Focused Ultrasound in the Treatment of Epilepsy: Current Applications and Future Directions

Epilepsy is the fourth most common neurological disorder, affecting nearly 1% of the global population. Despite recent advancements in medical therapies, approximately one-third of patients remain refractory to treatment, necessitating consideration of surgical intervention. Historically, epilepsy surgery has been invasive and maximalist in nature, involving extensive brain resections with significant risk for morbidity. However, emerging approaches offer promising, less-invasive alternatives. One such technique is focused ultrasound (FUS), a rapidly evolving, incisionless, image-guided therapy that allows physicians to precisely target specific brain regions with ultrasonic energy to achieve a range of therapeutic effects. Currently, FUS has been clinically applied for targeted brain ablation (high intensity or HIFU) and neuromodulation (low intensity or LIFU), with recent basic science applications of sonogenetics and targeted drug delivery through the blood brain barrier (Precise Intracerebral Noninvasive Guided, or PING, Surgery) offering new opportunities for clinical translation. This review summarizes pre-clinical and clinical applications of FUS for epilepsy treatment, addresses challenges to implementation, and explores key areas for future research.