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Transcranial Focused Ultrasound Targeting the Amygdala May Increase Psychophysiological and Subjective Negative Emotional Reactivity in Healthy Older Adults

Bianca Hoang-Dang, Sabrina E. Halavi, Natalie M. Rotstein, Norman M. Spivak, Nolan H. Dang, Luka Cvijanovic, Sonja H. Hiller, Mauricio Vallejo-Martelo, Benjamin M. Rosenberg, Andrew Swenson, Sergio Becerra, Michael Sun, Malina E. Revett, David Kronemyer, Rustin Berlow, Michelle G. Craske, Nanthia Suthana, Martin M. Monti, Tomislav D. Zbozinek, Susan Y. Bookheimer, Taylor P. Kuhn

Biological Psychiatry Global Open Science 2024, 4, 100342 · 10.1016/j.bpsgos.2024.100342

human healthyhealthybehaviourautonomic physiologyclinical scale

Abstract

Background The amygdala is highly implicated in an array of psychiatric disorders but is not accessible using currently available noninvasive neuromodulatory techniques. Low-intensity transcranial focused ultrasound (TFUS) is a neuromodulatory technique that has the capability of reaching subcortical regions noninvasively. Methods We studied healthy older adult participants ( N = 21, ages 48-79 years) who received TFUS targeting the right amygdala and left entorhinal cortex (active control region) using a 2-visit within-participant crossover design. Before and after TFUS, behavioral measures were collected via the State-Trait Anxiety Inventory and an emotional reactivity and regulation task utilizing neutral and negatively valenced images from the International Affective Picture System. Heart rate and self-reported emotional valence and arousal were measured during the emotional reactivity and regulation task to investigate subjective and physiological responses to the task. Results Significant increases in both self-reported arousal in response to negative images and heart rate during emotional reactivity and regulation task intertrial intervals were observed when TFUS targeted the amygdala; these changes were not evident when the entorhinal cortex was targeted. No significant changes were found for state anxiety, self-reported valence to the negative images, cardiac response to the negative images, or emotion regulation. Conclusions The results of this study provide preliminary evidence that a single session of TFUS targeting the amygdala may alter psychophysiological and subjective emotional responses, indicating some potential for future neuropsychiatric applications. However, more work on TFUS parameters and targeting optimization is necessary to determine how to elicit changes in a more clinically advantageous way.

Abstract via europepmc.

Specieshuman
Subjects21 participants
Sessions per subject2
Randomisedyes
Blindingdouble
Sham / controlactive control site
Auditory controlnot reported
Readout timingoffline
Anaesthesianot applicable
Readoutsbehaviour, autonomic physiology, clinical scaleState-Trait Anxiety Inventory (STAI); Emotional Reactivity and Regulation Task (ERRT) with Self-Assessment Manikin valence/arousal ratings; heart rate (interbeat interval) via ECG
Direction of effectexcitatoryTFUS targeting the right amygdala increased self-reported arousal to negative images and increased heart rate (decreased interbeat interval) during intertrial intervals of a mildly aversive task, interpreted by the authors as evidence of excitation of the amygdala rather than the intended inhibition; entorhinal cortex TFUS produced no such changes.
Adverse eventsobservedNo serious adverse events were reported. One participant experienced a brief period of irritability and tearfulness shortly after TFUS targeting the amygdala, which mostly resolved by the end of the session and fully resolved within 3 days.

Exposures

Exposure 1: TFUS targeting the right amygdala

Target: amygdala — “right amygdala
Device: BrainSonix · BrainSonix Corp. · BX Pulsar 1002

Pulse timing
Waveformpulsed
Fundamental frequency (kHz)650✓✓
Pulse duration (ms)5✓✓
Pulse repetition frequency (Hz)10✓✓
Duty cycle (%)5pulse duration × PRF gives 5%✓✓
Sonication duration (s)not reported
Pressure and intensity, by domain
Free-field pressure (kPa)not reported
Free-field Isppa (W/cm²)not reported
Free-field Ispta (W/cm²)not reported
In-situ estimatederatingsingle value
In-situ pressure (kPa)not reported
In-situ Isppa (W/cm²)not reported
In-situ Ispta (W/cm²)0.72✓✓
Protocol, in the paper’s words

For TFUS targeting the amygdala, a pulse repetition frequency of 10 Hz and a pulse width of 5 ms were used because these parameters were hypothesized to inhibit activity, and disruption of amygdala activity is hypothesized to be beneficial in treating anxiety disorders.

Exposure 2: TFUS targeting the left entorhinal cortex (active control)

Target: entorhinal cortex — “left entorhinal cortex
Device: BrainSonix · BrainSonix Corp. · BX Pulsar 1002

Pulse timing
Waveformpulsed
Fundamental frequency (kHz)650✓✓
Pulse duration (ms)0.5✓✓
Pulse repetition frequency (Hz)100✓✓
Duty cycle (%)5pulse duration × PRF gives 5%✓✓
Sonication duration (s)not reported
Pressure and intensity, by domain
Free-field pressure (kPa)not reported
Free-field Isppa (W/cm²)not reported
Free-field Ispta (W/cm²)not reported
In-situ estimatederatingsingle value
In-situ pressure (kPa)not reported
In-situ Isppa (W/cm²)not reported
In-situ Ispta (W/cm²)0.72✓✓
Protocol, in the paper’s words

Conversely, TFUS of the entorhinal cortex used a pulse repetition frequency of 100 Hz and a pulse width of 0.5 ms, parameters that have been hypothesized to increase activity because it has been hypothesized that excitation of the entorhinal cortex improves learning and memory.

Flags from extraction

  • exposures[0].in_situ.ispta_w_cm2Paper describes Ispta.3 as derated using a 0.3 dB/cm-MHz derating factor but does not state whether the underlying (non-derated) value was measured in water or estimated; classified here as in_situ (derating) per the paper's own description of Ispta.3 as a derated value.
  • randomisedPaper states the study used a randomized, double-blinded crossover design for order of target site, not randomization to treatment arm per se (all participants received both conditions).
  • sham_typeThere is no inactive/sham condition; the entorhinal cortex TFUS served as an active control site rather than a sham.