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Tang KWK, Jeong J, Hsieh JC, Yao M, Ding H, Wang W, Liu X, Pyatnitskiy I, He W, Moscoso-Barrera WD, Lozano AR, Artman B, Huh H, Wilson PS, Wang H. Bioadhesive hydrogel-coupled and miniaturized ultrasound transducer system for long-term, wearable neuromodulation. Nat Commun 2025; 16:4940. [PMID: 40436843 PMCID: PMC12119832 DOI: 10.1038/s41467-025-60181-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 05/16/2025] [Indexed: 06/01/2025] Open
Abstract
Transcranial focused ultrasound is a promising non-invasive method for neuromodulation, particularly for neurodegenerative and psychiatric conditions. However, its use in wearable systems has been limited due to bulky devices and reliance on ultrasound gel, which dehydrates and lacks stable adhesion for long-term use. Here, we present a miniaturized wearable ultrasound device, comparable in size to standard electrophysiological electrodes, integrated with a bioadhesive hydrogel for stable, long-term somatosensory cortical stimulation. Our air-cavity Fresnel lens based self-focusing acoustic transducer was fabricated via a lithography-free microfabrication process, achieving 30.7 W/cm² (1.92 MPa) acoustic intensity and 10 mm focal depth. The hydrogel couplant exhibited less than 13% acoustic attenuation and maintained a stable adhesion force of 0.961 N/cm for 35 days. Using this system, we successfully suppressed somatosensory evoked potentials elicited by functional electrical stimulation over 28 days, demonstrating the device's potential for long-term, wearable neuromodulation applications.
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Affiliation(s)
- Kai Wing Kevin Tang
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Jinmo Jeong
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Ju-Chun Hsieh
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Mengmeng Yao
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Hong Ding
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Wenliang Wang
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Xiangping Liu
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Ilya Pyatnitskiy
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Weilong He
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - William D Moscoso-Barrera
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Anakaren Romero Lozano
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Brinkley Artman
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Heeyong Huh
- Department of Aerospace Engineering and Engineering Mechanics, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Preston S Wilson
- Walker Department of Mechanical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Huiliang Wang
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA.
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2
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Wang J, Wang Y, Qie S. Transcranial ultrasound stimulation in neuromodulation: a bibliometric analysis from 2004 to 2024. Front Neurosci 2025; 19:1595061. [PMID: 40433495 PMCID: PMC12106416 DOI: 10.3389/fnins.2025.1595061] [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: 03/17/2025] [Accepted: 04/29/2025] [Indexed: 05/29/2025] Open
Abstract
Background Transcranial ultrasound stimulation (TUS) is a non-invasive neuromodulation technique with promising clinical potential. Its therapeutic efficacy and safety are significantly influenced by stimulation parameters. However, the global research hotspots and future research trends of TUS application in the field of rehabilitation are unclear. This study analyzes the status of TUS research. Understand the annual publication trends, international and institutional cooperation pattern and influential authors and journals and keyword hotspot. Methods A comprehensive literature search was conducted on the Web of Science core database using TUS-related subject headings until 27 December 2024. Two researchers independently screened articles based on pre-determined inclusion and exclusion criteria. Software packages such as CiteSpace and VOSviewer were used to visualize the results. Results A total of 577 literatures were included. The results show that the annual publication volume shows an increasing trend, reaching a peak in 2024. The United States, China and Germany dominated the number of publications, with the largest number of institutions being Harvard University, the University of Toronto and Brigham and Women's Hospital. Brain stimulation is the journal with the most articles and citations. Research hotspots include transcranial magnetic stimulation, noninvasive brain stimulation, Parkinson's disease, and Alzheimer's disease. Conclusion A bibliometric analysis of the literature shows that research interest in transcranial ultrasound stimulation is growing rapidly, with annual publications growing exponentially since 2013 and receiving increasing attention from researchers. The findings suggest that TUS is currently used primarily in neurological diseases, particularly in the study of Parkinson's disease and Alzheimer's disease. At the same time, it is found that an emerging international cooperation model with the partnership between the United States, China and Germany as the core has gradually taken shape. Although preclinical studies have shown promising neuromodulator effects, the current study suggests that TUS needs to undergo further multicenter clinical validation. These findings provide evidence to guide future research priorities for non-invasive neuromodulation.
