Neurosurgeon at Carolina leads breakthrough treatment for epilepsy

After seeing the success of incisionless approaches in other neurological disorders, UNC School of Medicine neurosurgeon Dr. Vibhor Krishna began leading Carolina’s efforts to extend focused ultrasound to epilepsy.

Epilepsy causes bursts of abnormal electrical activity in the brain, leading to unprovoked, recurring seizures. For some, it stems from genetics, brain injury, or autoimmune disorders. For others, the causes remain unknown. Sleep deprivation, stress, illness and various other factors can all trigger seizures. One in 26 people will develop epilepsy in their lifetime.

And it’s notoriously difficult to study and treat. For the 15 million people whose seizures don’t respond to medication, called refractory epilepsy, the stakes are even higher — and the options far more limited.

That’s where Krishna’s work comes in. He’s spent the past 15 years exploring whether focused ultrasound could offer something new: a way to target the specific brain tissue causing seizures without invasive surgery.

Precision without incision

In the 1960s, functional neurosurgeons used a procedure called brain ablation to help patients with tremors or Parkinson’s disease regain control. A small, heated probe inserted into the brain could destroy small swaths of affected tissue, reducing abnormal activity. But the approach carried risks — bleeding, swelling and unintended neurological effects — and gradually fell out of favor as reversible techniques emerged.

Deep brain stimulation replaced ablation as the favored approach. Instead of destroying tissue, surgeons implanted electrodes to modulate brain activity through electrical signals. DBS became a standard treatment for many movement disorders and is now being studied in psychiatric conditions like depression and bipolar disorder.

Then, in the early 2010s, focused ultrasound entered the scene.

The new technology produced similar results to ablation but did so in an entirely new way. Instead of opening the skull, physicians could deliver energy from outside the body, aiming over a thousand ultrasound beams at a target deep in the brain. Together, they generate enough heat to alter tissue with millimeter precision — without incision.

When a mentor encouraged Krishna to attend a treatment for a patient with tremors, he was blown away by its accuracy.

“I realized that you could make a profound impact in patients’ symptoms without ever touching their head,” he recalls.

A groundbreaking treatment

Like Parkinson’s disease, epilepsy often involves abnormal activity originating from specific regions of the brain and hijacking routine neural circuits. But epilepsy poses unique challenges. Seizure networks can be harder to map, and the consequences of targeting the wrong area can be significant. But advances in imaging and years of experience with ultrasound technology gave Krishna and his colleagues a reason to try.

Patients lie in an MRI scanner wearing a specialized helmet that delivers hundreds of ultrasound beams through the skull. They remain awake as physicians monitor both the machine’s aim and the patient’s memory in real time.

There are no incisions, no implanted hardware, and typically, a much shorter recovery time. For patients who have spent years weighing the risks of surgery, the difference can be profound.

Krishna is leading a small Phase 1 clinical trial at UNC Health with 10 patients, three of whom have been treated so far with encouraging results. One patient, who previously experienced around six seizures a month, has been seizure-free for nearly five years.

The consistent results of this trial have positioned Carolina as a leader in this emerging field — and given Krishna’s team confidence that they are moving in the right direction

For patients, those outcomes are measured not just in numbers, but in daily life: the ability to leave home without fear, to regain a sense of independence, and to imagine a future not defined by uncertainty.

Read more about Dr. Vibhor Krishna and his work.