The Impact of Focused Ultrasound Thalamotomy of the Anterior Nucleus for Focal-Onset Epilepsy on Anxiety

The purpose of this study is to evaluate the feasibility, safety, and effects on anxiety of high intensity focused ultrasound ablation (FUSA) in patients suffering from treatment-refractory focal epilepsy and anxiety. FUSA is a non-invasive neurosurgical procedure that uses ultrasound waves, sent directly through the scalp and skull, to precisely target small abnormal areas of the brain. For this study, the targeted area of the brain is the anterior nucleus of the thalamus. This brain region may cause seizures and may also be involved in anxiety. The study will test if FUSA is safe and tolerated, and if it reduces anxiety and brain response to threat in patients with anxiety receiving the procedure for partial-onset epilepsy that is resistant to medications.

Inclusion Criteria: * Disabling, medically refractory epilepsy (≥2 anti-epileptic drug failures). * Focal onset seizures with secondary generalization; with or without primary generalized seizures. * Previous seizure work-up within 12 months of enrollment date to include: A. Home EEG or EMU video EEG or intracranial EEG. B. High definition MRI imaging/PET imaging. C. Baseline neuropsychological assessment, which includes the Wechsler Advanced Clinical Solutions - Test of Premorbid Functioning (TOPF). * ≥ 3 seizures/month on average within 3 months of enrollment. * Stable medication (including anti-epileptic and psychotropic/psychoactive medications) dosage for 3 months before enrollment. * Moderate-severe anxiety as measured by the Hamilton Anxiety Rating Scale (HAM-A) score \> 17. * Anterior Nucleus (AN) identifiable on MRI (structural T1 and T2 images). * Willing to maintain seizure diary (3 months before \& 3 months after). * Involved care provider. * Written informed consent to participate. * Ability to comply with all testing, follow-ups, and study appointments and protocols. Exclusion Criteria: * Low seizure frequency (\ 100 on medication). * Patients receiving dialysis; * Patients with risk factors for intraoperative or postoperative bleeding: Platelet count less than 100,000 per cubic millimeter; PT\> 14PTT \> 40; INR \> 1.43. * History of abnormal bleeding and/or coagulopathy. * Receiving anticoagulant (e.g., Warfarin) or antiplatelet (e.g., aspirin) therapy within one week of focused ultrasound procedure or drugs known to increase risk of hemorrhage (e.g., Avastin) within one month of scheduled focused ultrasound procedure. * History of intracranial hemorrhage. * Active or suspected, acute or chronic uncontrolled infection or known life-threatening systemic disease; * History of immunocompromised status, including patients who are HIV positive. * Subjects with remarkable atrophy and poor healing capacity of the scalp. * Evidence for calcifications that might interfere with treatment safety (per CT). * Skull Density Ratio (SDR) \