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Affiliation(s)
- Jingxuan Wang
- Beijing Rehabilitation Medicine, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuling Wang
- Department of Orthopedics II, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shuyan Qie
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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3
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Rotstein NM, Cohen ZD, Welborn A, Zbozinek TD, Akre S, Jones KG, Null KE, Pontanares J, Sanchez KL, Flanagan DC, Halavi SE, Kittle E, McClay MG, Bui AAT, Narr KL, Welsh RC, Craske MG, Kuhn TP. Investigating low intensity focused ultrasound pulsation in anhedonic depression-A randomized controlled trial. Front Hum Neurosci 2025; 19:1478534. [PMID: 40196448 PMCID: PMC11973349 DOI: 10.3389/fnhum.2025.1478534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 03/05/2025] [Indexed: 04/09/2025] Open
Abstract
Introduction Anhedonic depression is a subtype of depression characterized by deficits in reward processing. This subtype of depression is associated with higher suicide risk and longer depressive episodes, underscoring the importance of effective treatments. Anhedonia has also been found to correlate with alterations in activity in several subcortical regions, including the caudate head and nucleus accumbens. Low intensity focused ultrasound pulsation (LIFUP) is an emerging technology that enables non-invasive stimulation of these subcortical regions, which were previously only accessible with surgically-implanted electrodes. Methods This double-blinded, sham-controlled study aims to investigate the effects of LIFUP to the left caudate head and right nucleus accumbens in participants with anhedonic depression. Participants in this protocol will undergo three sessions of LIFUP over the span of 5-9 days. To investigate LIFUP-related changes, this 7-week protocol collects continuous digital phenotyping data, an array of self-report measures of depression, anhedonia, and other psychopathology, and magnetic resonance imaging (MRI) before and after the LIFUP intervention. Primary self-report outcome measures include Ecological Momentary Assessment, the Positive Valence Systems Scale, and the Patient Health Questionnaire. Primary imaging measures include magnetic resonance spectroscopy and functional MRI during reward-based tasks and at rest. Digital phenotyping data is collected with an Apple Watch and participants' personal iPhones throughout the study, and includes information about sleep, heart rate, and physical activity. Discussion This study is the first to investigate the effects of LIFUP to the caudate head or nucleus accumbens in depressed subjects. Furthermore, the data collected for this protocol covers a wide array of potentially affected modalities. As a result, this protocol will help to elucidate potential impacts of LIFUP in individuals with anhedonic depression.
