The open house included presentations from 大象传媒 Health leadership, functional neurosurgeon Dr. Vibhor Krishna, and from 大象传媒 Health focused ultrasound patient, Doug Bell. The event also included tours of the state-of-the-art facility. 鈥淭hrough strategic partnerships and increased research collaboration, we aim to undertake clinical trials and expand indications for conditions like epilepsy, brain tumors, traumatic brain injury, and Alzheimer鈥檚 disease, offering hope where it鈥檚 needed most,鈥� said Dr. Krishna. 鈥淔urthermore, we are committed to nurturing the next generation of neurosurgeons and scientists, to make a wider impact, ensuring a legacy of healing and innovation in the future.鈥�

Focused ultrasound is an incision-less treatment for patients with movement disorders. Like deep brain stimulation, Focused ultrasound can be an effective treatment option for patients who either don鈥檛 respond to medication or initially respond to medication that eventually becomes ineffective. Focused ultrasound is an outpatient procedure, and many patients walk away from the procedure tremor-free.

Dr. Krishna hopes to continue growing the focused ultrasound program at 大象传媒 Health. 鈥淚n the next five years, we foresee a landscape where focused ultrasound treatment becomes a cornerstone of care, not only in North Carolina but beyond, touching the lives of patients worldwide,鈥� said Dr. Krishna.

CHAPEL HILL, NC 鈥� The human brain constantly receives information from the body, specifically from internal organs such as the heart and lungs. This information seldom reaches consciousness but is crucial for maintaining a healthy body and for influencing performance in the brain, including perception, emotion, and cognition. Now, researchers are investigating how exactly the brain processes the incoming stream of information from the heart and lungs, leading to a broader understanding of brain-body integration and the resulting health or disease.

聽in the聽Proceedings of the National Academy of Sciences听(PNAS), co-senior authors聽Vibhor Krishna, MD, associate professor of neurosurgery at the 大象传媒;聽, director of the Rockefeller Neuroscience Institute and associate dean of neuroscience at the West Virginia School of Medicine; and聽, director of the laboratory of cognitive neuroscience at the Swiss Federal Institute of Technology, discovered that specific neurons in the thalamus are actively involved in processing cardiac and respiratory signals.

鈥淓ach heartbeat and every breath create a rich, incoming stream of sensory information for the human brain,鈥� said Krishna. 鈥淗owever, a deeper understanding of how the brain integrates this information has remained elusive. We have been interested in discovering how the human brain achieves the integration of cardio-respiratory information and whether its breakdown is linked to any disorders of the brain, heart, or lungs observed in the clinic.鈥�

Over the years, clinical and research teams collaborated to painstakingly study this integration using an established technique of microelectrode recording during deep brain stimulation surgery.聽Using a new approach to study single neurons in three different thalamic regions, the researchers were able to observe a direct functional involvement of thalamic and subthalamic neurons in processing cardio-respiratory signals. This information can help to better characterize how subcortical regions of the brain process signals through a functional pathway from internal organs.

To complete this work, the research team took advantage of microelectrode recordings during deep brain stimulation for patients undergoing treatment for neurological conditions. The researchers then used these recordings to investigate the activity of single neurons related to cardiac and respiratory functions in three subcortical regions: ventral intermedius nucleus and ventral caudalis nucleus of the thalamus, and the subthalamic nucleus.

They found that about 70% of the recorded neurons were modulated by either the heartbeat, the cardiac inter-beat interval, or the respiration.

These cardiac and respiratory response patterns varied largely across neurons both in terms of timing and their kind of modulation, the authors wrote. A substantial proportion of these visceral neurons 鈥� about 30% 鈥� were responsive to more than one of the tested signals, underlining specialization and integration of cardiac and respiratory signals in subthalamic nucleus and thalamic neurons.

鈥淲e think our work will be significant for several medical specializations, including cardiology, pulmonology, neurology, psychiatry, and psychological research,鈥� Krishna said.

Rezai added, 鈥淏etter understanding of the human brain is the next frontier. And interdisciplinary collaborations between functional neurosurgeons and neuroscientists will enable us to gain an unprecedented window into the inner functioning of the human brain.鈥�

Applauding this research as a significant step forward, Nelson Oyesiku, MD, PhD, chair of the 大象传媒 Department of Neurosurgery, said, 鈥淲e understand that the brain maintains homeostasis throughout the body through direct neurological and endocrine regulation. This research reveals that the incoming information from the heart and lungs is processed in the thalamic and subthalamic brain regions, besides other regions, enabling our brain to effectively assume its role in regulating bodily functions.鈥�

Media contact:聽Mark Derewicz,聽大象传媒

Watch the full webinar below:

Click to read his article, “A phase 1 open-label trial evaluating focused ultrasound unilateral anterior thalamotomy for focal onset epilepsy” below.

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Dr. Vibhor Krishna with 大象传媒 Neurology鈥檚 Dr. Daniel Roque at the Insightec鈥檚 Focus Forward Neuroinnovators Summit in Miami, FL.

It is an exciting time for the 大象传媒 Health physicians that provide surgical treatment for patients with movement disorders. Drs Daniel Roque from 大象传媒 Neurology and Dr, Vibhor Krishna from 大象传媒 Neurosurgery attended the Focus Forward Neuroinnovators Summit organized by Insightec in Miami, FL. This partnership will make the transformational focused ultrasound therapy, a less invasive treatment option for patients with movement disorders, 聽a reality for our patients at 大象传媒 Health.

Learn more about our focused ultrasound research.

