We developed a remote ultrasound system (Remus) that programmatically targets deep brain regions with high spatiotemporal precision and in a multi-focal manner. We validated these functions by modulating two deep brain nuclei—the left and right lateral geniculate nucleus—in a task-performing nonhuman primate. This flexible system will enable researchers and clinicians to diagnose and treat specific deep brain circuits in a noninvasive yet targeted manner, thus embodying the promise of personalized treatments of brain disorders. Remus delivers ultrasound into deep brain targets of task-performing subjects Targets are specified programmatically and at high spatial and temporal precision Brief pulses delivered to deep brain regions modulate visual choice behavior The system enables reproducible daily applications and continuous safety monitoring
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43
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Yang FY, Huang LH, Wu MT, Pan ZY. Ultrasound Neuromodulation Reduces Demyelination in a Rat Model of Multiple Sclerosis. Int J Mol Sci 2022; 23:ijms231710034. [PMID: 36077437 PMCID: PMC9456451 DOI: 10.3390/ijms231710034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Microglia, astrocytes, and oligodendrocyte progenitor cells (OPCs) may serve as targets for remyelination-enhancing therapy. Low-intensity pulsed ultrasound (LIPUS) has been demonstrated to ameliorate myelin loss and inhibit neuroinflammation in animal models of brain disorders; however, the underlying mechanisms through which LIPUS stimulates remyelination and glial activation are not well-understood. This study explored the impacts of LIPUS on remyelination and resident cells following lysolecithin (LPC)-induced local demyelination in the hippocampus. Demyelination was induced by the micro-injection of 1.5 μL of 1% LPC into the rat hippocampus, and the treatment groups received daily LIPUS stimulation for 5 days. The therapeutic effects of LIPUS on LPC-induced demyelination were assessed through immunohistochemistry staining. The staining was performed to evaluate remyelination and Iba-1 staining as a microglia marker. Our data revealed that LIPUS significantly increased myelin basic protein (MBP) expression. Moreover, the IHC results showed that LIPUS significantly inhibited glial cell activation, enhanced mature oligodendrocyte density, and promoted brain-derived neurotrophic factor (BDNF) expression at the lesion site. In addition, a heterologous population of microglia with various morphologies can be found in the demyelination lesion after LIPUS treatment. These data show that LIPUS stimulation may serve as a potential treatment for accelerating remyelination through the attenuation of glial activation and the enhancement of mature oligodendrocyte density and BDNF production.
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Affiliation(s)
- Feng-Yi Yang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-2826-7281; Fax: +886-2-2820-1095
| | - Li-Hsin Huang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Meng-Ting Wu
- Division of Neurosurgery, Cheng Hsin General Hospital, Taipei 112, Taiwan
| | - Zih-Yun Pan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
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44
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Butler CR, Rhodes E, Blackmore J, Cheng X, Peach RL, Veldsman M, Sheerin F, Cleveland RO. Transcranial ultrasound stimulation to human middle temporal complex improves visual motion detection and modulates electrophysiological responses. Brain Stimul 2022; 15:1236-1245. [PMID: 36067978 DOI: 10.1016/j.brs.2022.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Transcranial ultrasound stimulation (TUS) holds promise as a novel technology for non-invasive neuromodulation, with greater spatial precision than other available methods and the ability to target deep brain structures. However, its safety and efficacy for behavioural and electrophysiological modulation remains controversial and it is not yet clear whether it can be used to manipulate the neural mechanisms supporting higher cognitive function in humans. Moreover, concerns have been raised about a potential TUS-induced auditory confound. OBJECTIVES We aimed to investigate whether TUS can be used to modulate higher-order visual function in humans in an anatomically-specific way whilst controlling for auditory confounds. METHODS We used participant-specific skull maps, functional localisation of brain targets, acoustic modelling and neuronavigation to guide TUS delivery to human visual motion processing cortex (hMT+) whilst participants performed a visual motion detection task. We compared the effects of hMT+ stimulation with sham and control site stimulation and examined EEG data for modulation of task-specific event-related potentials. An auditory mask was applied which prevented participants from distinguishing between stimulation and sham trials. RESULTS Compared with sham and control site stimulation, TUS to hMT+ improved accuracy and reduced response times of visual motion detection. TUS also led to modulation of the task-specific event-related EEG potential. The amplitude of this modulation correlated with the performance benefit induced by TUS. No pathological changes were observed comparing structural MRI obtained before and after stimulation. CONCLUSIONS The results demonstrate for the first time the precision, efficacy and safety of TUS for stimulation of higher-order cortex and cognitive function in humans whilst controlling for auditory confounds.
