Vienna as the international research centre for ultrasound brain therapies

Currently, two different ultrasound brain therapies are available: surgery (developed in Toronto) and brain stimulation (developed in Vienna). Transcranial pulse stimulation (TPS), which was developed under the leadership of MedUni Vienna, has spread particularly quickly (first description 2019). The procedure has a broad potential field of application and can be used as an adjunct therapy for diseases where effective therapies are difficult or altogether lacking. Importantly, all ongoing treatments can be continued, and TPS has the potential to be an additional therapeutic opportunity.

Developed under the direction of clinical neuroscientist Roland Beisteiner from MedUni Vienna's Neurology Department, the method relies on precision and deep stimulation compared to classic brain stimulation methods, which work with magnetic and electric fields. "Ultrasound brain stimulation is a very complex therapy that requires a high level of brain function expertise," explains Roland Beisteiner. "When performed by brain experts, it leads to an improvement in clinical performance scales and a subjective assessment as a 'very helpful new therapy' in the vast majority of patients”.

In their review, authors also state that patient data, although increasing, are still limited. For example, there are 16 published clinical studies on ultrasound neuromodulation. Although it is not a causal therapy for neurodegenerative diseases, improvements have already been published for various brain disorders such as Alzheimer’s dementia, Parkinson's disease, stroke, depression and traumatic brain injury. However, to date, there are not enough sham-controlled studies on the subjectively experienced improvements in the clinical data to deduce the exact difference to pure placebo effects.

"The documentation of clinical effects depends on clinical assessments and rating scales, which often lack sensitivity to small differences and have considerable dependence on the assessors," explains Beisteiner, "it is therefore of utmost importance to include sham conditions and independent neurophysiological measurements (MRI, electrophysiology) in clinical trials. The extensive variables provide many research opportunities, but also many dependencies and difficulties in interpreting the effect."

Ultrasound brain stimulation is a non-invasive technique to activate brain cells from the outside
"Although we are still in the early stages of our research, it is already apparent that TPS is a safe method and can support and stimulate the brain's rehabilitation mechanisms," Beisteiner explains. Overall, ultrasonic brain stimulation had established itself as an international success story with a high potential to play an important role in the treatment of neurological and psychiatric diseases in the future. Further research into the mode of action and possible applications is ongoing. "Fascinating prospects for future applications arise from brain-state-based stimulation, or 'closed loop stimulation'," explains Beisteiner, "here brain activity is measured simultaneously and disturbed brain functions are specifically treated through stimulation."

Publication: Advanced Science
Ultrasound Neuromodulation as a new Brain Therapy
Roland Beisteiner, Mark Hallett, Andres M. Lozano
DOI: 10.1002/advs.202205634