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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(07): s00451808087
DOI: 10.1055/s-0045-1808087
Point of View

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

Flávia de Paiva Santos Rolim 
1   Universidade de Fortaleza, Faculdade de Medicina, Fortaleza CE, Brazil.
2   Hospital Geral de Fortaleza, Departamento de Neurologia, Núcleo de Distúrbios do Movimento, Fortaleza CE, Brazil.
,
Denise Maria Menezes Cury Portela 
3   Centro Universitário UNINOVAFAPI, Faculdade de Medicina, Teresina PI, Brazil.
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Abstract

Deep brain stimulation (DBS) has been widely accepted as a powerful tool capable of suppressing tremor by modulating the neuronal circuitry, with long-term adaptability and a profile of low adverse effects. It has been the primary treatment for refractory tremor for decades, with sustained long-term efficacy. Recently, magnetic resonance-guided high-frequency focused ultrasound (HIFU) has emerged as an alternative, prompting comparisons between these approaches. Deep brain stimulation offers long-lasting tremor control in Parkinson's disease (PD) and essential tremor (ET). In addition, it enables us to advance our understanding of brain circuits by integrating neuroimaging, electrophysiology, and connectomics data to map the best stimulation spots. Technologies such as adaptive and directional DBS enable real-time adjustments and greater precision, optimizing results and minimizing adverse effects. Although HIFU shows promising results, it remains an ablative and non-adjustable therapy, contrasting with DBS's dynamic and customizable advances.

Keywords

Tremor - Deep Brain Stimulation - High-Intensity Focused Ultrasound Ablation - Movement Disorders

Authors' Contributions

Conceptualization: FPSR, DMMC; Data curation: FPSR, DMMC; Formal analysis: FPSR, DMMC; Project administration: FPSR, DMMC; Supervision: FPSR, DMMC; Validation: FPSR, DMMC; Visualization: FPSR, DMMC; Writing – original draft: FPSR, DMMC; Writing – review & editing: FPSR, DMMC.


Data Availability Statement

All data generated or analyzed during this study are fully available and can be provided by the corresponding author upon request.


Editor-in-Chief: Hélio A. G. Teive 0000-0003-2305-1073.


Associate Editor: Carlos Henrique Ferreira Camargo 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-0045-1809660 and https://doi.org/10.1055/s-0045-1808084.




Publication History

Received: 22 January 2025

Accepted: 27 February 2025

Article published online:
06 July 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
Flávia de Paiva Santos Rolim, Denise Maria Menezes Cury Portela. High-intensity focused ultrasound (HIFU) versus deep brain stimulation (DBS) for refractory tremor: team DBS. Arq Neuropsiquiatr 2025; 83: s00451808087.
DOI: 10.1055/s-0045-1808087