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Affiliation(s)
- Christopher R Butler
- Department of Brain Sciences, Imperial College London, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
| | - Edward Rhodes
- Department of Brain Sciences, Imperial College London, UK; UK Dementia Research Institute, Imperial College London, UK
| | | | - Xinghao Cheng
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Robert L Peach
- Department of Brain Sciences, Imperial College London, UK; Department of Neurology, University Hospital of Würzburg, Germany
| | | | - Fintan Sheerin
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Nakajima K, Osada T, Ogawa A, Tanaka M, Oka S, Kamagata K, Aoki S, Oshima Y, Tanaka S, Konishi S. A causal role of anterior prefrontal-putamen circuit for response inhibition revealed by transcranial ultrasound stimulation in humans. Cell Rep 2022; 40:111197. [PMID: 35977493 DOI: 10.1016/j.celrep.2022.111197] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/20/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
Stopping an inappropriate response requires the involvement of the prefrontal-subthalamic hyperdirect pathway. However, how the prefrontal-striatal indirect pathway contributes to stopping is poorly understood. In this study, transcranial ultrasound stimulation is used to perform interventions in a task-related region in the striatum. Functional magnetic resonance imaging (MRI) reveals activation in the right anterior part of the putamen during response inhibition, and ultrasound stimulation to the anterior putamen, as well as the subthalamic nucleus, results in significant impairments in stopping performance. Diffusion imaging further reveals prominent structural connections between the anterior putamen and the right anterior part of the inferior frontal cortex (IFC), and ultrasound stimulation to the anterior IFC also shows significant impaired stopping performance. These results demonstrate that the right anterior putamen and right anterior IFC causally contribute to stopping and suggest that the anterior IFC-anterior putamen circuit in the indirect pathway serves as an essential route for stopping.
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Affiliation(s)
- Koji Nakajima
- Department of Neurophysiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Department of Orthopaedic Surgery, The University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takahiro Osada
- Department of Neurophysiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Akitoshi Ogawa
- Department of Neurophysiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Masaki Tanaka
- Department of Neurophysiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Satoshi Oka
- Department of Neurophysiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Seiki Konishi
- Department of Neurophysiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Research Institute for Diseases of Old Age, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Sportology Center, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Advanced Research Institute for Health Science, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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46
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Chen H, Felix C, Folloni D, Verhagen L, Sallet J, Jerusalem A. Modelling transcranial ultrasound neuromodulation: an energy-based multiscale framework. Acta Biomater 2022; 151:317-332. [PMID: 35902037 DOI: 10.1016/j.actbio.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
Several animal and human studies have now established the potential of low intensity, low frequency transcranial ultrasound (TUS) for non-invasive neuromodulation. Paradoxically, the underlying mechanisms through which TUS neuromodulation operates are still unclear, and a consensus on the identification of optimal sonication parameters still remains elusive. One emerging hypothesis based on thermodynamical considerations attributes the acoustic-induced nerve activity alterations to the mechanical energy and/or entropy conversions occurring during TUS action. Here, we propose a multiscale modelling framework to examine the energy states of neuromodulation under TUS. First, macroscopic tissue-level acoustic simulations of the sonication of a whole monkey brain are conducted under different sonication protocols. For each one of them, mechanical loading conditions of the received waves in the anterior cingulate cortex region are recorded and exported into a microscopic cell-level 3D viscoelastic finite element model of neuronal axon embedded extracellular medium. Pulse-averaged elastically stored and viscously dissipated energy rate densities during axon deformation are finally computed under different sonication incident angles and are mapped against distinct combinations of sonication parameters of the TUS. The proposed multiscale framework allows for the analysis of vibrational patterns of the axons and its comparison against the spectrograms of stimulating ultrasound. The results are in agreement with literature data on neuromodulation, demonstrating the potential of this framework to identify optimised acoustic parameters in TUS neuromodulation. The proposed approach is finally discussed in the context of multiphysics energetic considerations, argued here to be a promising avenue towards a scalable framework for TUS in silico predictions. STATEMENT OF SIGNIFICANCE: Low-intensity transcranial ultrasound (TUS) is poised to become a leading neuromodulation technique for the treatment of neurological disorders. Paradoxically, how it operates at the cellular scale remains unknown, hampering progress in personalised treatment. To this end, models of the multiphysics of neurons able to upscale results to the organ scale are required. We propose here to achieve this by considering an axon submitted to an ultrasound wave extracted from a simulation at the organ scale. Doing so, information pertaining to both stored and dissipated axonal energies can be extracted for a given head/brain morphology. This two-scale multiphysics energetic approach is a promising scalable framework for in silico predictions in the context of personalised TUS treatment.
