Speaker Profile

Lecture Abstract：
Scientists have been devoted into the understanding of using focused ultrasound as a
therapeutic tool since 1950. Yet, before the diagnostic ultrasound has even been clinically
adopted much earlier in the 80s, focused ultrasound clinically proved its therapeutic
efficacy and biomedical value way behind until this early century. Focused ultrasound has
unique niche to be able to sharply steer radiation force energy into deep seated soft tissue
and can induce localized thermal or mechanical related biophysical effect. Focused
ultrasound can even penetrate through the human skull to achieve noninvasive brain
therapy. Regulatory approved its clinical practice in abdomen, bone, and brain, and more
and more clinical applications are under discovery, development and clinical validation.
Clinician relies on engineers dedicating on comprehensive system design to secure
focused ultrasound energy delivery and to eventually achieve therapeutic bioeffect. In this
presentation, the view angle from the engineering design perspective on focused
ultrasound will be explored. Topics such as biosystem consideration, biophysical
mechanism, medical device design, as well as clinical adoption on blood-brain barrier
opening and neuromodulation using focused ultrasound will be covered.

Executive Summary：
Dr. Chang graduated from Yonsei University College of Medicine in 1983. He completed his neurosurgical residency and fellowship for stereotactic & functional neurosurgery at Severance Hospital, Yonsei University in Seoul, Korea.

Dr. Chang specializes in stereotactic & functional neurosurgery and his main interest is the neuromodulation of the central nervous system with new innovative techniques (electrical stimulation, focused ultrasound and etc).

As a leading pioneer in the field of stereotactic and functional neurosurgery, which is closely related to the rapidly developing field of neuroscience, Dr. Chang has laid the foundation for clinical research for stereotactic & functional neurosurgery in Korea. He is known to have adopted and introduced various cutting-edge techniques in Korea for the first time, such as radiofrequency cingulotomy for obsessive compulsive disorders (OCD) in 1998, and Deep Brain Stimulation (DBS) techniques for the treatment of chronic neurological disorders such as Parkinson’s disease (PD) and essential tremor (ET) in 2000.

Dr. Chang also participated for innovative clinical research of MRI-Guided Focused Ultrasound Surgery (MRgFUS) from the primary stage to the treatment of various conditions such as Parkinson’s disease, obsessive-compulsive disorder (OCD), and depression. Through his continued research in this technique, he has contributed more than any other person to the wide adoption and understanding of MRgFUS around the world by the suggestion of the special standard guideline of SDR (skull density ratio) for selecting the optimal candidates of MRgFUS lesioning procedure. Because of these contributions, he received the most honorable prize of International Society for Therapeutic Ultrasound (ISTU) so called the William and Francis Fry Honorary Award at the 2021 annual meeting of ISTU.

Since 1993, Dr. Chang has published more than 270 academic papers in SCI(E) journals around the world.
He has been selected as the co-author of prominent neurosurgery textbooks more than 8 times, and he has authored countless domestic papers and textbooks.

Currently Dr. Chang serves as a section editor of World Neurosurgery which is an official journal of World Federation of Neurological Surgeons (WFNS). He is also a member of the editorial board for the official journal of World Society for Stereotactic & Functional Neurosurgery (WSSFN) as well as the official journal of the International Neuromodulation Society (INS).

In addition to his various editorial duties, Dr. Chang served as the president of many academic societies such as Korean Society for Stereotactic & Functional Neurosurgery (KSSFN, 2014), Korean Society for Therapeutic Ultrasound (KSTU, 2014-2018), Korean Neurosurgical Society (KNS,.2016-2018), International Society for Reconstructive Neurosurgery (ISRN, 2005-2009), Asian Australasian Society for Stereotactic & Functional Neurosurgery (AASSFN, 2011-2013) and World Society for Stereotactic & Functional Neurosurgery (WSSFN., 2019-2022).
And he is currently serving as the 1st president of Asian Pacific Society for Transcranial Focused Ultrasound Surgery (2023 - )

And he is working at Korea University Anam hospital from March of 2024.

