Abstract
Initially used in the treatment of prostate cancer and uterine fibroids, the role of focused ultrasound has expanded as transcranial acoustic wave distortion and other limitations have been overcome. Its utility relies on focal energy deposition via acoustic wave propagation. The duty cycle and intensity of focused ultrasound influence the rate of energy deposition and result in unique physiologic and biomechanical effects. Thermal ablation via high-intensity continuous exposure generates coagulative necrosis of tissues. High-intensity, pulsed application reduces temporally averaged energy deposition, resulting in mechanical effects, including reversible, localized BBB disruption, which enhances neurotherapeutic agent delivery. While the precise mechanisms remain unclear, low-intensity, pulsed exposures can influence neuronal activity with preservation of cytoarchitecture. Its noninvasive nature, high-resolution, radiation-free features allow focused ultrasound to compare favorably with other modalities. We discuss the physical characteristics of focused ultrasound devices, the biophysical mechanisms at the tissue level, and current and emerging applications.
Highlights
Jordao et al group further demonstrated a significant reduction inBy applying focused ultrasound (FUS) in a pulsed mode rather than a continuous ap- amyloid- plaque burden in the antibody ϩ FUS treatment hemiplication, the temporally averaged rate of energy deposition is sphere relative to the contralateral FUS-naive cerebral hemi-
Advantages and Obstacles of focused ultrasound (FUS) High-intensity MR imaging– guided FUS (MRgFUS) shares a great deal of therapeutic overlap with surgical resection and stereotactic radiosurgery, albeit with a few important distinctions
The ability to focus acoustic wave propagation noninvasively on the scale of a few millimeters while manipulating the magnitude of energy deposition to create unique bioeffects offers versatility that is unparalleled in neurotherapeutics and research (Table)
Summary
By applying FUS in a pulsed mode rather than a continuous ap- amyloid- plaque burden in the antibody ϩ FUS treatment hemiplication, the temporally averaged rate of energy deposition is sphere relative to the contralateral FUS-naive cerebral hemi-. Low-Intensity, Pulsed FUS Neuromodulation, or the ability to reversibly influence neuronal activity, either via excitation or reversible suppression, has enormous therapeutic potential. Deep brain stimulation has gained wideshown, without an increase in apoptosis or loss of BBB integrity. This was measured indirectly by using antibodies targeting apoptotic mediators and via a lack of intra-axial fluorescein isothiocyanate-dextran (10 kDa), which does not cross the BBB under normal conditions.[31]. Yoo et al[28] achieved reliable neurostimulation spread acceptance in the treatment of movement disorders, including Parkinson disease and essential tremor.[25] Electroconvulsive therapy[26] and, more recently, transcranial magnetic and reversible suppression by using remote low-intensity FUS in a rabbit model, as confirmed by fMRI and electroencephalographic recordings (Fig 5). Clinical applications of focused ultrasound and the proposed mechanisms of action
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