Dr. Krishna’s research will benefit the lives of patients with essential tremor, allowing many to return to normal activities that were inhibited by tremor.

Over 10 million Americans live with essential tremor, a common neurological disorder and a leading cause of functional and psychological聽disabilities. While some patients gain tremor control using medications, up to 20% of essential tremor patients cannot achieve satisfactory tremor control by relying on medication alone.

Focused ultrasound ablation of the ventral intermediate nucleus (Vim) is an FDA-approved procedure for essential tremor patients resistant to medications. Guided by real-time MR imaging, this procedure is incisionless, and allows neurosurgeons to precisely target and ablate the brain area causing the tremor. 鈥淲e are honored to receive research funding from the National Institutes of Health and are excited about the opportunity to make a difference in the lives of individuals suffering from essential tremor,鈥� said Dr. Krishna. 鈥淚 am grateful to my mentors, collaborators, and the clinical and research staff.”

An artist鈥檚 representation of the focused ultrasound transducer which incorporates roughly 1000 ultrasound emitting elements. The ultrasound beam from each element is focused on the Vim (shown in red).

The success of this treatment depends on the ability to accurately ablate the Vim without damaging the surrounding structures. Dr. Krishna’s grant-funded research will optimize this emerging treatment by identifying Vim and its boundaries, standardizing the ultrasound delivery, and monitoring the ultrasound treatment with novel imaging techniques. “The Department of Neurosurgery at 大象传媒 Health is absolutely delighted to announce the National Institutes of Health investigator grant to Neurosurgeon-Neuroscientist, Dr. Vibhor Krishna, to investigate focused ultrasound in essential tremor,鈥� said Dr. Nelson Oyesiku, Chair of 大象传媒 Health鈥檚 Department of Neurosurgery. 鈥淭his cutting-edge research brings new hope to restoring motor function to patients with a debilitating movement disorder.”

Dr. Krishna’s focused ultrasound ablation research is also supported by the , an organization that aims to accelerate the development and adoption of focused ultrasound. “The Focused Ultrasound Foundation has supported the testing, funding, and clinical rollout of focused ultrasound treatment for essential tremor and many other indications,” said Dr. Neal F. Kassell, founder and chairman of the foundation. 鈥淧atients have been excited to pursue this emerging treatment 鈥� which is now covered by Medicare in all 50 U.S. states 鈥� to alleviate their tremors and improve quality of life. Dr. Krishna鈥檚 research aims to make this treatment safer and even more effective, and his research findings will be highly relevant and anticipated by the focused ultrasound community.鈥�

Dr. Vibhor Krishna joined faculty last year as an associate professor. His research and clinical focus is the treatment of movement disorders, including essential tremor, Parkinson’s disease, and epilepsy. “Through this opportunity, we aim to develop a deeper understanding of brain function relevant to tremor treatment and its modulation with focused ultrasound ablation,” said Krishna.

Our quest to solve the mysterious case of 鈥渄isappearing ablation鈥漚fter focused ultrasound surgery led us to consult and collaborate with Dr. Mojgan Hodaie. Dr. Hodaie, Professor of Neurosurgery at the University of Toronto, has pioneered the use of diffusion MRI to detect tissue response to surgery and used that information to optimize the neurosurgical techniques.

Together with Dr. Hodaie, we investigated the existing and novel techniques to determine how much target tissue was ablated. We made two critical observations:

1. The imaging sequence and the timing of acquisition limited our ability to measure tissue ablation accurately. For example, the T2-weighted imaging sequence precisely determined 鈥渨here鈥� the tissue was ablated but was limited in determining 鈥渉ow much鈥� tissue was ablated, especially if acquired 24 hours after surgery. On the contrary, thermography accurately defined 鈥渉ow much鈥� ablation was performed but performed poorly in determining 鈥渨here鈥� the tissue was ablated. More importantly, thermography was limited to point-of-care and was not helpful once the treatment was completed. Once again, and to our surprise, RDI accurately determined both 鈥渨here鈥� and 鈥渉ow much鈥� tissue was ablated after focused ultrasound surgery.

2. The tissue ablation that was critical for a durable tremor reduction was the bottom half of the VIM (remember this was the target nucleus for surgery), especially the lower VIM border as it merged into the subthalamic white matter. This finding was similar to what another group had recently published. However, what surprised us most was that any digression from聽this bottom half of the VIM into the subthalamic white matter increased the risk of side effects. Therefore, we concluded that VIM ablation needed to be performed within the borders of the VIM, and even a millimeter extension beyond these boundaries could be risky.

Equipped with these novel insights, we assembled a team required to undertake a deeper dive to investigate what the optimal technique for focused ultrasound ablation would look like.聽聽The logical next step was to apply for an NIH grant to investigate and solve the next set of challenges – what are the limits of RDI in determining tissue ablation, and how does a standardized technique for tissue ablation match up against the standard approach?

As we conclude this post, we thank you for your continued engagement with this series. We will have some exciting news in our next update coming soon.

Read the .

Focused Ultrasound to Deliver Molecular Modulators. American Society of Stereotactic and Functional Neurosurgery, Biennial Meeting, June 5, 2022, Atlanta, GA

Technology to assess your results – Focused Ultrasound Ablation. American Society of Stereotactic and Functional Neurosurgery, Biennial Meeting, June 6, 2022, Atlanta, GA

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Focused Ultrasound is an image-guided, noninvasive, non-ionizing therapeutic technology. 2022 Epilepsy Foundation Pipeline Conference, June 6, 2022, Santa Clara, CA

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