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Affiliation(s)
- Haoyu Chen
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ciara Felix
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Davide Folloni
- Wellcome Centre for Integrative Neuroimaging (WIN), Department of Experimental Psychology, University of Oxford, Oxford, UK; Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lennart Verhagen
- Wellcome Centre for Integrative Neuroimaging (WIN), Department of Experimental Psychology, University of Oxford, Oxford, UK; Donders Institute, Radboud University, Nijmegen, Netherlands
| | - Jérôme Sallet
- Wellcome Centre for Integrative Neuroimaging (WIN), Department of Experimental Psychology, University of Oxford, Oxford, UK; Inserm, Stem Cell and Brain Research Institute, Université Lyon 1, Bron, France
| | - Antoine Jerusalem
- Department of Engineering Science, University of Oxford, Oxford, UK.
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47
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Neuromodulation Using Transcranial Focused Ultrasound on the Bilateral Medial Prefrontal Cortex. J Clin Med 2022; 11:jcm11133809. [PMID: 35807094 PMCID: PMC9267901 DOI: 10.3390/jcm11133809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Transcranial focused ultrasound (tFUS) is a promising technique of non-invasive brain stimulation for modulating neuronal activity with high spatial specificity. The medial prefrontal cortex (mPFC) has been proposed as a potential target for neuromodulation to prove emotional and sleep qualities. We aim to set up an appropriate clinical protocol for investigating the effects of tFUS stimulation of the bilateral mPFC for modulating the function of the brain-wide network using different sonication parameters. Seven participants received 20 min of 250 kHz tFUS to the bilateral mPFC with excitatory (70% duty cycle with sonication interval at 5 s) or suppressive (5% duty cycle with no interval) sonication protocols, which were compared to a sham condition. By placing the cigar-shaped sonication focus on the falx between both mPFCs, it was possible to simultaneously stimulate the bilateral mPFCs. Brain activity was analyzed using continuous electroencephalographic (EEG) recording during, before, and after tFUS. We investigated whether tFUS stimulation under the different conditions could lead to distinctive changes in brain activity in local brain regions where tFUS was directly delivered, and also in adjacent or remote brain areas that were not directly stimulated. This kind of study setting suggests that dynamic changes in brain cortical responses can occur within short periods of time, and that the distribution of these responses may differ depending on local brain states and functional brain architecture at the time of tFUS administration, or perhaps, at least temporarily, beyond the stimulation time. If so, tFUS could be useful for temporarily modifying regional brain activity, modulating functional connectivity, or reorganizing brain functions associated with various neuropsychiatric diseases, such as insomnia and depression.
