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PubMed This is a summary of 30 peer-reviewed journal articles Updated
Neurology

Can I Get Focused Ultrasound Instead of DBS for Parkinson's?

At a Glance

Deep Brain Stimulation (DBS) and Focused Ultrasound both treat advanced Parkinson's disease. DBS involves a reversible, adjustable surgical implant that treats both sides of the body. Focused Ultrasound avoids traditional surgery but creates a permanent brain lesion, usually on just one side.

In this answer

6 sections

01

How Do They Work?

02

The Trade-Off: Irreversible vs. Adjustable

03

Treating One Side vs. Both Sides

04

Quick Comparison

05

Why is DBS Still the “Standard” for Many?

06

Who Might Choose Focused Ultrasound?

When medications no longer control Parkinson’s disease symptoms effectively, many patients begin considering advanced therapies. If you are hoping to avoid traditional open brain surgery, you might wonder if you can get Focused Ultrasound instead of Deep Brain Stimulation (DBS).

The short answer is yes: Focused Ultrasound is an option for some people, but there are significant clinical differences between the two. Focused Ultrasound uses sound waves to create a permanent change (a lesion) in the brain, often providing immediate relief for tremors. However, it is an irreversible procedure and is typically only used to treat one side of the body. DBS, while requiring traditional surgery to place implanted hardware, is reversible, adjustable, and can treat symptoms on both sides of the body [1][2][3].

Because of these differences, DBS remains the standard advanced treatment for many Parkinson’s patients, while Focused Ultrasound serves as an important alternative for those who cannot or prefer not to undergo traditional surgery.

How Do They Work?

Both treatments target specific areas deep in the brain—such as the subthalamic nucleus or globus pallidus—to disrupt the abnormal signals that cause Parkinson’s symptoms [4][5]. However, they disrupt these signals in very different ways.

Deep Brain Stimulation (DBS):
DBS acts like a pacemaker for your brain. A neurosurgeon implants thin wires (leads) into the brain and connects them to a battery pack placed under the skin in your chest [6][7]. It uses adjustable electrical pulses to control your symptoms, a process called electrical neuromodulation [4].

MR-Guided Focused Ultrasound (MRgFUS):
Focused ultrasound uses highly concentrated sound waves, guided by an MRI, to heat and destroy a very tiny, specific area of brain tissue responsible for symptoms [4][8]. This permanent destruction of tissue is called thermal ablation. While there are no incisions, no holes drilled in the skull, and no hardware left in the body, the procedure is still physically demanding [9][10]. Your head must be completely shaved, a rigid frame is pinned to your skull under local anesthesia to keep your head perfectly still, and you must lie inside an MRI scanner for several hours [11][12][13].

For both procedures, you generally remain awake so the surgical team can monitor your symptom relief and check for side effects in real time.

The Trade-Off: Irreversible vs. Adjustable

One of the most important differences between the two procedures is flexibility.

Because Focused Ultrasound destroys a small piece of brain tissue, the effects are permanent and irreversible [1][14]. This means that if you experience procedure-related side effects—such as speech difficulties, gait and balance problems, or numbness—those effects may also be permanent [15][16]. The treatment cannot be “turned down” or reversed later.

DBS, on the other hand, does not destroy brain tissue. Your doctor can adjust the electrical signals over time to match the progression of your Parkinson’s disease or to minimize side effects [6][17]. If necessary, the device can be turned off or completely removed.

Treating One Side vs. Both Sides

Parkinson’s disease typically affects both sides of the body as it progresses.

  • DBS is well-established as a treatment for symptoms on both sides of the body (bilateral treatment) [3][18].
  • Focused Ultrasound is primarily used to treat symptoms on just one side of the body (unilateral treatment), usually the side where symptoms are most severe [19][18]. While researchers are exploring performing Focused Ultrasound on both sides in staged procedures, doing so is more complex and carries a higher risk of cumulative neurological side effects, like speech and balance impairment [18][20].

Quick Comparison

Feature Deep Brain Stimulation (DBS) Focused Ultrasound (MRgFUS)
Method Electrical pulses (neuromodulation) Heat destruction (thermal ablation)
Incisions/Surgery Yes (traditional surgery) No (incisionless)
Hardware implanted? Yes (wires and battery) No
Adjustable/Reversible? Yes No (permanent lesion)
Sides treated Typically both (bilateral) Typically one (unilateral)
Patient preparation Traditional surgical prep Shaved head, pinned frame, MRI tube

Why is DBS Still the “Standard” for Many?

