Focused Ultrasound for Treatment of Epilepsy: a Systematic Review and Meta-analysis of Preclinical and Clinical Studies

Overview

Journal Neurosurg Rev

Specialty Neurosurgery

Date 2024 Nov 9

PMID 39521750

Authors

Alireza Soltani Khaboushan

Rasa Zafari

Mohammadmahdi Sabahi

Mirhojjat Khorasanizadeh

Mohammad Amin Dabbagh Ohadi

Oliver Flouty

Manish Ranjan

Konstantin V Slavin

Affiliations

Soon will be listed here.

Abstract

Various preclinical and clinical studies have demonstrated the neuromodulatory and ablative effects of focused ultrasound (FUS). However, the safety and efficacy of FUS in clinical settings for treating epilepsy have not been well established. This study aims to provide a systematic review of all preclinical and clinical studies that have used FUS for the treatment of epilepsy. A systematic search was conducted using Scopus, Web of Science, PubMed, and Embase databases. All preclinical and clinical studies reporting outcomes of FUS in the treatment of epilepsy were included in the systematic review. Random-effect meta-analysis was performed to determine safety in clinical studies and seizure activity reduction in preclinical studies. A total of 24 articles were included in the study. Meta-analysis demonstrated that adverse events occurred in 13% (95% CI = 2-57%) of patients with epilepsy who underwent FUS. The frequency of adverse events was higher with the use of FUS for lesioning (36%, 95% CI = 4-88%) in comparison to neuromodulation (5%, 95% CI = 0-71%), although this difference was not significant (P = 0.31). Three-level meta-analysis in preclinical studies demonstrated a reduced spike rate in neuromodulating FUS compared to the control group (P = 0.02). According to this systematic review and meta-analysis, FUS can be considered a safe and feasible approach for treating epileptic seizures, especially in drug-resistant patients. While the efficacy of FUS has been demonstrated in several preclinical studies, further research is necessary to confirm its effectiveness in clinical practice and to determine the adverse events.

References

de Boer H, Mula M, Sander J . The global burden and stigma of epilepsy. Epilepsy Behav. 2008; 12(4):540-6. DOI: 10.1016/j.yebeh.2007.12.019. View

Boon P, De Cock E, Mertens A, Trinka E . Neurostimulation for drug-resistant epilepsy: a systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response. Curr Opin Neurol. 2018; 31(2):198-210. DOI: 10.1097/WCO.0000000000000534. View

Scharfman H . The neurobiology of epilepsy. Curr Neurol Neurosci Rep. 2007; 7(4):348-54. PMC: 2492886. DOI: 10.1007/s11910-007-0053-z. View

Lopez Gonzalez F, Rodriguez Osorio X, Gil-Nagel Rein A, Carreno Martinez M, Serratosa Fernandez J, Villanueva Haba V . Drug-resistant epilepsy: definition and treatment alternatives. Neurologia. 2014; 30(7):439-46. DOI: 10.1016/j.nrl.2014.04.012. View

Englot D, Chang E . Rates and predictors of seizure freedom in resective epilepsy surgery: an update. Neurosurg Rev. 2014; 37(3):389-404. PMC: 5257205. DOI: 10.1007/s10143-014-0527-9. View

Lescrauwaet E, Vonck K, Sprengers M, Raedt R, Klooster D, Carrette E . Recent Advances in the Use of Focused Ultrasound as a Treatment for Epilepsy. Front Neurosci. 2022; 16:886584. PMC: 9251412. DOI: 10.3389/fnins.2022.886584. View

Foutz T, Wong M . Brain stimulation treatments in epilepsy: Basic mechanisms and clinical advances. Biomed J. 2021; 45(1):27-37. PMC: 9133258. DOI: 10.1016/j.bj.2021.08.010. View

Toffa D, Touma L, El Meskine T, Bouthillier A, Nguyen D . Learnings from 30 years of reported efficacy and safety of vagus nerve stimulation (VNS) for epilepsy treatment: A critical review. Seizure. 2020; 83:104-123. DOI: 10.1016/j.seizure.2020.09.027. View

Hartshorn A, Jobst B . Responsive brain stimulation in epilepsy. Ther Adv Chronic Dis. 2018; 9(7):135-142. PMC: 6009082. DOI: 10.1177/2040622318774173. View

10.

Bauer S, Baier H, Baumgartner C, Bohlmann K, Fauser S, Graf W . Transcutaneous Vagus Nerve Stimulation (tVNS) for Treatment of Drug-Resistant Epilepsy: A Randomized, Double-Blind Clinical Trial (cMPsE02). Brain Stimul. 2016; 9(3):356-363. DOI: 10.1016/j.brs.2015.11.003. View

11.

Cooper Y, Pianka S, Alotaibi N, Babayan D, Salavati B, Weil A . Repetitive transcranial magnetic stimulation for the treatment of drug-resistant epilepsy: A systematic review and individual participant data meta-analysis of real-world evidence. Epilepsia Open. 2018; 3(1):55-65. PMC: 5839309. DOI: 10.1002/epi4.12092. View

12.

San-Juan D, Espinoza Lopez D, Vazquez Gregorio R, Trenado C, Aragon M, Morales-Quezada L . Transcranial Direct Current Stimulation in Mesial Temporal Lobe Epilepsy and Hippocampal Sclerosis. Brain Stimul. 2016; 10(1):28-35. DOI: 10.1016/j.brs.2016.08.013. View

13.

Gil-Lopez F, Boget T, Manzanares I, Donaire A, Conde-Blanco E, Bailles E . External trigeminal nerve stimulation for drug resistant epilepsy: A randomized controlled trial. Brain Stimul. 2020; 13(5):1245-1253. DOI: 10.1016/j.brs.2020.06.005. View

14.

Hectors S, Jacobs I, Moonen C, Strijkers G, Nicolay K . MRI methods for the evaluation of high intensity focused ultrasound tumor treatment: Current status and future needs. Magn Reson Med. 2015; 75(1):302-17. DOI: 10.1002/mrm.25758. View

15.

Fomenko A, Neudorfer C, Dallapiazza R, Kalia S, Lozano A . Low-intensity ultrasound neuromodulation: An overview of mechanisms and emerging human applications. Brain Stimul. 2018; 11(6):1209-1217. DOI: 10.1016/j.brs.2018.08.013. View

16.

King R, Brown J, Newsome W, Pauly K . Effective parameters for ultrasound-induced in vivo neurostimulation. Ultrasound Med Biol. 2012; 39(2):312-31. DOI: 10.1016/j.ultrasmedbio.2012.09.009. View

17.

Younan Y, Deffieux T, Larrat B, Fink M, Tanter M, Aubry J . Influence of the pressure field distribution in transcranial ultrasonic neurostimulation. Med Phys. 2013; 40(8):082902. DOI: 10.1118/1.4812423. View

18.

Bystritsky A, Korb A, Douglas P, Cohen M, Melega W, Mulgaonkar A . A review of low-intensity focused ultrasound pulsation. Brain Stimul. 2011; 4(3):125-36. DOI: 10.1016/j.brs.2011.03.007. View

19.

McDannold , Hynynen K, Wolf D, Wolf G, Jolesz F . MRI evaluation of thermal ablation of tumors with focused ultrasound. J Magn Reson Imaging. 1998; 8(1):91-100. DOI: 10.1002/jmri.1880080119. View

20.

Bowary P, Greenberg B . Noninvasive Focused Ultrasound for Neuromodulation: A Review. Psychiatr Clin North Am. 2018; 41(3):505-514. DOI: 10.1016/j.psc.2018.04.010. View