Focused Ultrasound: Current and Future Uses (Podcast)

After focused ultrasound’s initial FDA approval in 2016 to treat essential tremor, its indication has since been expanded to tremor-dominant Parkinson’s disease as well. Now the technology, which combines high-frequency ultrasound with MRI, is being studied for an array of additional neurological applications.

“It’s a very new technology, and we’re still on the doorstep of figuring out of the different ways it can be useful,” says Daniel Lockwood, MD, a neuroradiologist in Cleveland Clinic’s Imaging Institute.

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Lockwood and Sean Nagel, MD, a stereotactic and functional neurosurgeon in Cleveland Clinic’s Center for Neurological Restoration, discuss current and novel uses of focused ultrasound. They share insights on:

• High-intensity focused ultrasound (HIFU) for patients with essential tremor and tremor-dominant Parkinson’s disease
• When to use HIFU versus deep brain stimulation
• Opening the blood-brain barrier with low-intensity focused ultrasound (LIFU)
• Details on a study using LIFU to treat patients with recurrent glioblastoma
• Possible side effects of focused ultrasound treatments
• Other potential applications for focused ultrasound, including epilepsy, psychiatric diseases, addiction and chronic neuropathic pain

Click the podcast player above to listen to the 25-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: Your team has been using this technology now for several years. Can you explain to our audience what HIFU is and your results to date?

Dr. Nagel: We acquired our device back at the end of 2018, and we have thus far treated about a hundred or so patients with either essential tremor or tremor-dominant Parkinson’s disease. The treatment couples an ultrasound transducer to an MRI. In these cases, I like to explain to patients that the MRI is used both for visualization and to record temperature changes in the brain. We are intentionally trying to create a small lesion in the thalamus. This has been known for many decades to be an excellent site that we can use to control somebody’s tremor that has been refractory to medications.

Most of the procedures take about two hours, on average. We do consider this incisionless, but it’s not noninvasive. We are making a small lesion in a select part of the brain. The treatment does include placing a small head frame as well, and that causes some discomfort for patients, but short of that, most patients find this pretty well tolerated.

Dr. Stevens: And my understanding is that you actually get real-time information back from the procedure. Tell us a bit about that.

Dr. Nagel: That’s right. So, each patient who we are evaluating, they undergo some pre-planning imaging. At that point, they are fitted with this head frame and then secured to the transducer helmet. Then we usually proceed in three phases. First is an alignment phase, followed by a verification phase and then a treatment phase. What’s unique about this procedure is that during the verification phase, we can turn the ultrasound on and use it at lower energies before we create a lesion, but enough that we can start to see some benefit in the patient’s tremor. This helps us effectively control their tremor by delivering the high energy at the correct spot. We estimate maybe eight to 10 sonications are required to complete the treatment, but the bulk of the sonications are really used both to align and verify the location before doing the final sonication.