Focused ultrasound for treatment of epilepsy: a systematic review and meta-analysis of preclinical and clinical studies

Abstract

Various preclinical and clinical studies have demonstrated the neuromodulatory and ablative effects of focused ultrasound (FUS). However, the safety and efficacy of FUS in clinical settings for treating epilepsy have not been well established. This study aims to provide a systematic review of all preclinical and clinical studies that have used FUS for the treatment of epilepsy. A systematic search was conducted using Scopus, Web of Science, PubMed, and Embase databases. All preclinical and clinical studies reporting outcomes of FUS in the treatment of epilepsy were included in the systematic review. Random-effect meta-analysis was performed to determine safety in clinical studies and seizure activity reduction in preclinical studies. A total of 24 articles were included in the study. Meta-analysis demonstrated that adverse events occurred in 13% (95% CI = 2-57%) of patients with epilepsy who underwent FUS. The frequency of adverse events was higher with the use of FUS for lesioning (36%, 95% CI = 4-88%) in comparison to neuromodulation (5%, 95% CI = 0-71%), although this difference was not significant (P = 0.31). Three-level meta-analysis in preclinical studies demonstrated a reduced spike rate in neuromodulating FUS compared to the control group (P = 0.02). According to this systematic review and meta-analysis, FUS can be considered a safe and feasible approach for treating epileptic seizures, especially in drug-resistant patients. While the efficacy of FUS has been demonstrated in several preclinical studies, further research is necessary to confirm its effectiveness in clinical practice and to determine the adverse events.

Keywords: Epilepsy; Focused ultrasound; Meta-analysis; Neuromodulation; Neurosurgery; Seizure.