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Affiliation(s)
- Natalie M. Rotstein
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Zachary D. Cohen
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Amelia Welborn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tomislav D. Zbozinek
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samir Akre
- Medical & Imaging Informatics Group, University of California, Los Angeles, Los Angeles, CA, United States
| | - Keith G. Jones
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kaylee E. Null
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jillian Pontanares
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Katy L. Sanchez
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Demarko C. Flanagan
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sabrina E. Halavi
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Evan Kittle
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mason G. McClay
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alex A. T. Bui
- Medical & Imaging Informatics Group, University of California, Los Angeles, Los Angeles, CA, United States
| | - Katherine L. Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Robert C. Welsh
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle G. Craske
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Taylor P. Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Xu S, Gu L, Bao B, Liu Q, Jin Q, Ma Y, Zhou S, Li B, Xu L, Guo G, Zhu J, Su KP, Sun P. Mechanistic insights into the neuroprotective effects of low-intensity transcranial ultrasound stimulation in post-cardiac arrest brain injury: Modulation of the Piezo1-Dkk3/PI3K-Akt pathway. Brain Behav Immun 2025; 127:341-357. [PMID: 40118226 DOI: 10.1016/j.bbi.2025.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 03/13/2025] [Accepted: 03/17/2025] [Indexed: 03/23/2025] Open
Abstract
Post-cardiac arrest brain injury (PCABI) remains a significant challenge, marked by high mortality and disability rates due to persistent neuroinflammation. This study explored the neuroprotective potential of low-intensity transcranial ultrasound stimulation (LITUS) in mitigating brain damage after cardiopulmonary resuscitation (CPR) using a murine model and in vitro assays. LITUS treatment improved 24-h survival rates and neurological recovery in cardiac arrest (CA) mice, as evidenced by behavioral assessments and reduced neurological deficit scores. Proteomic analyses revealed modulation of Piezo1-Dkk3/PI3K-Akt signaling pathway, characterized by decreased pro-inflammatory cytokines (IL-1β, IL-6, TNF-α). Mechanistic studies demonstrated that LITUS enhanced Piezo1 and Dkk3 activation, promoting calcium influx and anti-inflammatory responses. The Piezo1 antagonist GsMTx4 abrogated these effects, underscoring Piezo1's specific role. Additionally, in vitro experiments using oxygen/glucose deprivation and reoxygenation (OGD/R)-treated BV2 microglial cells confirmed that LITUS reduced inflammatory responses and enhanced cellular recovery via the Piezo1-Dkk3 axis. These findings highlight LITUS as a promising non-invasive therapeutic strategy to ameliorate PCABI by modulating neuroinflammation through the Piezo1-Dkk3/PI3K-Akt pathway. This work provides a basis for translational research and potential clinical applications in improving outcomes for CPR survivors.
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Affiliation(s)
- Shuang Xu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China; Department of Critical Care Medicine, Henan Key Laboratory for Critical Care Medicine, Zhengzhou Key Laboratory for Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Lulu Gu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Banghe Bao
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Qian Liu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Qiaofeng Jin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yannan Ma
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Emergency Medicine, Beijing Chao-Yang Hospital Capital Medical University, Beijing, China
| | - Siyi Zhou
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Beibei Li
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Li Xu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Guangqi Guo
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jinpiao Zhu
- Department of Rehabilitation, Perioperative and Systems Medicine Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Kuan-Pin Su
- Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
| | - Peng Sun
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China.
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5
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Radjenovic S, Bender L, Gaal M, Grigoryeva D, Mitterwallner M, Osou S, Zettl A, Plischek N, Lachmair P, Herzhauser K, Matt E, Beisteiner R. A retrospective analysis of ultrasound neuromodulation therapy using transcranial pulse stimulation in 58 dementia patients. Psychol Med 2025; 55:e70. [PMID: 40033713 PMCID: PMC12080636 DOI: 10.1017/s0033291725000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 02/05/2025] [Accepted: 02/12/2025] [Indexed: 03/05/2025]
Abstract
BACKGROUND Novel ultrasound neuromodulation techniques allow therapeutic brain stimulation with unmet precision and non-invasive targeting of deep brain areas. Transcranial pulse stimulation (TPS), a multifrequency sonication technique, is approved for the clinical treatment of Alzheimer's disease (AD). Here, we present the largest real-world retrospective analysis of ultrasound neuromodulation therapy in dementia (AD, vascular, mixed) and mild cognitive impairment (MCI). METHODS The consecutive sample involved 58 patients already receiving state-of-the-art treatment in an open-label, uncontrolled, retrospective study. TPS therapy typically comprises 10 sessions (range 8-12) with individualized MRI-based target areas defined according to brain pathology and individual pathophysiology. We compared the CERAD-Plus neuropsychological test battery results before and after treatment, with the CERAD Corrected Total Score ( CTS) as the primary outcome. Furthermore, we analyzed side effects reported by patients during the treatment period. RESULTS CERAD Corrected Total Score (CTS) significantly improved (p = .017, d = .32) after treatment (Baseline: M = 56.56, SD = 18.56; Post-treatment: M = 58.65, SD = 19.44). The group of top-responders (top quartile) improved even by 9.8 points. Fewer than one-third of all patients reported any sensation during treatment. Fatigue and transient headaches were the most common, with no severe adverse events. CONCLUSIONS The findings implicate TPS as a novel and safe add-on therapy for patients with dementia or MCI with the potential to further improve current state-of-the-art treatment results. Despite the individual benefits, further randomized, sham-controlled, longitudinal clinical trials are needed to differentiate the effects of verum and placebo.
