Focused Ultrasound Therapy
Focused ultrasound is an early-stage, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with multiple sclerosis (MS). This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue.
How it Works
Where the beams converge, focused ultrasound produces several therapeutic effects that are being evaluated. One is precise ablation (thermal destruction of tissue), which enables treatment without surgery. This treatment is only focused on the movement disorder, and is not intended to treat the underlying cause of MS.
The second mechanism utilizing focused ultrasound is to possibly treat the actual underlying cause of multiple sclerosis and preserve the myelin sheath (insulation around nerves) which allows nerves to transmit signals quickly and efficiently. Preclinical work has shown that focused ultrasound accelerates remyelinization of nerves.
The third area of research takes advantage of the ability of focused ultrasound to open the blood-brain barrier (BBB). Focused ultrasound can reversibly and safely allow the blood vessels in the brain to partially “open” the otherwise tight junctions, allowing certain therapies (genes, stem cells, neuroprotective and/or neurorestorative drugs, and medications) to enter the brain in specific areas. Current avenues of research involve delivering these therapies directly from the bloodstream itself or even within or attached to microbubbles.
For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing or infection – at a lower cost. It also offer precision targeting to minimize damage to healthy tissue and opens BBB safely to enhance drug delivery and immune effects. Focused ultrasound can also be repeated, if necessary.
A clinical trial has begun in Canada treating patients with multiple sclerosis induced hand tremor with focused ultrasound. This trial is only open to citizens of Canada.
Regulatory Approval and Reimbursement
Focused ultrasound treatment for multiple sclerosis is not yet approved by regulatory bodies or covered by medical insurance companies.
Gagliardo C, Ragonese P, Iacopino GD, Salemi G, Midiri M, D'Amelio M. Transcranial magnetic resonance-guided focused ultrasound thalamotomy as a safe treatment option in multiple sclerosis patients with essential tremor. Neurol Sci. 2020 Oct 22. doi: 10.1007/s10072-020-04841-4.
Máñez-Miró JU, Martínez-Fernández R, Del Alamo M, Pineda-Pardo JA, Fernández-Rodríguez B, Alonso-Frech F, Álvarez-Cermeño JC, Obeso JA. Focused ultrasound thalamotomy for multiple sclerosis-associated tremor. Mult Scler. 2019 Oct 16:1352458519861597. doi: 10.1177/1352458519861597.
B. Fernández-Rodríguez, D. Urso, M. Monje, JA. Pineda-Pardo, M. del Álamo, R. Blazquez-Navarro, F. Hernández-Fernández, L. Vela, F. Alonso-Frech, R. Martínez-Fernández, J. Obeso. MRI-guided Focused Ultrasound thalamotomy for Multiple Sclerosis-associated tremor: A case report [abstract]. Mov Disord.2018; 33 (suppl 2).
Olmstead TA, Chiarelli PA, Griggs DJ, McClintic AM, Myroniv AN, Mourad PD. Transcranial and pulsed focused ultrasound that activates brain can accelerate remyelination in a mouse model of multiple sclerosis. J Ther Ultrasound. 2018 Dec 10;6:11. doi: 10.1186/s40349-018-0119-1. eCollection 2018.
Robert J Motl, Anthony Podkowa, Rita J Miller, Michael L. Oelze. Focused ultrasound therapy of cercial lymph nodes in rats for alleviating EAE. Journal of Cerebral Blood Flow & Metabolism 2017, Vol. 37(4) 1236–1250
Sierra, C, Acosta, A, Chen C, Shih-Ying, W, Karakatsani, M, Bernal M, Konofagou, E. Lipid microbubbles as a vehicle for targeted drug delivery using focused ultrasound- induced blood brain barrier opening. Journal of Cerebral Blood Flow & Metabolism. 2017, Vol. 37(4) 1236–1250
Iodice R, Manganelli F, Dubbioso R. The therapeutic use of non-invasive brain stimulation in multiple sclerosis - a review. Restor Neurol Neurosci. 2017;35(5):497-509. doi: 10.3233/RNN-170735.
Yoo SH, Croce P, Margolin RW, Lee SD, Lee W. Pulsed focused ultrasound changes nerve conduction of earthworm giant axonal fibers. Neuroreport. 2017 Mar 1;28(4):229-233. doi: 10.1097/WNR.0000000000000745.
Darvas F1, Mehić E1, Caler CJ2, Ojemann JG1, Mourad PD3. Toward Deep Brain Monitoring with Superficial EEG Sensors Plus Neuromodulatory Focused Ultrasound. Ultrasound Med Biol. 2016 Aug;42(8):1834-47. doi: 10.1016/j.ultrasmedbio.2016.02.020. Epub 2016 May 13.
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