Objective: To compare outcomes of Deep Brain Stimulation (DBS) and Magnetic Resonance Guided Focused Ultrasound (MRgFUS) in the treatment of Essential Tremor (ET).

Background: ET is a common tremor syndrome that can be disabling for some patients. Pharmacologic therapies are first line but are often ineffective or poorly tolerated. Advanced therapies include DBS or MRgFUS. While both are available in many large centres, few studies have directly compared outcomes between MRgFUS and DBS.

Method: We conducted an observational cohort study of patients treated with DBS (2005–2023) or MRgFUS (2017–2023) at a single tertiary Movement Disorders Clinic. Included participants had medication-refractory ET, whereas those with Parkinson’s, dystonic tremor, or bilateral DBS were excluded. Variables collected included age, sex, diagnosis, procedure type and side, hand dominance, and medications. Clinical Rating Scale for Tremor (CRST) total score and subscores (A–C) were recorded at baseline and 1-year follow-up. The primary outcome was the percentage improvement on the treated side (CRST Part A); the secondary outcome was the percentage improvement in total CRST score.

Results: 80 participants were included: 62 (77.5%) male, 18 (22.5%) female; 34 in the DBS group and 46 in the MRgFUS group. The mean age was 64.12 (SD 10.52) in the DBS group and 72.37 (SD 7.53) in the MRgFUS group (p<0.001). Baseline tremor severity was 50.17 total CRST in the DBS group (SD 19.05) and 53.54 in the MRgFUS group (SD 18.24).. Mean improvement on the treated side at 1 year was 92.9% (SD 10.6) with DBS vs. 73.3% (SD 31.5) with MRgFUS (mean difference 19.54; 95% CI 8.98–30.10; p<0.001). Considering both sides (treated and untreated), the mean improvement was 68.90% (SD 23.46) with DBS vs. 43.87% (SD 34.88) with MRgFUS (mean difference 25.03; 95% CI 9.72–40.33; p=0.002). Total CRST improvement was 67.5% (SD 23.09) with DBS vs. 43.9% (SD 20.70) with MRgFUS (p<0.001).

Conclusion: Both unilateral DBS and unilateral MRgFUS produce robust, statistically significant tremor reduction; however, DBS demonstrated greater overall improvement. Reasons may include DBS programming optimization, differences in patient age, or targeting between DBS and MRgFUS lesioning.

References: 1. Sharma S, Pandey S. Treatment of essential tremor: current status. Postgrad Med J. 2020;96(1132):84-93. doi:10.1136/postgradmedj-2019-136647
2. Okelberry T, Lyons KE, Pahwa R. Updates in essential tremor. Parkinsonism Relat Disord. 2024;122(1):106086. doi:10.1016/j.parkreldis.2024.106086
3. Aderinto N, Abraham IC, Olatunji G, Kokori E, Yusuf IA, Isarinade DT. The Efficacy of Deep Brain Stimulation in the Treatment of Essential Tremor: A Systematic Review. Current Treatment Options in Neurology 2025 27:1. 2025;27(1):19-. doi:10.1007/s11940-025-00831-z
4. Elias WJ, Lipsman N, Ondo WG, et al. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. New England Journal of Medicine. 2016;375(8):730-739. doi:10.1056/nejmoa1600159

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparing-deep-brain-stimulation-and-mri-guided-focused-ultrasound-thalamotomy-for-essential-tremor-a-single-center-1-year-observational-study/