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Reclassifying transcranial pulse stimulation as TNUS: Nonlinear mechanics necessitate departure from the ITRUSST
Qinxi Luo1, Neng Huang2, Dan Li2
1Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China; School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China; Center for High Altitude Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
Transcranial Nonlinear Ultrasound Stimulation (TNUS) reclassifies Transcranial Pulse Stimulation (TPS), differentiating nonlinear mechanics from linear approaches. This framework enhances neuromodulation safety and efficacy for Alzheimer's disease (AD) treatment.
Area of Science:
- Neuroscience and Biomedical Engineering
- Non-invasive Neuromodulation
- Biophysics of Ultrasound
Background:
- Transcranial ultrasound shows promise for Alzheimer's disease (AD) treatment.
- Clinical use is limited by inconsistent classification of ultrasound approaches.
- Distinguishing between linear and nonlinear ultrasound biophysics is crucial.
Purpose of the Study:
- To introduce a Transcranial Nonlinear Ultrasound Stimulation (TNUS) framework.
- To formally reclassify Transcranial Pulse Stimulation (TPS).
- To differentiate nonlinear wave mechanics from quasi-linear acoustics.
Main Methods:
- Integrated biophysical modeling in the nonlinear Westervelt regime.
- Critical appraisal of clinical trial data for TPS.
- Comparative acoustic dosimetry analysis of linear LIFU and nonlinear TPS.
Main Results:
- TPS exhibits extreme pressure gradients, differing significantly from linear LIFU.
- Nonlinear regime enables Volume Force model and Ballistic Gating of ion channels.
- Brain atrophy and Cerebral Amyloid Angiography (CAA) complicate TPS delivery, requiring careful pressure management.
Conclusions:
- Future TPS optimization requires structure-aware dosimetry.
- Adaptive beamforming and individualized impulse titration are key.
- Mitigating refractive aberrations and vascular risks is essential for heterogeneous aging brains.
