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The Making of Medicine

‘Giggling’ Epilepsy Our Latest Target for Focused Ultrasound Research

I’ve told you about many of the ways we’re exploring the use of focused sound waves to do brain surgery without actually cutting into the skull, but here’s a new one: Dr. Nathan Fountain is testing focused ultrasound to treat a rare brain mass that causes unintentional giggling, seizures and other epilepsy symptoms.

These masses, known as hypothalamic hamartomas, don’t actually grow, so they’re not classed as brain tumors. Instead, they just sit there and cause problems. Traditionally we’ve treated them with surgery or, more recently, laser ablation, to burn them away by inserting a probe into the skull. Focused ultrasound, on the other hand, focuses sound waves through the skull to cause tissue to heat up. The idea is to either kill the tissue or disconnect the hamartoma from the brain, so that it remains in place but no longer causes trouble.

The lead surgeon on the research project is our Dr. Jeff Elias, MD, who previously pioneered the approach for the treatment of the most common movement disorder, called essential tremor. He and his team use MRI to see inside the brain in real time, so they can determine exactly where the sound waves are being targeted.

The use of focused ultrasound to target hypothalamic hamartomas remains investigational and is available only through a clinical trial. Fountain, however, is hopeful about the possibilities the approach offers. “This is very exciting for the epilepsy community because epilepsy surgery, and even just the evaluation to find suitable candidates, is very invasive and best treats superficial outside parts of the brain, while focused ultrasound is noninvasive and best treats deep parts of the brain,” he said.

Dr. Fountain and his colleagues are currently recruiting patients for the trial. To learn more, you can visit the trial’s page at, the federal government’s trial database.



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