Kamimura and Sokolov’s (2025) proposal for the use of magnetic resonance-guided focal ultrasound (MRgFUS) for neurological applications represents a turning point in translational brain engineering. The article, although technically robust and with language accessible to the industrial sector, lacks in-depth analysis of the integration between functional neuroimaging, neuroplasticity, and neuroimmune interfaces. The predominant focus on technical and regulatory aspects reflects a market-oriented perspective, but neglects profound neurobiological implications that arise from permanent brain ablation.
Ablation of the ventral intermediate nucleus of the thalamus, for example, although clinically effective against tremors, implies direct interference in thalamocortical circuits responsible for timing and motor integration functions. The article does not mention chronic microglia activation induced by thermal necrosis, a factor that can negatively influence neurogenesis and modulate limbic networks in an unpredictable manner in the medium term. There is also no analysis of the possible interference in the oscillatory synchrony between subcortical nuclei and the medial prefrontal cortex — fundamental for decision-making processes and emotional regulation.
Another critical point is the lack of discussion on the functional heterogeneity of the white matter adjacent to the target regions. Segmentation based exclusively on anatomical atlases, as suggested by the authors, is insufficient in view of the complexity of individual cortico-subcortical connections. The use of diffusion tensor tractography (DTI) should be normative in these protocols, especially when addressing the feasibility of bilateral ablation.
Despite the thermal precision described in the article — with real-time monitoring by resonance — the risk of extracerebral cavitation and displacement artifacts during sonication are not only technical limitations. They are neuroethical failure points, considering the possibility of irreversible damage in unintended areas. The replacement of the ablative paradigm by low-intensity neuromodulation should be encouraged as an evolutionary axis. The literature cited in the article itself indicates that neuromodulatory effects, even if transient, activate cortical circuits with significant effects on motor and cognitive symptoms.
In terms of translationality, the authors are right to point out the integration with artificial intelligence and the trend towards portability. However, such advances must be accompanied by integrative prediction systems that consider not only anatomical factors, but also genetic and biochemical profiles of patients. An ideal model would include variables such as dopamine receptor density, basal inflammation profiles, and neural oscillation patterns at rest.
I conclude that the article provides a comprehensive overview of the technology, but still operates under a sectoral logic. Applied neuroscience requires more than thermal efficiency and federal regulation. It requires an integrative model that understands the brain as an adaptive system and not as a modular ablative structure.
Reference: KAMIMURA, HAS; SOKOLOV, A. Transcranial magnetic resonance-guided focused ultrasound for neurological applications: industry challenges, innovations, and future directions. Journal of Neural Engineering, v. 22, n. 2, p. 021003, 2025. DOI: 10.1088/1741-2552/adc8d2.