Even though Focused Ultrasound avoids traditional brain surgery, DBS remains the standard surgical treatment for advanced Parkinson’s disease [6][21]. This is because:

  1. Broader Symptom Control: DBS is highly effective at managing a wider range of motor symptoms and medication-related complications, such as levodopa-induced dyskinesia [22][23].
  2. Adjustability: The ability to tweak stimulation settings as your disease changes over the years is a massive clinical advantage [6].
  3. Long-Term Evidence: DBS has decades of long-term data proving its continued effectiveness, whereas long-term data for Focused Ultrasound is still being gathered [24][25].

Who Might Choose Focused Ultrasound?

Focused Ultrasound is generally favored as an option for patients who:

  • Have symptoms primarily dominated by tremor on one side of the body [26][1].
  • Are older or have other medical conditions that put them at high risk for complications from traditional surgery, such as bleeding or infection [27][28].
  • Strongly prefer to avoid permanent medical implants or hardware in their body [27][29].
  • Have a favorable “skull density ratio” (the procedure requires specific skull thickness to allow sound waves to pass through effectively) [1][30].

Ultimately, the choice between DBS and Focused Ultrasound depends heavily on your specific symptoms, your overall health, and your personal comfort with surgery versus permanent changes to brain tissue.

Common questions in this guide

Am I a better candidate for DBS or Focused Ultrasound for Parkinson's?
Deep Brain Stimulation (DBS) is generally recommended for broad, long-term symptom control on both sides of the body because it is adjustable. Focused Ultrasound is typically favored for older patients or those who have severe tremors primarily on one side and want to avoid traditional surgery.
Is Focused Ultrasound a permanent treatment?
Yes, Focused Ultrasound is a permanent and irreversible procedure. It uses highly concentrated sound waves to heat and destroy a very tiny area of brain tissue that is causing your symptoms. Any side effects experienced may also be permanent.
Do I have to have my head shaved for Focused Ultrasound?
Yes, preparing for Focused Ultrasound requires your head to be completely shaved. A rigid frame is also pinned to your skull under local anesthesia to keep your head perfectly still while you lie inside an MRI scanner for the procedure.
Can Focused Ultrasound treat Parkinson's symptoms on both sides of my body?
Focused Ultrasound is primarily used to treat symptoms on just one side of the body, usually the side where symptoms are most severe. Treating both sides increases the risk of neurological side effects like speech and balance impairment.
Does Deep Brain Stimulation permanently destroy brain tissue?
No, Deep Brain Stimulation does not destroy brain tissue. It acts like a pacemaker for your brain, using an implanted device to send adjustable electrical pulses. The device can be adjusted, turned off, or completely removed if necessary.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Am I at a stage in my Parkinson's where I should be considering advanced therapies like DBS or Focused Ultrasound?
  2. 2.Based on my specific symptoms (tremor, stiffness, dyskinesia), am I a better candidate for DBS or Focused Ultrasound?
  3. 3.Do I have the right skull density to even be a candidate for Focused Ultrasound?
  4. 4.If I choose Focused Ultrasound now, does that permanently prevent me from getting Deep Brain Stimulation in the future?
  5. 5.What are the specific risks of permanent side effects, like speech or balance problems, with Focused Ultrasound compared to DBS?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

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References

References (30)
  1. 1

    From Ablation to Neuromodulation Platform: The Evolving Role of Magnetic Resonance-Guided Focused Ultrasound in Functional Neurosurgery.

    Lee S, Chang JW

    Journal of clinical neurology (Seoul, Korea) 2026; (22(1)):17-41 doi:10.3988/jcn.2025.0563.

    PMID: 41517810
  2. 2

    Unilateral Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy Thalamotomy for Essential Tremor.

    Aubignat M, Tir M, Ouendo M, et al.

    Movement disorders : official journal of the Movement Disorder Society 2024; (39(6)):1006-1014 doi:10.1002/mds.29790.

    PMID: 38532534
  3. 3

    Essential Tremor - Deep Brain Stimulation vs. Focused Ultrasound.

    Ferreira Felloni Borges Y, Cheyuo C, Lozano AM, Fasano A

    Expert review of neurotherapeutics 2023; (23(7)):603-619 doi:10.1080/14737175.2023.2221789.

