Therapeutic ultrasound: The future of epilepsy surgery? |
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| Affiliation: | 1. Department of Neurosurgery, CHR Citadelle, Liege, Belgium;2. Department of Neurosurgery, Sorbonne University, AP–HP, La Pitié-Salpêtrière Hospital, 75013, Paris, France;3. Sorbonne University, GRC 23, Brain Machine Interface, AP–HP, La Pitié-Salpêtrière Hospital, 75013 Paris, France;4. Sorbonne University, Advanced Surgical Research Technology Lab, Paris, France;5. Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne University, UMRS, 1127 Paris, France;1. Loyola University Health System, Department of Neurosurgery, Maywood, IL, United States;2. Loyola Stritch School of Medicine, Maywood, IL, United States;3. Edward Hines Jr., VA Hospital, Department of Neurosurgery, Hines, IL, United States;1. Sorbonne Université, Paris, France;2. Infectious and tropical diseases unit, Pitié-Salpêtrière hospital, AP–HP, Paris, France;3. Neurology department, Pitié-Salpêtrière, AP–HP, Paris, France;4. Parasitology department, Pitié-Salpêtrière, AP–HP, Paris, France;5. Inserm, Institut Pierre Louis d’épidémiologie et de santé publique, Sorbonne université, Paris, France;1. Service de neurologie, AP–HP, hôpital Avicenne, Bobigny, France;2. Service de réanimation, AP–HP, hôpital Avicenne, Bobigny, France;3. Université Sorbonne Paris Nord, Bobigny, France;4. Service de radiologie, AP–HP, hôpital Avicenne, Bobigny, France;5. Service de radiologie, Fondation Rothschild, Paris, France;1. Department of Neuromuscular diseases and Department of Anatomy, CHU Besançon, University of Franche-Comté, Besançon, France;2. Center for Brain and Nervous System Disorders, Genolier Swiss Medical Network and department of neurology and neurorehabilitation Clinique Valmont, Glion, Switzerland;1. Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA;2. Allegheny-Singer Research Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA;3. College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA;1. Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA;2. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA;3. Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA |
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| Abstract: | Epilepsy is one of the leading neurological diseases in both adults and children and in spite of advancement in medical treatment, 20 to 30% of patients remain refractory to current medical treatment. Medically intractable epilepsy has a real impact on a patient's quality of life, neurologic morbidity and even mortality. Actual therapy options are an increase in drug dosage, radiosurgery, resective surgery and non-resective neuromodulatory treatments (deep brain stimulation, vagus nerve stimulation). Resective, thermoablative or neuromodulatory surgery in the treatment of epilepsy are invasive procedures, sometimes requiring long stay-in for the patients, risks of permanent neurological deficit, general anesthesia and other potential surgery-related complications such as a hemorrhage or an infection. Radiosurgical approaches can trigger radiation necrosis, brain oedema and transient worsening of epilepsy. With technology-driven developments and pursuit of minimally invasive neurosurgery, transcranial MR-guided focused ultrasound has become a valuable treatment for neurological diseases. In this critical review, we aim to give the reader a better understanding of current advancement for ultrasound in the treatment of epilepsy. By outlining the current understanding gained from both preclinical and clinical studies, this article explores the different mechanisms and potential applications (thermoablation, blood brain barrier disruption for drug delivery, neuromodulation and cortical stimulation) of high and low intensity ultrasound and compares the various possibilities available to patients with intractable epilepsy. Technical limitations of therapeutic ultrasound for epilepsy surgery are also detailed and discussed. |
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| Keywords: | HIFU Innovative technologies Noninvasive approach Neuromodulation Thermoablation Blood-brain barrier opening Drug-resistant epilepsy |
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