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Ultrasound neuromodulation

Ultrasound neuromodulation. Jeff Elias, MD Dept. of Neurological Surgery. Disclosures. FUS for brain : Investigational in U.S. Ultrasound. Production of reversible changes in the central nervous system by ultrasound.

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Ultrasound neuromodulation

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  1. Ultrasound neuromodulation Jeff Elias, MD Dept. of Neurological Surgery

  2. Disclosures • FUS for brain : Investigational in U.S.

  3. Ultrasound

  4. Production of reversible changes in the central nervous system by ultrasound The possibility, already realized in animals, of making reversible lesions, the effects of which will pass off in 5-10 minutes while the patient is being observed … it will be relatively simple matter to change the parameters and buzz the site for the production of an enduring lesion. It should be possible for us to report on the first human cases at the next meeting of this society. -- Russell Meyers at the Harvey Cushing Society, 1957 WJ Fry. Science 1958

  5. Focused Ultrasound

  6. HIFU Neuromodulation

  7. 7 Acoustic effects at the focus • Thermal • Frictional energy btwn molecules ~ pressure/frequency of US pulse • Tissue ablation • Mechanical • Sustained cavitation – microbubbles oscillate (BBB disruption) • Inertial cavitation - microbubbles burst (Sonothrombolysis) • Neuromodulation • HIFU > 1000 W/cm2 • can induce coagulative necrosis and cavitation • LIFU: pulsed at 30-500 mW/cm2 • Nonthermal, mechanical

  8. LIFU Neuromodulation, cortex

  9. LIFU Neuromodulation

  10. US neuromodulation, humans --Tyler, Nature Neuroscience 2014

  11. US Neuromodulation Advantages • Transcranial • Noninvasive • Deep targets • Spatial resolution ~ mm • MRI compatible • Safe (MI/TI within FDA) Disadvantages • Early stage • Investigational • Not optimized • Unknowns • Mechanism • Cortical/subcortical • Focused/Unfocused

  12. US neuromodulation:Future indications • Refining stereotactic procedures • Brain mapping • New targets • Define deep circuits • Acutetherapy: seizure/status epilepticus (requires ‘nonfocal’ treatment) • Chronictherapy: depression (requires long term effects)

  13. Thank you

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