A panoramic review of transcranial focused ultrasound neuromodulation: from basic research to clinical applications.

This is a narrative review, not a systematic review or meta-analysis, so it may be subject to selection bias. Most clinical evidence comes from small sample sizes, case reports, or pilot studies, lacking the power of large randomized controlled trials. Human skulls attenuate ultrasound by 65-90%, leading to high variability in treatment response that is not fully addressed by current protocols. Auditory confounds are a significant methodological issue; many studies did not adequately control for the sound produced by the ultrasound device, which may have influenced neural activation. Long-term safety and efficacy data are lacking for repeated clinical use. The review includes many animal studies whose findings do not necessarily translate to humans due to anatomical and physiological differences.

The study was funded by the National Natural Science Foundation of China, Guangdong Basic and Applied Basic Research Foundation, China Postdoctoral Science Foundation, and Science and Technology Program of Guangzhou. No specific conflicts of interest related to commercial ultrasound companies were declared in the provided text.

Do not assume tFUS is a proven therapy for neurological conditions. The impressive tremor reduction figures come from small studies with high variability, and many neural effects may be confounded by the audible sound of the device rather than direct brain stimulation.