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Lescrauwaet E, Vonck K, Sprengers M, Raedt R, Klooster D, Carrette E, Boon P. Recent Advances in the Use of Focused Ultrasound as a Treatment for Epilepsy. Front Neurosci 2022; 16:886584. [PMID: 35794951 PMCID: PMC9251412 DOI: 10.3389/fnins.2022.886584] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Emma Lescrauwaet
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
- *Correspondence: Emma Lescrauwaet,
| | - Kristl Vonck
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Mathieu Sprengers
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Robrecht Raedt
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Debby Klooster
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Evelien Carrette
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Paul Boon
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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49
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Balbi M, Blackmore DG, Padmanabhan P, Götz J. Ultrasound-Mediated Bioeffects in Senescent Mice and Alzheimer's Mouse Models. Brain Sci 2022; 12:775. [PMID: 35741660 PMCID: PMC9221310 DOI: 10.3390/brainsci12060775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 02/01/2023] Open
Abstract
Ultrasound is routinely used for a wide range of diagnostic imaging applications. However, given that ultrasound can operate over a wide range of parameters that can all be modulated, its applicability extends far beyond the bioimaging field. In fact, the modality has emerged as a hybrid technology that effectively assists drug delivery by transiently opening the blood-brain barrier (BBB) when combined with intravenously injected microbubbles, and facilitates neuromodulation. Studies in aged mice contributed to an insight into how low-intensity ultrasound brings about its neuromodulatory effects, including increased synaptic plasticity and improved cognitive functions, with a potential role for neurogenesis and the modulation of NMDA receptor-mediated neuronal signalling. This work is complemented by studies in mouse models of Alzheimer's disease (AD), a form of pathological ageing. Here, ultrasound was mainly employed as a BBB-opening tool that clears protein aggregates via microglial activation and neuronal autophagy, thereby restoring cognition. We discuss the currently available ultrasound approaches and how studies in senescent mice are relevant for AD and can accelerate the application of low-intensity ultrasound in the clinic.
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Affiliation(s)
- Matilde Balbi
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia; (M.B.); (D.G.B.); (P.P.)
| | - Daniel G. Blackmore
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia; (M.B.); (D.G.B.); (P.P.)
- Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Pranesh Padmanabhan
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia; (M.B.); (D.G.B.); (P.P.)
- Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Jürgen Götz
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia; (M.B.); (D.G.B.); (P.P.)
- Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
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Brinker ST, Balchandani P, Seifert AC, Kim HJ, Yoon K. Feasibility of Upper Cranial Nerve Sonication in Human Application via Neuronavigated Single-Element Pulsed Focused Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1045-1057. [PMID: 35341621 DOI: 10.1016/j.ultrasmedbio.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
Sonicating deep brain regions with pulsed focused ultrasound using magnetic resonance imaging-guided neuronavigation single-element piezoelectric transducers is a new area of exploration for neuromodulation. Upper cranial nerves such as the trigeminal nerve and other nerves responsible for sensory/motor functions in the head may be potential targets for ultrasound pain therapy. The location of upper cranial nerves close to the skull base poses additional challenges when compared with conventional cortical or middle brain targets. In the work described here, a series of computational and empirical testing methods using human skull specimens were conducted to assess the feasibility of sonicating the trigeminal pathway near the sphenoid bone region. The results indicate a transducer with a focal length of 120 mm and diameter of 85 mm (350 kHz) can deliver sonication to upper cranial nerve regions with spatial accuracy comparable to that of focused ultrasound brain targets used in previous human studies. Temperature measurements in cortical bone and in the skull base with embedded thermocouples yield evidence of minimal bone heating. Conventional pulse parameters were found to cause reverberation interference patterns near the cranial floor; therefore, changes in pulse cycles and pulse repetition frequency were examined for reducing standing waves. Limitations and considerations for conducting ultradeep focal targeting in human applications are discussed.
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Affiliation(s)
- Spencer T Brinker
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA.
| | - Priti Balchandani
- BioMedical Engineering and Imaging Institute, Departments of Diagnostic, Molecular and Interventional Radiology, Neuroscience and Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alan C Seifert
- Biomedical Engineering and Imaging Institute, Department of Diagnostic, Molecular and Interventional Radiology, and Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hyo-Jin Kim
- Center for Healthcare Robotics, Korea Institute of Science and Technology, Seoul, South Korea
| | - Kyungho Yoon
- School of Mathematics and Computing (Computational Science and Engineering), Yonsei University, Seoul, South Korea
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