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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(07): s00451809660
DOI: 10.1055/s-0045-1809660
Point of View

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

Karina Silveira Massruhá 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
2   Hospital Israelita Albert Einstein, Departamento de Neurologia, São Paulo SP, Brazil.
,
Ellison Fernando Cardoso 
3   Hospital Israelita Albert Einstein, Departamento de Imagem, São Paulo SP, Brazil.
4   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, Seção de Neurorradiologia, São Paulo SP, Brazil.
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Abstract

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.

Keywords

Essential Tremor - Parkinson Disease - High-Intensity Focused Ultrasound Ablation - Tremors

Authors' Contributions

Writing – original draft: KSM; Writing – review & editing: KSM, EFC.


Editor-in-Chief: Hélio A. G. Teive.https://orcid.org/0000-0003-2305-1073


Associate Editor: Carlos Henrique Ferreira Camargo.https://orcid.org/0000-0002-3533-0347


Guest Editor: Rubens Gisbert Cury.https://orcid.org/0000-0001-6305-3327


This article is part of a debate series on Movement Disorders (Essential Tremor Non-Pharmacological Treatment). Check out the other points of view: https://doi.org/10.1055/s-0045-1808087 and https://doi.org/10.1055/s-0045-1808084




Publikationsverlauf

Eingereicht: 27. Januar 2025

Angenommen: 08. März 2025

Artikel online veröffentlicht:
17. Juli 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Karina Silveira Massruhá, Ellison Fernando Cardoso. High-intensity focused ultrasound (HIFU) versus deep brain stimulation (DBS) for refractory tremor: team HIFU. Arq Neuropsiquiatr 2025; 83: s00451809660.
DOI: 10.1055/s-0045-1809660
 

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