Objective: To compare MRgFUS and DBS for Parkinson’s tremor through a systematic review.

Background: Parkinson’s Disease (PD) is a neurodegenerative disorder characterized by tremors, which may become medication-resistant. Deep brain stimulation (DBS) is a well-established treatment, while magnetic resonance-guided focused ultrasound (MRgFUS) has emerged as a promising non-invasive alternative.

Method: PubMed, Embase, and LILACS were searched (2014-2024; English, Portuguese, Spanish). Included: RCTs, non-randomized trials, observational studies, comparing or evaluating MRgFUS/DBS in adults with PD, refractory tremor, reporting tremor (UPDRS-III, etc.). Two independent reviewers screened titles/abstracts; disagreements resolved by a third. Five reviewers independently assessed full texts and performed data extraction. Meta-analysis was precluded by heterogeneity; narrative synthesis performed, emphasizing comparisons.

Results: 33 studies included: 16 DBS and 17 MRgFUS. DBS studies included RCTs (n=4), retrospective cohort studies (n=8), and prospective studies (n=4). MRgFUS studies included RCTs (n=2), prospective studies (n=9), and retrospective studies (n=6). For DBS, STN was the most common target (n=8), followed by GPi (n=5). For MRgFUS, VIM thalamotomy was the most frequent procedure (n=9), followed by subthalamotomy (n=4). Across DBS, initial improvements in UPDRS-III motor scores ranged from 24% to 39% at 1-2 years, with tremor-specific improvements ranging from 50% to 70% in GPi-DBS and 25-40% STN-DBS. MRgFUS VIM thalamotomy studies consistently reported high initial tremor reduction, ranging from 60% to 88% on CRST or UPDRS. Subthalamotomy with MRgFUS showed motor score reductions ranging from 26% to 78%. DBS provided sustained benefits for up to 11 years, particularly in STN-DBS, while MRgFUS demonstrated rapid tremor reduction (60-88%), but long-term data is limited to 1-3 years.

Conclusion: Both DBS and MRgFUS are effective for refractory PD tremor. DBS offers sustained benefits, while MRgFUS provides a non-invasive option with rapid efficacy but limited long-term data. The choice of treatment depends on factors such as disease severity, patient preference, and tolerance to invasive procedures. Head-to-head trials with long-term follow-up are needed to determine optimal treatment strategies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-comparison-of-the-efficacy-and-safety-of-magnetic-resonance-guided-focused-ultrasound-ablation-mrgfus-and-deep-brain-stimulation-dbs-in-the-treatment-of-tremor-in-parkinsons-disease/