Is there a role for focused ultrasound in the treatment of refractory epilepsy?

Background: Although patients with drug-resistant epilepsy (DRE) have a <5% chance of seizure freedom with continued polypharmacy, surgical interventions remain underutilized. One potential driver of this trend is patient perceived fear of open surgery. Focused ultrasound is an incisionless, minimally invasive technique that has been used to treat epilepsy and has the potential to have a larger footprint within the epilepsy surgeon's armamentarium.

Summary: A brief overview of the underutilization of epilepsy surgery, the epilepsy treatment landscape, and current and emerging applications of focused ultrasound for DRE will be discussed. This article includes a brief comparison of focused ultrasound with other alternatives to open epilepsy surgery and a summary and appraisal of the existing literature.

Key messages: Focused ultrasound serves as a versatile, minimally invasive option for patients with contraindications to or concerns with open surgery or radiation exposure. Preliminary studies indicate disease-modifying benefit of high-intensity focused ultrasound (HIFU) ablation and potential neuromodulatory benefit and increased blood-brain barrier permeability of low-intensity focused ultrasound (LIFU). Higher level evidence is needed to elucidate the efficacy of LIFU and HIFU for the treatment of epilepsy. However, focused ultrasound is an emerging treatment modality that has the potential to transcend the traditional ablation paradigm and alter the cellular composition of epileptic networks for therapeutic effect.