Objective: To evaluate the safety and efficacy of subsequent Deep Brain Stimulation (DBS) as a management strategy for patients with recurrent or residual symptoms following MR-guided Focused Ultrasound (MRgFUS) thalamotomy.

Background: Despite its efficacy in treating medically refractory movement disorders, unilateral MRgFUS thalamotomy may result in tremor recurrence, requiring additional interventions.

Method: We retrospectively reviewed eight patients who underwent bilateral DBS following unilateral MRgFUS thalamotomy for medically refractory Essential Tremor (ET, n=7) or Tremor-Dominant Parkinson’s Disease (TDPD, n=1). We analyzed clinical indications, complications, and functional outcomes using the Fahn-Tolosa-Marin (FTM) Tremor Rating Scale and the Unified Parkinson’s Disease Rating Scale (UPDRS) Part III, respectively.

Results: The mean time from MRgFUS to bilateral DBS was 19.2 months (range: 6-48 months). Indications for DBS included tremor recurrence (n=4), technical inability to complete MRgFUS ablation due to anatomical limitation (n=2), and progression of contralateral symptoms (n=2). All patients tolerated the DBS procedure well. Post-operative functional outcomes were favorable, with FTM scores in available cases improving from a mean pre-DBS score of  52.3 to 15.3 (mean FTM reduction of 70.7%). The TDPD patient experienced a reduction of 64.9% in UPDRS Part III OFF score, improving from 57 pre-DBS to 20.

Conclusion: Prior unilateral MRgFUS thalamotomy does not limit the safety and effectiveness of subsequent bilateral DBS. DBS serves as a viable treatment option in case of suboptimal MRgFUS outcomes, providing adjustable therapy and a flexible approach for managing progressive disease. In some patients, the residual MRgFUS lesion may enhance DBS efficacy, allowing adequate tremor control at lower ipsilateral stimulation thresholds. 

Partial data (n=3) presented at the CNS Annual Meeting; October 11-15, 2025.

Pre- and Postoperative FTM and UPDRS-OFF scores

Patient-specific Diffusion Tractography

Pre- (top) and 6-months post-DBS (row) FTM spirals

References: [1] Bhatia KP, Bain P, Bajaj N, et al. Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018;33(1):75-87. doi:10.1002/mds.27121  

[2] Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015;30(12):1591-1601. doi:10.1002/mds.26424

[3] Abusrair AH, Elsekaily W, Bohlega S. Tremor in Parkinson’s Disease: From Pathophysiology to Advanced Therapies. Tremor Other Hyperkinet Mov (N Y). 2022;12:29. Published 2022 Sep 13. doi:10.5334/tohm.712

[4] Pouratian N, Baltuch G, Elias WJ, Gross R. American Society for Stereotactic and Functional Neurosurgery Position Statement on Magnetic Resonance-Guided Focused Ultrasound for the Management of Essential Tremor. Neurosurgery. 2020;87(2):E126-E129. doi:10.1093/neuros/nyz510

[5] Elias WJ, Lipsman N, Ondo WG, et al. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med. 2016;375(8):730-739. doi:10.1056/NEJMoa1600159

[6] Cosgrove GR, Lipsman N, Lozano AM, et al. Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results. J Neurosurg. 2022;138(4):1028-1033. Published 2022 Aug 5. doi:10.3171/2022.6.JNS212483

[7] Halpern CH, Santini V, Lipsman N, et al. Three-year follow-up of prospective trial of focused ultrasound thalamotomy for essential tremor. Neurology. 2019;93(24):e2284-e2293. doi:10.1212/WNL.0000000000008561

[8] Chang JW, Park CK, Lipsman N, et al. A prospective trial of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor: Results at the 2-year follow-up. Ann Neurol. 2018;83(1):107-114. doi:10.1002/ana.25126

[9] Park YS, Jung NY, Na YC, Chang JW. Four-year follow-up results of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor. Mov Disord. 2019;34(5):727-734. doi:10.1002/mds.27637

[10] Krishna V, Sammartino F, Cosgrove R, et al. Predictors of Outcomes After Focused Ultrasound Thalamotomy. Neurosurgery. 2020;87(2):229-237. doi:10.1093/neuros/nyz417

[11] Levi V, Eleopra R, Franzini A, Romito L. Is Deep Brain Stimulation still an option for tremor recurrence after Focused Ultrasound thalamotomy? A case report. J Clin Neurosci. 2019;68:344-346. doi:10.1016/j.jocn.2019.07.035  

[12] Maamary J, Peters J, Kyle K, Barnett Y, Jonker B, Tisch S. Effective Subthalamic Nucleus Deep Brain Stimulation Following MRgFUS for Tremor Dominant Parkinson’s Disease. Mov Disord Clin Pract. 2023;10(3):486-492. Published 2023 Jan 30. doi:10.1002/mdc3.13662

[13] Wang TR, Dallapiazza RF, Moosa S, Huss D, Shah BB, Elias WJ. Thalamic Deep Brain Stimulation Salvages Failed Focused Ultrasound Thalamotomy for Essential Tremor: A Case Report. Stereotact Funct Neurosurg. 2018;96(1):60-64. doi:10.1159/000486646

« Back to 2026 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/outcomes-of-bilateral-deep-brain-stimulation-following-prior-mr-guided-focused-ultrasound-thalamotomy/