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Affiliation(s)
- Sonja Radjenovic
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Lena Bender
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Martin Gaal
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daria Grigoryeva
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Sarah Osou
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Zettl
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nina Plischek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Patrick Lachmair
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Katrin Herzhauser
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Eva Matt
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Roland Beisteiner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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6
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Murphy KR, Nandi T, Kop B, Osada T, Lueckel M, N'Djin WA, Caulfield KA, Fomenko A, Siebner HR, Ugawa Y, Verhagen L, Bestmann S, Martin E, Butts Pauly K, Fouragnan E, Bergmann TO. A practical guide to transcranial ultrasonic stimulation from the IFCN-endorsed ITRUSST consortium. Clin Neurophysiol 2025; 171:192-226. [PMID: 39933226 DOI: 10.1016/j.clinph.2025.01.004] [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: 02/06/2024] [Revised: 01/05/2025] [Accepted: 01/09/2025] [Indexed: 02/13/2025]
Abstract
Low-intensity Transcranial Ultrasonic Stimulation (TUS) is a non-invasive brain stimulation technique enabling cortical and deep brain targeting with unprecedented spatial accuracy. Given the high rate of adoption by new users with varying levels of expertise and interdisciplinary backgrounds, practical guidelines are needed to ensure state-of-the-art TUS application and reproducible outcomes. Therefore, the International Transcranial Ultrasonic Stimulation Safety and Standards (ITRUSST) consortium has formed a subcommittee, endorsed by the International Federation of Clinical Neurophysiology (IFCN), to develop recommendations for best practices in human TUS applications. The practical guide presented here provides a brief introduction into ultrasound physics and sonication parameters. It explains the requirements of TUS lab equipment and transducer selection and discusses experimental design and procedures alongside potential confounds and control conditions. Finally, the guide elaborates on essential steps of application planning for stimulation safety and efficacy, as well as considerations when combining TUS with neuroimaging, electrophysiology, or other brain stimulation techniques. We hope that this practical guide to TUS will assist both novice and experienced users in planning and conducting high-quality studies and provide a solid foundation for further advancements in this promising field.
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Affiliation(s)
- Keith R Murphy
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Tulika Nandi
- Neuroimaging Center, Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center, Mainz, Germany; Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands
| | - Benjamin Kop
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands
| | - Takahiro Osada
- Department of Neurophysiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Maximilian Lueckel
- Neuroimaging Center, Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center, Mainz, Germany; Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - W Apoutou N'Djin
- LabTAU, INSERM, Centre Léon Bérard, Université Claude Bernard Lyon 1, F-69003 Lyon, France
| | - Kevin A Caulfield
- Medical University of South Carolina, Department of Psychiatry & Behavioral Sciences, Charleston, SC, USA
| | - Anton Fomenko
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - Lennart Verhagen
- Donders Institute for Brain, Cognition, and Behavior, Radboud University, Nijmegen, Netherlands
| | - Sven Bestmann
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, University College London, UK
| | - Eleanor Martin
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Kim Butts Pauly
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Elsa Fouragnan
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Til Ole Bergmann
- Neuroimaging Center, Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center, Mainz, Germany; Leibniz Institute for Resilience Research (LIR), Mainz, Germany.
