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.