Focused ultrasound trimmed delusions in 10 patients, a pilot study

Ten people, one session each, and a fake session a week apart. That was the design of a small study led by psychiatrists and engineers at NYU Langone Health, in which the sound waves were aimed at a region deep in the brain that is usually out of reach without surgery. The participants had schizophrenia or schizoaffective disorder, and their delusions had continued despite drug treatment. Neither they nor the staff who rated their symptoms knew which session was real.

The technique is called transcranial ultrasound stimulation. The device sends gentle, focused sound waves through the skull, and depending on the settings they can boost or suppress the activity of brain cells in the targeted area. The team aimed the waves, guided by an MRI scan, at the globus pallidus internus, part of a circuit that helps control movement, thought and emotion. Earlier work by the same group had linked problems in this circuit to delusions, and to how well patients responded to medication. The waves were applied for 10 minutes, in 30-second on-off cycles.

The result, reported in the journal npj Acoustics, was a drop of 1.2 points on average on a standard clinical scale of delusion severity after the real session. After the sham session, in which the device was switched on but the waves were blocked, scores rose by 0.4 points on average. The gap between the two was still present at the end of the seven-day follow-up. Fatigue, headache and brief flare-ups of psychotic symptoms were mild and short-lived, and they occurred at similar rates in both sessions. Lead author Wei Qi of NYU Grossman School of Medicine called the findings "early evidence" that one session can safely tune a circuit linked to psychosis. The authors are equally clear about the limits: ten patients, one session, and a drop that the researchers themselves describe as modest.

What changes, and for whom, is still a question of years rather than months. Today, people with schizophrenia whose delusions resist drugs have no equivalent non-invasive option tested in a controlled trial, and this study is the first to suggest that aiming ultrasound at this circuit might help rather than only prove safe. Senior author Donald C. Goff said that further work is needed to establish whether targeted ultrasound could one day supplement, or even replace, standard medicines. The next step is a larger study, with repeated sessions over longer periods and imaging to confirm that the target region is reached in each patient. Until those results exist, the technique remains a research tool, and nobody should read this study as a treatment.