Lecture Abstract：
Introduction
Our knowledge of the nervous system in health and disease has, however, increased considerably during the last fifty years. Today, neurosurgery reveals promising new stereotactic strategies such as neuromodulation by the thermal lesioning, deep brain stimulation, radiosurgery, MR guided focused ultrasound surgery (MRgFUS) or etc to deal with diseases of the nervous system. Most recently, the field of MRgFUS is evolving and offers the new hope for the treatment of many neurological disorders through both ablative mechanism (lesioning) and non-ablative mechanisms such as drug delivery, neuromodulation and blood brain barrier (BBB) opening.

Methods and Results
We already demonstrated the beneficial effect of MRgFUS lesioning procedures patients with essential tremor (ET), Parkinson’s disease (PD), obsessive compulsive disorders (OCD) and depression especially for those who are refractory for the medical managements. As well, we developed and offered the concept of skull density ratio (SDR) to find the appropriate and more efficient candidates of MRgFUS lesioning procedure. Recently we also underwent the clinical investigation to confirm the role and the beneficial effect of blood brain barrier opening with MRgFUS for Alzheimer’s disease and glioblastoma.

Conclusion
In this presentation, I will demonstrate my personal clinical experiences as well as my troubleshooting to overcome the various obstacles of making successful lesioning and the blood brain barrier opening of MRgFUS for various brain disorders.

Executive Summary：
Dr. Rou-Shayn Chen devoted himself to the specialty of movement disorders for more than 20 years and chaired the Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital for more than 10 years from 2004 to 2014. He was the President of the Taiwan Movement Disorders Society (TMDS) from 2011 to 2013 and the Taiwan Neurological Society from 2019 to 2021.
He is now the principal executive director of the Taiwan Neurophysiological Society and Taiwan Movement Disorder Society. His major clinical works focus on diagnosis and pharmacological intervention of Parkinson’s disease and dystonia. He was one of the pioneers to use botulinum toxin in treating dystonic patients especially with focal hand dystonia. During the past decade, He also built up one registration system for clinical follow up in detail of Parkinson’s disease in Taiwan.
Dr. Chen's clinical work has been instrumental in advancing the diagnosis and pharmacological intervention of Parkinson's disease and dystonia. He is particularly renowned for his pioneering use of botulinum toxin in treating dystonic patients, especially those with focal hand dystonia. Over the past decade, he has also established a comprehensive registration system for the detailed clinical follow-up of Parkinson's disease in Taiwan.
Dr. Chen's research is focused on the neurophysiology of cortical plasticity, repetitive transcranial magnetic stimulation with the theta burst paradigm, and transcranial low-intensity ultrasound stimulation. He has also delved into the complex issues of non-motor symptoms and gait problems in patients with Parkinson's disease, contributing to our understanding of the condition.
Apart from being a physician, he founded two major biennale international congresses in Taiwan. One was designed for movement disorders, TIC-PDMD, which started in 2013; the other was designed for the whole neurological society, ITCN, which started in 2015.
TIC-PDMD: Taiwan International Congress of Parkinson's disease and movement disorder; ITCN: International Taiwanese Congress of Neurology

Lecture Abstract：
Low-intensity transcranial ultrasound stimulation (TUS) is an innovative noninvasive brain stimulation (NIBS) technique for neuromodulation. Compared to repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), TUS provides the advantage of a remarkable level of spatial specificity and the capacity to target deeper brain structures.
Currently, the research of TUS focused on neuromodulation pays much attention to long-term potentiation and depression through synaptic plasticity, which is also the possible physiological basis of rTMS and tDCS. However, the most advanced reports showed complete conflict results in inducing enhanced cortical excitability, and there was no consensus worldwide on the protocol to execute the TUS for preferential effects.
Apart from the pattern-dependent paradigm of TUS (cTBS TUS or iTBS TUS), the other possibility would be to rely on intensity-dependent to provide enhancement or a depressing effect. The evidence supporting the impact of TUS by different intensities comes from the NICE model, which postulated that weak intensity through mechanical changes to reach the effect. Those include: 1. Change of membrane conformational status; 2. opening of mechanosensitive ion channels. The most significant mechanosensitive channels include the piezo, acid-sensing ion, and transient receptor potential channels.

In this talk, we will discuss the preliminary results of the TUS’s aftereffect caused by the weak intensity of NaiFus applications.