Living with a tremor (as the result of a life-long essential tremor or a tremor that has developed as the result of Parkinson’s disease) can have a significant impact on your confidence and ability to carry out everyday tasks. While medications are the first line treatment for managing tremor symptoms, when these avenues no longer provide desired relief or can’t be tolerated, other options may be able to help.
“Deep brain stimulation (DBS) and high-intensity focused ultrasound (HIFU) are two additional options we have for helping patients manage their tremors,” says Efstathios Kondylis, M.D., a neurosurgeon at Henry Ford Health. “A neurosurgeon can work with you to determine which option may work best for your symptoms.”
Here, Dr. Kondylis explains the difference between these two treatment options – weighing the pros and cons of each.
Deep Brain Stimulation: Customizable Tremor Treatment
Deep brain stimulation (DBS) is perhaps the most well-known treatment option for tremors. With this treatment, patients undergo a two-part surgery to have electrodes surgically placed in the brain and a neurostimulator in the chest, respectively. After the procedure, follow up appointments with your treatment team will allow them to program the device for tremor relief.
“Since this procedure requires surgery, an ideal candidate would have to be evaluated to see if undergoing surgery would be a safe option,” saw Dr. Kondylis. “And, as time goes on, your device’s batteries will need to be changed.”
However, while this option may seem more invasive, the silver lining is that DBS devices are adjustable. So, as your tremors worsen or change over time, the DBS device can be reprogrammed for continued relief.
High-Intensity Focused Ultrasound: Same-Day Tremor Relief
High Intensity Focused Ultrasound (HIFU) uses sound waves to treat the area of your brain that causes tremors. During this procedure, a frame is placed on the patient’s head as they lay in an MRI machine. High powered sounds waves are then used to create a lesion in the part of the brain causing the tremors, allowing patients to have immediate improvement to their condition after treatment.
“HIFU treatment does require patients to have their head shaved and lay in an MRI machine for an extended period of time,” says Dr. Kondylis. “Still, many patients are attracted to the idea of HIFU because it offers a non-invasive, incision-free treatment for tremors.”
Deciding Which Treatment Option Is Best For You
Once you have had your tremor diagnosed and have been referred to a neurosurgeon, there are many factors that influence which of these treatment options might be right for you. This might include:
- Age: “Patient’s age is a risk that has to be considered when discussing surgery,” says Dr. Kondylis. Your age may be a limiting factor for DBS, but there is no upper age limit in place for HIFU.
- Tremor type: Whether you have an essential tremor or tremors related to Parkinson’s disease may dictate the type of treatment your neurosurgeon recommends. For example, because Parkinson’s disease is degenerative, tremors can get worse over time. In these instances, DBS may be the preferred option since its settings can be adjusted.
- Mobility: HIFU may cause imbalance, though this is usually temporary. Patients with existing mobility issues who are considering HIFU should be prepared for the possibility that they could need some extra help getting around for several weeks or months after the procedure.
- Physical health: Additionally, your physical ability (beyond your age) may impact how well you can tolerate these procedures. For example, HIFU treatment may not be suitable for people who struggle to breath while laying down or are claustrophobic.
Treatment Options For Movement Disorders
Like with any major medical procedure, these treatment options are not without their risks. With both procedures, patients are likely to experience numbness or balances issues immediately following. (Most of these symptoms will clear up in the months follow your treatment.)
“Many providers have different philosophies on the use of DBS or HIFU for tremor treatment,” says Dr. Kondylis. “In all cases, a multidisciplinary team will evaluate your symptoms before considering which surgical option would be best for your case.”
Reviewed by Dr. Efstathios Kondylis, a neurosurgeon who sees patients at Henry Ford Hospital.