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7
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Matt E, Mitterwallner M, Radjenovic S, Grigoryeva D, Weber A, Stögmann E, Domitner A, Zettl A, Osou S, Beisteiner R. Ultrasound Neuromodulation With Transcranial Pulse Stimulation in Alzheimer Disease: A Randomized Clinical Trial. JAMA Netw Open 2025; 8:e2459170. [PMID: 40009384 PMCID: PMC11866033 DOI: 10.1001/jamanetworkopen.2024.59170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 12/06/2024] [Indexed: 02/27/2025] Open
Abstract
Importance Given the increasing prevalence of dementia and the limited treatment options available, ultrasound neuromodulation could serve as a novel add-on therapy to standard treatments for Alzheimer disease (AD). As ultrasound neuromodulation is still in its early stages, further research is essential to fully explore its potential in treating brain disorders. Objective To evaluate clinical and functional imaging effects of transcranial pulse stimulation (TPS) in patients with AD. Design, Setting, and Participants A randomized, double-blind, sham-controlled, crossover clinical trial was conducted at the Medical University of Vienna between January 1, 2017, and July 27, 2022. Sixty patients with clinically diagnosed AD receiving state-of-the-art treatment were randomly allocated to treatment sequence groups verum-sham (first cycle verum, second cycle sham, n = 30) and sham-verum (n = 30). Data analysis was performed from July 28, 2022, to September 5, 2024. Intervention Each participant received 6 verum and 6 sham TPS sessions (6000 pulses, 0.20 mJ/mm2, 5 Hz) to frontoparietal brain areas. Main Outcomes and Measures Neuropsychological tests, including the primary outcome Consortium to Establish a Registry for Alzheimer's Disease (CERAD) corrected total score (CTS), were performed at baseline and 1 week, 1 month, and 3 months following the stimulations in each cycle. Primary and secondary outcomes, including functional magnetic resonance imaging and Beck Depression Inventory-II, were analyzed by intention-to-treat analysis and, for sensitivity, by per protocol analysis. Results For the intention-to-treat analysis, 60 patients between ages 51 and 82 years (mean [SD], 70.65 [8.16] years; 30 females; 30 males) were included. The CERAD CTS increased by a mean (SD) of 2.22 (6.87) points in the verum condition from 70.93 (14.27) points at baseline to 73.15 (14.90) 3 months after stimulation, while the mean (SD) score in the sham condition increased by 1.00 (6.82) point vs baseline from 71.68 (13.62] at baseline to 72.68 (14.48) 3 months after stimulation. Primary data analysis of the condition × session interaction was not significant (P = .68; partial η2 [ηp2] = 0.01), but its interaction with age was P = .003; ηp2 = 0.08, followed by post hoc analyses of age subsamples. Although several patients older than 70 years benefited from verum TPS, only the younger subgroup (≤70 years) showed significantly higher CTS increases for verum in all poststimulation sessions (condition × session: P = .005; ηp2 = 0.16). At 3 months after stimulation, for example, a mean (SD) 3.91 (7.86)-point increase was found for verum TPS in the younger patients, but a mean (SD) CTS decrease of 1.83 (5.80) was observed for sham. Memory-associated brain activation was significantly higher after verum TPS in the precuneus, visual, and frontal areas, while resting state functional connectivity was significantly upregulated in the dorsal attention network. In the per protocol sample, a significant reduction of the Beck Depression Inventory-II scores 3 months following verum TPS was found (verum baseline: 7.27 [5.87]; verum 3 months after stimulation: 5.27 [5.27]; sham baseline: 6.70 [5.65]; sham 3 months after stimulation: 6.22 [4.40]; P = .008; ηp2 = 0.23). During both verum and sham conditions, the most common observed adverse symptom was depression; no major neuropathologic change was detected in the patients by detailed neuroradiologic assessments. Conclusions and Relevance In this randomized clinical trial of TPS in patients with AD, a 2-week verum treatment improved cognitive scores in the younger subgroup, ameliorated depressive symptoms, and induced upregulation of functional brain activation and connectivity. These findings suggest TPS may be a safe and promising add-on therapy for patients with AD receiving state-of-the-art treatment. Trial Registration ClinicalTrials.gov Identifier: NCT03770182.
