Objective: High intensity focused ultrasound (HIFU) referrals to a multidisciplinary movement disorders center can come from many different sources. We aimed to evaluate referrals, based upon several metrics, and if the referrals resulted in completing HIFU at our center.

Background: HIFU has two FDA approved neurologic indications, Parkinson’s disease related tremor and dyskinesia and essential tremor (ET). With the expansion of this technology, there has been an increase in outreach and marketing directed toward patients and healthcare providers. This has contributed to several different referral methods for HIFU evaluations including from subspecialized providers, general neurologists, primary care providers, patient self-referrals, and referrals through industry partners. The percentage and quality of these referrals has not been thoroughly evaluated.

Method: We performed a retrospective chart review of all the HIFU referrals to the University of Colorado from December 2023 to January 2025. We evaluated several metrics of referrals including: the referred diagnosis, confirmation of referred diagnosis, medication trials, and outcomes of referrals.

Results: A total of 121 individuals were referred for HIFU. Of these, 52% completed the evaluation and did not proceed with HIFU, 40% underwent unilateral treatments, and 8% remain under the evaluation process. Reasons for not proceeding with HIFU were ineligibility determined by the healthcare team in 38% and patient preferences in 62%. In those who completed the evaluation process, 11% were misdiagnosed and 4.5% had not tried first-line medications. Functional tremor and Parkinson’s disease were the conditions most frequently misdiagnosed as ET.  Of individuals incorrectly diagnosed, 83% came from industry partner referrals.

Conclusion: Conditions misdiagnosed and/or not adequately tried on medications constituted 15% of completed referrals to our center. It is essential for other centers to be aware of this relatively high percentage, especially in consideration for an elective brain surgery. Having a multidisciplinary team thoroughly evaluate surgical candidacy for HIFU, as is standard of care for deep brain stimulation, is highly encouraged.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/outcomes-of-focused-ultrasound-referrals-at-a-movement-disorders-center/