Key Points
- Dr. Krishna is a functional neurosurgeon at the University of North Carolina–Chapel Hill.
- As a clinician researcher, he uses focused ultrasound to treat movement disorders, chronic pain, and epilepsy.
Vibhor Krishna, MD, is an associate professor with tenure and vice chair of inpatient operations in the department of neurosurgery at the University of North Carolina (UNC). He is a functional neurosurgeon leading UNC’s focused ultrasound program in the treatment of movement disorders and epilepsy.
We recently spoke with Dr. Krishna about his work and exciting new research findings.
How did you first hear about focused ultrasound?
I first learned about focused ultrasound in 2008 or 2009 during a faculty candidate research presentation. The candidate, who had completed residency training at the University of Virginia, discussed ongoing investigations in neurological applications of focused ultrasound and how it could potentially open the blood-brain barrier with microbubbles and modulate brain function. It was the first time I had seen the technology, and I found the concept both novel and incredibly exciting.
What interests you about the technology?
What interests me most about focused ultrasound is its potential to provide incision-less, minimally invasive treatments with a high degree of precision. It offers the ability to deliver therapeutics to virtually any area of the brain and modulate brain function in regions that are difficult or impossible to access with current approaches. Those capabilities address many of the biggest challenges we face in neuroscience and neurosurgery today.
Who inspires you in the field?
Personally, I’ve been lucky to learn from pioneers like Andres Lozano, MD, PhD, and Kullervo Hynynen, PhD, who recognized the potential of focused ultrasound early and dedicated their careers to moving the technology forward. But as a clinician, my biggest inspiration comes from my patients, especially the ones who come to clinic having done their research and believe focused ultrasound is the treatment that makes the most sense to them.
How do you think focused ultrasound is making a difference in medicine?
Focused ultrasound has really challenged a lot of our conventional thinking. Twenty or thirty years ago, ablation treatment to relieve tremors in both arms for essential tremor or Parkinson’s disease was considered too risky because of the potential for significant side effects. Today, with focused ultrasound, we can safely perform those treatments in a staged fashion, changing what we thought was possible. It’s also led us to explore new brain targets, like the pallidothalamic tract (PTT), to improve symptoms in Parkinson’s disease and expand our treatment options.
What’s been especially exciting is how quickly the technology has evolved. Focused ultrasound has only been in clinical use for movement disorders for a little over a decade, and we’re already seeing next-generation systems like Exablate Prime, along with new techniques that continue to improve precision and outcomes. The pace of innovation has been remarkable, and it’s one of the things that makes this field so exciting.
Why is the PTT target an important development for patients with Parkinson’s disease?
The PTT as a target for ablation was first tested in Europe, where Dr. Daniel Jeanmonod and his group reported very promising results. More recently, an international clinical trial evaluated the safety and effectiveness of using focused ultrasound ablation of the PTT in two staged treatments, six months apart, to address symptoms on both sides of the body. That work has really opened up a new avenue for treating patients with Parkinson’s disease.
This treatment is especially important for patients whose symptoms fluctuate throughout the day. They take their medication, their symptoms improve, and then as the effect wears off, the symptoms come back—so it becomes a roller coaster of stiffness, slowness, and tremor. By targeting the PTT, we’re able to address all of those symptoms on both sides of the body, and when the treatment is done successfully, many patients are also able to reduce the medication side effects like dyskinesias. That can make a profound impact on quality of life.
Now that this treatment is being deployed on a larger scale across the country, we’re continuing to see very satisfying initial results. Patients are experiencing meaningful improvements in their symptoms, and overall, I think it’s been a transformational addition to the way we treat Parkinson’s disease.
Tell us about your epilepsy research.
Treatment-resistant epilepsy is a major global health challenge. While we’ve made significant progress with newer medications, there is still a substantial number of patients who do not respond to medical therapy. Focused ultrasound is a very exciting match for this disease because it offers an incisionless way to deliver therapies, modulate brain function, and potentially ablate brain tissue involved in epilepsy.
There are several approaches being explored with focused ultrasound for epilepsy. Across the country, groups are studying how ultrasound can open the blood-brain barrier and deliver therapeutics, primarily in preclinical animal models. Other groups are investigating neuromodulation, where ultrasound can be used to modulate brain activity and reduce the risk of seizures, and this approach is now being tested in clinical trials in patients with medication-refractory epilepsy.
Another important application is using focused ultrasound to ablate areas involved in epilepsy or interrupt the pathways through which seizures travel across the brain. We are particularly interested in targeting the anterior thalamic nucleus, which sits at the intersection of important brain networks connecting where seizures begin with the rest of the brain. By interrupting those pathways, we hope to reduce the spread of seizures, and we have already tested this approach in a phase-one, US Food and Drug Administration–regulated clinical trial in three patients.
Can you share early results from that trial?
We’ve been very encouraged by what we’ve seen so far. The treatment has been safe, and we’ve seen dramatic reductions in seizure frequency. The first patient we treated, who previously had several seizures a month, has now been seizure-free for nearly five years after treatment. The second patient went from almost 100 seizures a month to about four seizures a month. And the third patient, who also had a very high seizure burden, has had only one seizure in the six months since treatment. These initial results are very promising, and while there is still more work to do, we are excited to study this in a larger group of patients and move closer to potentially making focused ultrasound a standard treatment option for epilepsy.
Tell us about your team.
At UNC, we have a multidisciplinary team that is helping advance focused ultrasound through clinical care, research, and education. We work with neurosurgery residents, biomedical engineering students, and trainees who are eager to learn about this technology and contribute to its future. One exciting example is Nicole Silva, MD, who recently completed a Foundation-funded project looking at gender differences in access to focused ultrasound treatment for essential tremor. Her work helped us better understand why women may be underrepresented among patients receiving treatment, including delays in diagnosis, medication initiation, and specific challenges with the treatment process itself. Her work was published in Stereotactic and Functional Neurosurgery.
Beyond our own team, we also have the opportunity to train students, researchers, and other clinical centers that are beginning their focused ultrasound programs. Seeing students experience the technology firsthand and realize its potential as a future area of research and innovation is incredibly rewarding. We’re also proud to share what we’ve learned with other institutions, helping the field continue to grow and ensuring that more patients can benefit from this technology.
Have there been any patients who made an impact on you and your work?
One of the most profound patients I cared for came to us seeking focused ultrasound for disabling essential tremor. Cooking for her family was her greatest joy, but the last Thanksgiving, her tremors caused a fire in her home as she was preparing the family meal. She was unhurt, but her house burned down, and her children were considering transitioning her to a nursing home.
She told me that she had already undergone an evaluation for deep brain stimulation, but she did not want an invasive procedure. That conversation reinforced for me how important it is to offer treatments that align with what patients are willing to pursue. That’s why focused ultrasound is so meaningful—it fills an important gap by providing an effective, incision-less treatment option that many patients find more acceptable.
This profile was adapted from Dr. Krishna’s Curing with Sound podcast from June 2026.
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