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Affiliation(s)
- Eva Matt
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Michael Mitterwallner
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sonja Radjenovic
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daria Grigoryeva
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Weber
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Stögmann
- Memory Outpatient Clinic, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Alina Domitner
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Zettl
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sarah Osou
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Roland Beisteiner
- Functional Brain Diagnostics and Therapy, Department of Neurology, Medical University of Vienna, Vienna, Austria
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Sharif F, Harmer CJ, Klein-Flügge MC, Tan H. Novel NIBS in psychiatry: Unveiling TUS and TI for research and treatment. Brain Neurosci Adv 2025; 9:23982128251322241. [PMID: 40092509 PMCID: PMC11909681 DOI: 10.1177/23982128251322241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 02/03/2025] [Indexed: 03/19/2025] Open
Abstract
Mental disorders pose a significant global burden and constitute a major cause of disability worldwide. Despite strides in treatment, a substantial number of patients do not respond adequately, underscoring the urgency for innovative approaches. Traditional non-invasive brain stimulation techniques show promise, yet grapple with challenges regarding efficacy and specificity. Variations in mechanistic understanding and reliability among non-invasive brain stimulation methods are common, with limited spatial precision and physical constraints hindering the ability to target subcortical areas often implicated in the disease aetiology. Novel techniques such as transcranial ultrasonic stimulation and temporal interference stimulation have gained notable momentum in recent years, possibly addressing these shortcomings. Transcranial ultrasonic stimulation (TUS) offers exceptional spatial precision and deeper penetration compared with conventional electrical and magnetic stimulation techniques. Studies targeting a diverse array of brain regions have shown its potential to affect neuronal excitability, functional connectivity and symptoms of psychiatric disorders such as major depressive disorder. Nevertheless, challenges such as target planning and addressing acoustic interactions with the skull must be tackled for its widespread adoption in research and potentially clinical settings. Similar to transcranial ultrasonic stimulation, temporal interference (TI) stimulation offers the potential to target deeper subcortical areas compared with traditional non-invasive brain stimulation, albeit requiring a comparatively higher current for equivalent neural effects. Promising yet still sparse research highlights TI's potential to selectively modulate neuronal activity, showing potential for its utility in psychiatry. Overall, recent strides in non-invasive brain stimulation methods like transcranial ultrasonic stimulation and temporal interference stimulation not only open new research avenues but also hold potential as effective treatments in psychiatry. However, realising their full potential necessitates addressing practical challenges and optimising their application effectively.
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Affiliation(s)
- Faissal Sharif
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Miriam C. Klein-Flügge
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Huiling Tan
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Keihani A, Sanguineti C, Chaichian O, Huston CA, Moore C, Cheng C, Janssen SA, Donati FL, Mayeli A, Moussawi K, Phillips ML, Ferrarelli F. Transcranial Focused Ultrasound Neuromodulation in Psychiatry: Main Characteristics, Current Evidence, and Future Directions. Brain Sci 2024; 14:1095. [PMID: 39595858 PMCID: PMC11592166 DOI: 10.3390/brainsci14111095] [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: 09/30/2024] [Revised: 10/26/2024] [Accepted: 10/28/2024] [Indexed: 11/28/2024] Open
Abstract
Non-invasive brain stimulation (NIBS) techniques are designed to precisely and selectively target specific brain regions, thus enabling focused modulation of neural activity. Among NIBS technologies, low-intensity transcranial focused ultrasound (tFUS) has emerged as a promising new modality. The application of tFUS can safely and non-invasively stimulate deep brain structures with millimetric precision, offering distinct advantages in terms of accessibility to non-cortical regions over other NIBS methods. However, to date, several tFUS aspects still need to be characterized; furthermore, there are only a handful of studies that have utilized tFUS in psychiatric populations. This narrative review provides an up-to-date overview of key aspects of this NIBS technique, including the main components of a tFUS system, the neuronavigational tools used to precisely target deep brain regions, the simulations utilized to optimize the stimulation parameters and delivery of tFUS, and the experimental protocols employed to evaluate the efficacy of tFUS in psychiatric disorders. The main findings from studies in psychiatric populations are presented and discussed, and future directions are highlighted.