    PMID: 37288812
  4. 4

    Focused Ultrasound and Other Lesioning Therapies in Movement Disorders.

    Walters H, Shah BB

    Current neurology and neuroscience reports 2019; (19(9)):66 doi:10.1007/s11910-019-0975-2.

    PMID: 31377876
  5. 5

    MR-guided focused ultrasound pallidotomy for Parkinson's disease: safety and feasibility.

    Eisenberg HM, Krishna V, Elias WJ, et al.

    Journal of neurosurgery 2021; (135(3)):792-798 doi:10.3171/2020.6.JNS192773.

    PMID: 33481557
  6. 6

    Tremor in Parkinson's Disease: From Pathophysiology to Advanced Therapies.

    Abusrair AH, Elsekaily W, Bohlega S

    Tremor and other hyperkinetic movements (New York, N.Y.) 2022; (12()):29 doi:10.5334/tohm.712.

    PMID: 36211804
  7. 7

    Current Practice and the Future of Deep Brain Stimulation Therapy in Parkinson's Disease.

    Almeida L, Deeb W, Spears C, et al.

    Seminars in neurology 2017; (37(2)):205-214 doi:10.1055/s-0037-1601893.

    PMID: 28511261
  8. 8

    Magnetic resonance-guided focused ultrasound thalamotomy for tremor: a report of 30 Parkinson's disease and essential tremor cases.

    Zaaroor M, Sinai A, Goldsher D, et al.

    Journal of neurosurgery 2018; (128(1)):202-210.

    PMID: 28298022
  9. 9

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

    Massruhá KS, Cardoso EF

    Arquivos de neuro-psiquiatria 2025; (83(7)):1-4 doi:10.1055/s-0045-1809660.

    PMID: 40675616
  10. 10

    Techniques, Indications, and Outcomes in Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Tremor.

    Maesawa S, Nakatsubo D, Tsugawa T, et al.

    Neurologia medico-chirurgica 2021; (61(11)):629-639 doi:10.2176/nmc.ra.2021-0187.

    PMID: 34470990
  11. 11

    Dexmedetomidine Sedation in Magnetic Resonance-Guided Focused Ultrasound Thalamotomy: A Case Series of 3 Patients.

    Fusco P, De Sanctis F, Di Carlo S, et al.

    A&A practice 2019; (12(11)):406-408 doi:10.1213/XAA.0000000000000946.

    PMID: 31162170
  12. 12

    Factors Associated with Headache and Nausea During Magnetic Resonance-Guided Focused Ultrasound for Tremor.

    Cacho-Asenjo E, Honorato-Cia C, Nuñez-Cordoba JM, et al.

    Movement disorders clinical practice 2021; (8(5)):701-708 doi:10.1002/mdc3.13210.

    PMID: 34307742
  13. 13

    Technical Principles and Clinical Workflow of Transcranial MR-Guided Focused Ultrasound.

    Meng Y, Jones RM, Davidson B, et al.

    Stereotactic and functional neurosurgery 2021; (99(4)):329-342 doi:10.1159/000512111.

    PMID: 33302282
  14. 14

    Current Approach to Surgical Management of Tremor Disorders.

    Chavira-Hernandez G, Fasano A

    Seminars in neurology 2026; doi:10.1055/a-2789-0271.

    PMID: 41539330
  15. 15

    Patient-Reported Outcomes After Focused Ultrasound Thalamotomy for Tremor-Predominant Parkinson's Disease.

    Maragkos GA, Kosyakovsky J, Zhao P, et al.

    Neurosurgery 2023; (93(4)):884-891 doi:10.1227/neu.0000000000002518.

    PMID: 37133259
  16. 16

    Motor and non-motor outcome in tremor dominant Parkinson's disease after MR-guided focused ultrasound thalamotomy.

    Purrer V, Pohl E, Borger V, et al.

    Journal of neurology 2024; (271(7)):3731-3742 doi:10.1007/s00415-024-12469-z.

    PMID: 38822147
  17. 17

    Globus Pallidus Interna or Subthalamic Nucleus Deep Brain Stimulation for Parkinson Disease: A Review.

    Ramirez-Zamora A, Ostrem JL

    JAMA neurology 2018; (75(3)):367-372 doi:10.1001/jamaneurol.2017.4321.

