Transcranial focused ultrasound (tFUS): a promising noninvasive deep brain stimulation approach for pain.
Transcranial focused ultrasound (tFUS): a promising noninvasive deep brain stimulation approach for pain.
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经颅聚焦超声（tFUS）：一种有前途的无创深部脑刺激治疗疼痛的方法。
DOI：
10.1038/s41386-023-01699-w
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Peng,Xiaolong
中科院分区：
文献类型：
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作者：
Badran,BasharW;Peng,Xiaolong
疼痛是一种复杂的体验，涉及感官、情感和动机层面。有几个皮层和皮层下的大脑结构促成了这种复杂性，包括体感皮层、丘脑、脑岛、杏仁核和前额皮质。目前，最可靠的抗疼痛作用是通过阿片类药物结合伤害感觉结构引起疼痛减轻。随着阿片类药物的激增及其严重的副作用和滥用的可能性，针对这些疼痛相关的大脑区域的非侵入性脑刺激等替代干预措施可能提供另一种解决方案。两种常见的无创神经刺激方法是经颅磁刺激（TMS）和经颅直流电刺激（tDCS）。经颅磁刺激（TMS）是美国食品和药物管理局（FDA）批准用于治疗抑郁症的药物，它对皮层产生可靠的作用，并通过下游释放内源性阿片类物质[2]产生抗疼痛作用。tDCS是一种低幅度电刺激方式，具有轻微的镇痛效果。许多疼痛网络结构位于大脑深处，TMS或tDCS无法到达（图1）。因此，需要一种非侵入性的深度神经调节方法来进入与疼痛相关的大脑结构。经颅聚焦超声（Transcranial focused ultrasound, tFUS）是非侵入性的、具有较强生物效应的新技术。tFUS利用压电换能器产生的超声波在大脑深处达到顶峰。与TMS相比，这些超声力具有更深的穿透范围和更高的焦点分辨率（深度：tFUS≈1-12 cm， TMS≈1-4 cm；焦点：tFUS< 1cm， TMS< 3cm）。当以高强度（1000 W）传递时，超声引起组织加热（热消融），并且
Pain is a complex experience that involves sensory, emotional, and motivational dimensions. There are several cortical and subcortical brain structures that contribute to this complexity, including the somatosensory cortex, thalamus, insula, amygdala, and prefrontal cortex. Presently, the most reliable anti-pain effects are elicited via opioids binding at nociception structures to elicit reductions in pain. With the proliferation of opioids, and their serious side effects and potential for abuse, alternative interventions like noninvasive brain stimulation targeting these pain-related brain regions could provide an alternative solution [1].Two common noninvasive neurostimulation approaches for pain are transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). TMS, which is Food and Drug Administration (FDA) approved for treating depression, induces reliable effects on the cortex, and produces anti-pain effects via downstream release of endogenous opioids [2]. tDCS is a lowamplitude electrical stimulation modality demonstrating a mild analgesic effect. Many of the pain network structures are found deep within the brain, inaccessible by TMS or tDCS (Fig. 1). Therefore, there is a need for a non-invasive, deep neuromodulation approach to access pain associated brain structures. Transcranial focused ultrasound (tFUS) has emerged as a promising new technology that is both noninvasive and deep in its bioeffects [3]. tFUS utilizes piezoelectric transducers generating ultrasonic waves that summate deep in the brain. These ultrasonic forces have a deeper penetration range and more focal resolution than TMS (Depth: tFUS≈ 1-12 cm, TMS≈ 1-4 cm; Focality: tFUS< 1cm, TMS< 3cm). tFUS, when delivered at a high intensity (1000 W), ultrasound causes tissue heating (thermoablation), and