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Affiliation(s)
- Ahmadreza Keihani
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
| | - Claudio Sanguineti
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
- Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Omeed Chaichian
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
| | - Chloe A. Huston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
| | - Caitlin Moore
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
| | - Cynthia Cheng
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
| | - Sabine A. Janssen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
| | - Francesco L. Donati
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
| | - Ahmad Mayeli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
| | - Khaled Moussawi
- Department of Neurology, University of California, San Francisco, CA 94143, USA;
| | - Mary L. Phillips
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.K.); (C.S.); (O.C.); (C.A.H.); (C.M.); (C.C.); (S.A.J.); (A.M.); (M.L.P.)
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Murphy K, Fouragnan E. The future of transcranial ultrasound as a precision brain interface. PLoS Biol 2024; 22:e3002884. [PMID: 39471185 PMCID: PMC11521279 DOI: 10.1371/journal.pbio.3002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2024] Open
Abstract
Our understanding of brain circuit operations and disorders has rapidly outpaced our ability to intervene and restore them. Developing technologies that can precisely interface with any brain region and circuit may combine diagnostics with therapeutic intervention, expediting personalised brain medicine. Transcranial ultrasound stimulation (TUS) is a promising noninvasive solution to this challenge, offering focal precision and scalability. By exploiting the biomechanics of pressure waves on brain tissue, TUS enables multi-site targeted neuromodulation across distributed circuits in the cortex and deeper areas alike. In this Essay, we explore the emergent evidence that TUS can functionally test and modify dysfunctional regions, effectively serving as a search and rescue tool for the brain. We define the challenges and opportunities faced by TUS as it moves towards greater target precision and integration with advanced brain monitoring and interventional technology. Finally, we propose a roadmap for the evolution of TUS as it progresses from a research tool to a clinically validated therapeutic for brain disorders.
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Affiliation(s)
- Keith Murphy
- Department of Radiology, Stanford University, Stanford, California, United States of America
- Attune Neurosciences, San Francisco, California, United States of America
| | - Elsa Fouragnan
- Brain Research and Imaging Centre, University of Plymouth, Plymouth, United Kingdom
- School of psychology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Beisteiner R, Lozano A, Di Lazzaro V, George MS, Hallett M. Clinical recommendations for non-invasive ultrasound neuromodulation. Brain Stimul 2024; 17:890-895. [PMID: 39084519 DOI: 10.1016/j.brs.2024.07.013] [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: 04/04/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
Non-invasive ultrasound neuromodulation has experienced exponential growth in the neuroscientific literature, recently also including clinical studies and applications. However, clinical recommendations for the secure and effective application of ultrasound neuromodulation in pathological brains are currently lacking. Here, clinical experts with neuroscientific expertise in clinical brain stimulation and ultrasound neuromodulation present initial clinical recommendations for ultrasound neuromodulation with relevance for all ultrasound neuromodulation techniques. The recommendations start with methodological safety issues focusing on technical issues to avoid harm to the brain. This is followed by clinical safety issues focusing on important factors concerning pathological situations.
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Affiliation(s)
- Roland Beisteiner
- Department of Neurology, Functional Brain Diagnostics and Therapy, High Field MR Center, Medical University of Vienna, Vienna, Austria.
| | - Andres Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Mark S George
- Brain Stimulation Division, Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, USA
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