    PMID: 29356826
  18. 18

    Focused ultrasound: focused on tremor.

    Davidson B, Lozano AM

    Expert review of medical devices 2025; (22(5)):467-475 doi:10.1080/17434440.2025.2489493.

    PMID: 40184524
  19. 19

    Bilateral Focused Ultrasound Thalamotomy for Essential Tremor (BEST-FUS Phase 2 Trial).

    Iorio-Morin C, Yamamoto K, Sarica C, et al.

    Movement disorders : official journal of the Movement Disorder Society 2021; (36(11)):2653-2662 doi:10.1002/mds.28716.

    PMID: 34288097
  20. 20

    Four-tract tractography: multiparametric direct targeting of the dentatorubrothalamic tract.

    Seas A, Hon K, Chung D, et al.

    Neurosurgical focus: Video 2024; (11(2)):V2 doi:10.3171/2024.7.FOCVID2483.

    PMID: 39399523
  21. 21

    Surgical Treatment of Parkinson's Disease: Devices and Lesion Approaches.

    Sharma VD, Patel M, Miocinovic S

    Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics 2020; (17(4)):1525-1538 doi:10.1007/s13311-020-00939-x.

    PMID: 33118132
  22. 22

    Uncoupling of dopaminergic and subthalamic stimulation: Life-threatening DBS withdrawal syndrome.

    Reuter S, Deuschl G, Falk D, et al.

    Movement disorders : official journal of the Movement Disorder Society 2015; (30(10)):1407-13 doi:10.1002/mds.26324.

    PMID: 26184453
  23. 23

    Pallidal versus subthalamic nucleus deep brain stimulation for levodopa-induced dyskinesia.

    Fan SY, Wang KL, Hu W, et al.

    Annals of clinical and translational neurology 2020; (7(1)):59-68 doi:10.1002/acn3.50961.

    PMID: 31813194
  24. 24

    Magnetic resonance-guided focused ultrasound treatment for essential tremor shows sustained efficacy: a meta-analysis.

    Miller WK, Becker KN, Caras AJ, et al.

    Neurosurgical review 2022; (45(1)):533-544 doi:10.1007/s10143-021-01562-w.

    PMID: 33978922
  25. 25

    Unilateral Thalamic Deep Brain Stimulation Versus Focused Ultrasound Thalamotomy for Essential Tremor.

    Harary M, Segar DJ, Hayes MT, Cosgrove GR

    World neurosurgery 2019; (126()):e144-e152 doi:10.1016/j.wneu.2019.01.281.

    PMID: 30794976
  26. 26

    Comparative Study of Focused Ultrasound Unilateral Thalamotomy and Subthalamotomy for Medication-Refractory Parkinson's Disease Tremor.

    Paschen S, Natera-Villalba E, Pineda-Pardo JA, et al.

    Movement disorders : official journal of the Movement Disorder Society 2025; (40(5)):823-833 doi:10.1002/mds.30159.

    PMID: 40028918
  27. 27

    Comparative Evaluation of Magnetic Resonance-Guided Focused Ultrasound Surgery for Essential Tremor.

    Kim M, Jung NY, Park CK, et al.

    Stereotactic and functional neurosurgery 2017; (95(4)):279-286 doi:10.1159/000478866.

    PMID: 28810261
  28. 28

    Magnetic resonance-guided focused ultrasound thalamotomy as a viable option for essential tremor after deep brain stimulation explantation: illustrative case.

    Souza DN, Folz CC, Seas A, et al.

    Journal of neurosurgery. Case lessons 2025; (10(1)).

    PMID: 40623329
  29. 29

    Diffusion imaging changes in the treated tract following focused ultrasound thalamotomy for tremor.

    Mazerolle EL, Warwaruk-Rogers R, Romo P, et al.

    Neuroimage. Reports 2021; (1(1)):100010 doi:10.1016/j.ynirp.2021.100010.

    PMID: 40568235
  30. 30

    Characteristics of Pain During MRI-Guided Focused Ultrasound Thalamotomy.

    He X, Oshino S, Hosomi K, et al.

    Neurosurgery 2023; (93(2)):358-365 doi:10.1227/neu.0000000000002420.

    PMID: 36861986

This page provides educational information on surgical and non-surgical treatments for Parkinson's disease. It does not replace professional medical advice from your neurologist or neurosurgeon.

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