Acute stroke: therapeutic transcranial Doppler sonography

Transcranial focused ultrasound for the treatment of tremor: A preliminary case series

BACKGROUND

Essential tremor (ET) can be debilitating. Treatments for ET include beta-blockers and surgical interventions. Low-intensity focused ultrasound (LIFU) may offer an office-based non-invasive alternative.

OBJECTIVE

This pilot open label clinical trial explores safety, feasibility, and potential efficacy of LIFU in treatment of ET.

METHODS

We report outcomes from the first 10 participants in this IRB-approved trial of LIFU for treatment of ET. The ventral intermediate nucleus of the thalamus (Vim) was targeted using structural and functional MRI. Participants underwent eight 10-min sessions of LIFU targeting the contralateral (Vim) to the most affected hand. Safety was closely monitored; Global Rating of Change (GRC) and The Essential Tremor Rating Scale (TETRAS) scores were collected.

RESULTS

No adverse effects were reported. Eight participants reported a GRC ≥2. TETRAS performance subscale demonstrated clinically significant improvement in all participants.

CONCLUSION

Preliminary findings support LIFU's safety and feasibility. The potential efficacy encourages additional sham-controlled studies.

The Role of Ultrasound as a Diagnostic and Therapeutic Tool in Experimental Animal Models of Stroke: A Review

Ultrasound is a noninvasive technique that provides real-time imaging with excellent resolution, and several studies demonstrated the potential of ultrasound in acute ischemic stroke monitoring. However, only a few studies were performed using animal models, of which many showed ultrasound to be a safe and effective tool also in therapeutic applications. The full potential of ultrasound application in experimental stroke is yet to be explored to further determine the limitations of this technique and to ensure the accuracy of translational research. This review covers the current status of ultrasound applied to monitoring and treatment in experimental animal models of stroke and examines the safety, limitations, and future perspectives.

Focused transcranial ultrasound for treatment of neurodegenerative dementia

Introduction

Preclinical studies support investigation of focused ultrasound for breakdown of cerebral pathologies in neurodegenerative conditions including Alzheimer's disease (AD) and Parkinson's disease (PD).

Methods

A focused transcranial Doppler device with probes (2 MHz, 520 mW/cm²) affixed bilaterally was used to target the hippocampus (AD) or substantia nigra (PD) with functional magnetic resonance imaging navigation for enhanced plaque removal. A total of 22 patients (n = 11 AD, n = 11 PD) underwent 8 consecutive, weekly, 1-hour treatments wherein sleep was encouraged naturally or pharmacologically. Cognitive and motor functioning assessment was carried out using standardized evaluations at baseline and conclusion.

Results

Of all, 62.5% of patients had one or more improved cognitive scores without data incongruence, 87% had stable or improved fine motor scores, and 87.5% had stable or improved gross motor scores. No adverse events were reported.

Discussion

The safety of focused transcranial Doppler and possible enhancement in patient functioning were suggested by outcome data.

Comparative study of standing wave reduction methods using random modulation for transcranial ultrasonication

Various transcranial sonotherapeutic technologies have risks related to standing waves in the skull. In this study, we present a comparative study on standing waves using four different activation methods: sinusoidal (SIN), frequency modulation by noise (FMN), periodic selection of random frequency (PSRF), and random switching of both inverse carriers (RSBIC). The standing wave was produced and monitored by the schlieren method using a flat plane and a human skull. The minimum ratio RSW, which is defined by the ratio of the mean of the difference between local maximal value and local minimal value of amplitude to the average value of the amplitude, was 36% for SIN, 24% for FMN, 13% for PSRF, and 4%for RSBIC for the flat reflective plate, and it was 25% for SIN, 11% for FMN, 13% for PSRF, and 5% for RSBIC for the inner surface of the human skull. This study is expected to have a role in the development of safer therapeutic equipment.

Standing-wave suppression for transcranial ultrasound by random modulation

Low-frequency transcranial ultrasound (<<1 MHz) is being investigated for a number of brain therapies, including stroke, tumor ablation, and localized opening of the blood-brain barrier. However, lower frequencies have been associated with the production of undesired standing waves and cavitation in the brain. Presently, we examine an approach to suppress standing waves during continuous-wave (CW) transcranial application. The investigation uses a small randomization in the frequency content of the signal for suppressing standing waves. The approach is studied in an ex-vivo human skull and a plastic-walled chamber, representing idealized conditions. The approach is compared to single-frequency CW operation as well as to a swept-frequency input. Acoustic field scans demonstrate that the swept-frequency method can suppress standing waves in the plastic chamber and skull by 3.4 and 1.6 times, respectively, compared to single-frequency CW excitation. With random modulation, standing waves were reduced by 5.6 and 2 times, respectively, in the plastic chamber and skull. It is expected that the process may play a critical role in providing a safer application of the ultrasound field in the brain and may have application in other areas where standing waves may be created.