Fishman Paul S, Frenkel Victor
Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Neurotherapeutics. 2017 Apr;14(2):393-404. doi: 10.1007/s13311-017-0515-1.
Therapeutic ultrasound is only beginning to be applied to neurologic conditions, but the potential of this modality for a wide spectrum of brain applications is high. Engineering advances now allow sound waves to be targeted through the skull to a brain region selected with real time magnetic resonance imaging and thermography, using a commercial array of focused emitters. High intensities of sonic energy can create a coagulation lesion similar to that of older radiofrequency stereotactic methods, but without opening the skull. This has led to the recent Food and Drug Administration approval of focused ultrasound (FUS) thalamotomy for unilateral treatment of essential tremor. Clinical studies of stereotactic FUS for aspects of Parkinson's disease, chronic pain, and refractory psychiatric indications are underway, with promising results. Moderate-intensity FUS has the potential to safely open the blood-brain barrier for localized delivery of therapeutics, while low levels of sonic energy can be used as a form of neuromodulation.
治疗性超声才刚刚开始应用于神经系统疾病，但这种治疗方式在广泛的脑部应用中具有很高的潜力。目前的工程技术进步使得声波能够通过颅骨靶向作用于利用实时磁共振成像和热成像技术选定的脑区，这一过程使用的是商用聚焦发射器阵列。高强度的声能能够产生与传统射频立体定向方法类似的凝固性损伤，但无需打开颅骨。这促使美国食品药品监督管理局最近批准了聚焦超声丘脑切开术用于单侧治疗特发性震颤。针对帕金森病、慢性疼痛和难治性精神疾病等方面的立体定向聚焦超声临床研究正在进行，且已取得了有前景的结果。中等强度的聚焦超声有潜力安全地打开血脑屏障以实现治疗药物的局部递送，而低水平的声能则可作为一种神经调节形式。
