High-intensity focused ultrasound (HIFU) versus deep brain stimulation (DBS) for refractory tremor: team HIFU.

High-intensity focused ultrasound (HIFU) has emerged as a minimally invasive and incision-free alternative for managing tremors associated with essential tremor (ET) and Parkinson's disease (PD). Approved by the United States Food and Drug Administration (FDA) for unilateral and staged bilateral thalamotomy, HIFU also addresses cardinal PD symptoms such as rigidity and bradykinesia through pallidotomy. Tremor improvement rates range from 50 to 75% for ET and 60 to 90% for tremor-dominant PD, with long-term efficacy sustained up to 5 years posttreatment, including 73% tremor improvement in a recent controlled multicenter study. Unlike deep brain stimulation (DBS), HIFU eliminates hardware-related complications, such as infections and intracerebral hemorrhage, and minimizes postprocedural maintenance. Adverse events are primarily mild and transient, including temporary paresthesia and imbalance. Real-time magnetic resonance imaging (MRI) guidance enhances targeting precision, enabling patients to resume daily activities within 24 hours. These attributes make HIFU a durable and effective treatment option.

Introduction

Purpose Thermal ablation

Study Objective To evaluate the efficacy, safety, and durability of high-intensity focused ultrasound (HIFU) as a minimally invasive treatment for tremor in essential tremor and Parkinson's disease.

Disease model Essential tremor; Parkinson's disease

MRI or image guidance method Real-time magnetic resonance imaging (MRI) guidance

Targeted brain region(s) Thalamus

Outcomes and Safety

Summary of Outcomes High-intensity focused ultrasound (HIFU) produced substantial and durable tremor reduction—50–75% improvement for essential tremor and 60–90% for tremor-dominant Parkinson’s disease (73% in a recent controlled multicenter study) with benefits sustained up to 5 years and mainly mild, transient adverse events (paresthesia, imbalance); MRI-guided targeting enabled rapid recovery. The paper did not report testing multiple focused ultrasound parameter variants or identify specific successful parameter sets.

Duration of biological effect Up to 5 years

Safety-related matter Adverse events were reported as primarily mild and transient, including temporary paresthesia and imbalance. HIFU also avoids hardware-related complications such as infections and intracerebral hemorrhage, and patients often resume daily activities within 24 hours.

Brain Region

Ultrasound Parameters

Focal Characteristics Focal depth: None; Focal length: None; Aperture size: None

Treatment frequency Single session

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