Transcranial Focused Ultrasound (tFUS) is Coming to Brain Health
The ability to change the brain using ultrasound, with Dr. Owen Muir
The Frontier Psychiatrists is on the cutting edge of letting the general public know what the editor of the publication thinks is coming next. My track record is pretty good—I called ERISA lawsuits about health plan PBM nonsense, I called accelerated TMS having novel payment models, I called MDMA not getting over the line with the FDA, I called TMS being better than meds…the bias is, of course, that I write all the time. I’m only highlighting my wins here. So, watch out for what I tell you!
Today, I’m introducing tFUS to my readers. Transcranial-focused ultrasound (tFUS) can be used to change how the brain functions.1 I’ve been excited about this technology for a while. We are, for example, running a clinical trial at Acacia Clinics (where I work) using this technology to evaluate it’s utility in the treatment of Anxiety.
In science speak, this is broadly what it’s doing:
Low intensity transcranial focused ultrasound (tFUS) can exert non-destructive mechanical pressure effects on cellular membranes and ion channels and has been shown to modulate the activity of peripheral nerves, spinal reflexes, the cortex, and even deep brain nuclei, such as the thalamus
Yes, dear readers, this is the same ultrasound you remember from your pregnancy and your echocardiogram. It uses sound waves to penetrate the body. Instead of just generating images, we can use them to change the brain’s functioning. Depending on the stimulator's settings, tFUS can target a spot in the brain…and increase or decrease neuronal firing.
The promise, compared to brain stimulation using transcranial magnetic stimulation (TMS), boils down to the laws of physics. Magnetic field strength gets weaker over even short distances thanks to its inverse square power law:
Gosh, that is a LOT OF MATH. I know, I know. Practically, it means TMS can stimulate the surface of the brain and not deeper areas of the brain.
Sound follows a theoretically similar inverse square power law; however, the density of the material through which it’s traveling leads to some different physics, and that means—waving a giant wand glossing over some very math content— ultrasound can penetrate deeper into the brain than magnetism. It can change neural signaling patterns deep in the brain in a way TMS can’t. It’s much closer to a non-invasive tool able to accomplish deep brain stimulation-like effects, but absent the neurosurgeon having to drill into your head.
This technology, still in clinical trials, has already had published results in conditions like “altering pain thresholds:”
It worked to make things hurt less. Or, if you are writing for a science audience who likes things to be more challenging to understand:
In summary, there was a significant antinociceptive effect of tFUS on pain thresholds. However, tFUS did not signifi- cantly change sensory or tolerance thresholds, although the group differences for tolerance were in the direction of an antinociceptive effect.2
Somebody, please remind me to ask my children if the Band-Aid on their knee has a significant anti-nociceptive effect on the boo-boo. tFUS has also been used in depression with success. However, the author’s ability to create a non-misleading graphic still could benefit from enhanced methodology:
Cause that isn’t too much data in one image or anything. Regardless, this pilot trial worked (big time):
Depression responded to stimulation but not to sham stimulation.3 That is what we are looking for in science! Significant differences, absent broken blinds.
Multiple companies are working in the space, including Samn.ai, OpenWater, and BrainSonix. Over 100m has been raised, just at OpenWater alone. The race is on! Meanwhile, if you are interested in a clinical trial for anxiety symptoms with tFUS, please click here.
More to come here on The Frontier Psychiatrists, of course.
Zhang T, Pan N, Wang Y, Liu C, Hu S. Transcranial Focused Ultrasound Neuromodulation: A Review of the Excitatory and Inhibitory Effects on Brain Activity in Human and Animals. Front Hum Neurosci. 2021 Sep 28;15:749162. doi: 10.3389/fnhum.2021.749162. PMID: 34650419; PMCID: PMC8507972.
Badran, B. W., Caulfield, K. A., Stomberg-Firestein, S., Summers, P. M., Dowdle, L. T., Savoca, M., ... & George, M. S. (2022). Sonication of the anterior thalamus with MRI-Guided transcranial focused ultrasound (tFUS) alters pain thresholds in healthy adults: A double-blind, sham-controlled study. Focus, 20(1), 90-99.
Oh, J., Ryu, J. S., Kim, J., Kim, S., Jeong, H. S., Kim, K. R., ... & Seok, J. H. (2024). Effect of low-intensity transcranial focused ultrasound stimulation in patients with major depressive disorder: a randomized, double-blind, sham-controlled clinical trial. Psychiatry Investigation, 21(8), 885.
This is awesome