Transcranial ultrasound with electrical stimulation of the cerebello-parietal nucleus on cerebral blood flow and limb function in patients with stroke

Jing Liu, Lu-Yi Wang, Zi-Bo Liu, Hong-Ling Li, Yu-Yan Chen, Xiao-Kai Yuan, Lin Chi

Neurological Sciences 2025, 46, 257-266 · 10.1007/s10072-024-07704-4

human patientstrokeclinical scalecerebral haemodynamics

Abstract

Objective To investigate the efficacy of transcranial ultrasound stimulation (TUS) combined with Fastigial nucleus stimulation (FNS) on cerebral blood flow and limb function in patients in the acute phase of ischemic stroke. Methods A total of 90 patients in the acute phase of ischemic stroke were randomly divided into an FNS, TUS, and TUS + FNS group (30 patients each), and all patients also received conventional treatment. The FNS group was treated with FNS alone. The TUS group was treated with TUS alone. The TUS + FNS group was treated with both TUS and FNS. The three groups were treated once a day for 6 days a week. Results The simplified Fugl-Meyer Assessment (FMA) and Barthel index scores (BI), and the peak systolic blood flow velocity (Vs) and the mean blood flow velocity (Vm) of the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery, were significantly higher in all three groups compared with before treatment (P Conclusion The FNS and TUS treatments improved the function of and accelerated cerebral blood flow in patients with acute ischemic stroke to different degrees, and the combined use of both treatment types was overall more effective.

Abstract via europepmc.

Specieshuman

Subjects30, 30swept participants

Sessions per subject8

Randomisedyes

Blindingnot reported

Sham / controlnone

Auditory controlnot reported

Readout timingoffline

Anaesthesianot applicable

Readoutsclinical scale, cerebral haemodynamics — Simplified Fugl-Meyer Assessment (FMA); Barthel Index (BI); Transcranial Doppler (TCD) peak systolic (Vs) and mean (Vm) blood flow velocity of ACA/MCA/PCA

Direction of effectnot assessedTUS (alone or combined with FNS) increased peak systolic and mean blood flow velocity in the ACA, MCA and PCA and improved FMA and Barthel Index scores relative to before treatment, with the TUS+FNS combined group showing greater improvement than either treatment alone; the study assessed clinical/vascular outcomes rather than a direct measure of cortical excitatory/inhibitory neuromodulation.

Adverse eventsnone observedAfter the treatment, a good effect was also obtained, and no patients were found [to have] obvious adverse reactions (wording as in source, likely a translation artifact).

Exposures

Exposure 1: Transcranial ultrasound stimulation to bilateral temporal and occipital windows

Target: whole brain or unfocused — “bilateral temporal window (1 cm above the zygomatic arch) and occipital window (1 cm below the occipital tuberosity), covering ACA/MCA/PCA blood supply areas”
Device: other named manufacturer · Shijiazhuang Du Kang Medical Devices Co., Ltd. · DK-102TC transcranial ultrasound electrotherapy instrument ✓

Pulse timing
Waveform	pulsed
Fundamental frequency (kHz)	800	✓✓✓
Pulse duration (ms)	10	✓✓✓
Pulse repetition frequency (Hz)	6.7, 16.7swept	✓?⚑
Duty cycle (%)	not reported	⚑
Sonication duration (s)	1,200	✓✓✓

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 estimate	not reported
In-situ pressure (kPa)	not reported
In-situ Isppa (W/cm²)	not reported
In-situ Ispta (W/cm²)	not reported
Isppa, domain unspecified (W/cm²)	0.9	✓✓✓⚑

Protocol, in the paper’s words

Collimated pulse wave from a 40-mm probe (effective radiation area 3-4 cm2); pulse duration 10 ms; pulse repetition period 60-150 ms; duty cycle of the output waveform given as ratios 1:5, 1:8, 1:11, 1:14. Three probes placed at bilateral temporal and occipital windows; stimulation frequency 800 kHz +/-10%, intensity 0.9 W/cm2, duration 20 min, once daily, 6 days/week, average treatment course 8 days (max 12 days).

Flags from extraction

exposures[0].timing.pulse_repetition_frequency_hz — Converted from the stated pulse repetition period (60-150 ms) to Hz; paper does not itself state a PRF in Hz.
exposures[0].timing.duty_cycle_pct — Paper states duty cycle only as ratios (1:5, 1:8, 1:11, 1:14) without specifying whether this is on:off or on:total, so it cannot be safely converted to a percentage.
exposures[0].unspecified_domain.isppa_w_cm2 — Paper states only a generic 'stimulation intensity' (0.9 W/cm2) without specifying spatial-peak-pulse-average vs spatial-average-temporal-average, and without stating whether this is a free-field or in-situ value.
exposures[0].target.terms — TUS target is described only as bilateral temporal and occipital acoustic windows for whole-brain blood-flow enhancement, not a specific anatomical structure; mapped to whole_brain_or_unfocused.
n_subjects — Total ultrasound-exposed n is the sum of the TUS-only and TUS+FNS groups (30 each); paper never states this combined total directly, so the two group sizes are listed rather than summed.
direction_of_effect — Study reports vascular (blood-flow velocity) and functional (FMA/BI) outcomes rather than a direct measure of cortical excitation/inhibition; mapped to not_assessed.
adverse_events — Source sentence ('no patients were found. Obvious adverse reactions occurred.') appears to be a translation/OCR artifact; interpreted as meaning no adverse reactions were observed.