Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 May 5:15:18.
doi: 10.5334/tohm.987. eCollection 2025.

High Intensity Focused Ultrasound - Longitudinal Data on Efficacy and Safety

Betsy Thomas  1 , Gabriele Bellini  2   3 , Wen-Yu Lee  4 , Yidan Shi  4 , Alon Mogilner  5 , Michael H Pourfar  5
Affiliations
Review

High Intensity Focused Ultrasound - Longitudinal Data on Efficacy and Safety

Betsy Thomas et al. Tremor Other Hyperkinet Mov (N Y). .

Abstract

Background: High intensity focused ultrasound (HiFU) is a relatively new incisionless intervention used for treatment of essential tremor and Parkinson's disease tremor. Understanding the indications, benefits, risks and limitations of HiFU, as well as how it compares to deep brain stimulation (DBS), is important in guiding appropriate recommendations for prospective patients.

Methods: Current literature on efficacy and safety of HiFU in essential tremor and Parkinson's disease was reviewed. We additionally reviewed data on the patients who presented to our center for HiFU consultation, including outcomes of patients with low skull density ratios, and distances traveled for the procedure.

Results/discussion: HiFU is an effective and generally well-tolerated treatment for tremor. Adverse events, especially gait instability, are typically temporary but should be discussed with patients. The risk of tremor recurrence in certain patients with Parkinson's disease is also of note. Identifying appropriate candidates for either intervention remains crucial and involves considering each patient's circumstances and preferences, potential adverse effects, and practical aspects like access to follow-up and expectations. Data on bilateral HiFU lesioning, use of HiFU in patients with low skull density ratios, and emerging targets like the pallidothalamic tract are discussed as well.

Keywords: Essential Tremor; Focused Ultrasound; HiFU; High Intensity; Parkinson’s Disease.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare.

Figures

HiFU Contraindications
Figure 1
Absolute Contraindications to HiFU.
SDR<0.40 Outcomes
Figure 2
Outcomes of patients with SDR ≤ 0.40.
CRST Hand Tremor Score Improvement after ViM HiFU in ET
Figure 3
Change in CRST hand tremor score after ViM HiFU for Essential Tremor.
CRST C Improvement after ViM HiFU in ET
Figure 4
Change in CRST C scores after ViM HiFU for Essential Tremor.
QUEST Improvement after ViM HiFU in ET
Figure 5
Change in CRST C and QUEST scores after ViM HiFU for Essential Tremor.
UPDRS III Improvement after ViM HiFU in PD.
Figure 6
Change in UPDRS part III scores after HiFU in studies targeting the ViM in Parkinson’s disease.
UPDRS III Improvement after GPi HiFU in PD
Figure 7
Change in UPDRS part III scores after HiFU in studies targeting the GPi in Parkinson’s disease.
UPDRS III Improvement after STN HiFU in PD
Figure 8
Change in UPDRS part III scores after HiFU in studies targeting the STN in Parkinson’s disease.
PDQ-39 Improvement after ViM HiFU in PD
Figure 9
Change in Disability Scores Post-HiFU in Parkinson’s disease, assessed by PDQ-39.
Adverse Events after ViM HiFU in PD and ET
Figure 10
Adverse events after ViM HiFU in Essential Tremor and Parkinson’s Disease.
Adverse Events after GPi HiFU in PD
Figure 11
Adverse events after GPi HiFU in Parkinson’s disease.
Adverse Events after STN HiFU in PD
Figure 12
Adverse events after STN HiFU in Parkinson’s disease.
Factors influencing decision-making between HiFU or DBS
Figure 13
Factors influencing decision-making between HiFU or DBS.
See this image and copyright information in PMC

References

    1. Chang WS, Jung HH, Zadicario E, Rachmilevitch I, Tlusty T, Vitek S, Chang JW. Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull. J Neurosurg. 2016. Feb;124(2):411–6. DOI: 10.3171/2015.3.JNS142592 - DOI - PubMed
    1. Boutet A, Gwun D, Gramer R, Ranjan M, Elias GJB, Tilden D, Huang Y, Li SX, Davidson B, Lu H, Tyrrell P, Jones RM, Fasano A, Hynynen K, Kucharczyk W, Schwartz ML, Lozano AM. The relevance of skull density ratio in selecting candidates for transcranial MR-guided focused ultrasound. J Neurosurg. 2019. May 3;132(6):1785–1791. DOI: 10.3171/2019.2.JNS182571 - DOI - PubMed
    1. Vetkas A, Boutet A, Sarica C, Germann J, Gwun D, Yamamoto K, Jung HH, Alkhotani A, Samuel N, Lang S, Conner CR, Elias GJB, Cheyuo C, Chow C, Santyr B, Iorio-Morin C, Yang AZ, Candeias da Silva C, Fasano A, Kalia SK, Lozano AM. Successful magnetic resonance-guided focused ultrasound treatment of tremor in patients with a skull density ratio of 0.4 or less. J Neurosurg. 2023. Sep 1;140(3):639–647. DOI: 10.3171/2023.6.JNS23171 - DOI - PubMed
    1. Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, Schwartz M, Hynynen K, Lozano AM, Shah BB, Huss D, Dallapiazza RF, Gwinn R, Witt J, Ro S, Eisenberg HM, Fishman PS, Gandhi D, Halpern CH, Chuang R, Butts Pauly K, Tierney TS, Hayes MT, Cosgrove GR, Yamaguchi T, Abe K, Taira T, Chang JW. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med. 2016. Aug 25;375(8):730–9. DOI: 10.1056/NEJMoa1600159 - DOI - PubMed
    1. Elias WJ, Huss D, Voss T, Loomba J, Khaled M, Zadicario E, et al. A pilot study of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2013;369(7):640–8. DOI: 10.1056/NEJMoa1300962 - DOI - PubMed

MeSH terms

LinkOut - more resources