Insights into early applications of focused ultrasound in psychiatry

Summaries 2 min 10

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Created On: 18/12/2024

Advances in MRI-guided focused ultrasound (FUS) show promise for psychiatric disorders, building on its success in treating movement disorders compared to deep brain stimulation. This systematic review assessed the current FUS applications in psychiatry and explored its potential and challenges.

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Key take away

Focused ultrasound presents as an encouraging non-invasive breakthrough in psychiatric treatment, possibly transmuting care for patients who haven't responded to traditional therapies.

Background

Method

A thorough review following PRISMA guidelines of studies exploring psychiatric uses of FUS was conducted. It included the articles indexed in PubMed from 2014 to 2024. The treated psychiatric conditions, neural targets, outcomes, study designs, and sonication parameters were analyzed, and the key factors for using FUS in psychiatric treatment were highlighted. The ongoing clinical trials in this field were also reviewed.

Result

Only 10 fulfilled the criteria for inclusion out of 250 articles. Eight of these studies concentrated on the clinical, safety, and imaging features of MRI-guided focused ultrasound for obsessive-compulsive disorder (OCD). Other 3 scrutinized its use for tackling treatment-resistant depression. Bilateral stereotactic anterior capsulotomy achieved a 67% full response rate (≥35% decrease in the Yale-Brown Obsessive-Compulsive Rating Scale score) for OCD and a 33% full response rate (≥50% decrease on the Hamilton Depression Rating Scale) for treatment-resistant depression. Sonications varied from 8 to 36, with target temperatures between 51°C and 56°C.

A notable decrease in OCD symptoms was linked to lesions in the anterodorsal anterior limb of the internal capsule. This was also linked with enhanced connectivity with the left dorsolateral prefrontal cortex and dorsal anterior cingulate cortex. Depression and anxiety reductions were associated with decreased beta-band activity in frontocentral and temporal regions. Low-intensity FUS (LIFU) targeting the nucleus accumbens notably diminished cue-reactive cravings in opioid-use disorder patients for up to 90 days. No severe adverse events were documented, only mild side effects like nausea, headaches, and pin-site swelling were prevalent. Fourteen active clinical trials were found, primarily examining LIFU for depression.

Conclusion

FUS is shown to be a promising therapy for OCD, but more research is needed on parameters and ethical issues as it expands to other psychiatric conditions.