A guide to choosing the right treatment for essential tremor and Parkinson’s disease.

If you’re researching advanced treatments for essential tremor, Parkinson’s disease or other movement disorders, two options will appear frequently – Deep Brain Stimulation (DBS) and MR-guided focused ultrasound (MRgFUS).

While both treatments are highly effective, they differ in important ways, especially in invasiveness, adjustability, long-term results and suitability for specific symptoms.

This guide breaks down everything you need to know about Deep Brain Stimulation v MRgFUS, helping you understand how each treatment works and which option may be best for you.

What Is Deep Brain Stimulation (DBS)?

DBS is a surgical procedure where electrodes are implanted into specific brain regions. These electrodes are connected to a small battery (similar to a pacemaker), which is placed under the skin in the chest. The system delivers electrical stimulation to regulate abnormal brain signals.

How DBS works

DBS involves a surgical procedure in which electrodes are implanted into specific areas of the brain responsible for movement control. These electrodes are connected to a programmable pulse generator and placed under the skin in the chest, which delivers controlled electrical impulses to regulate abnormal brain activity. One of the key advantages of DBS is its adjustability. Doctors can fine-tune the stimulation settings over time to match changes in symptoms or disease progression. Because of this flexibility, DBS is effective for a wide range of Parkinson’s symptoms, extending far beyond tremor alone.

Conditions treated

DBS is used to treat several neurological conditions, most commonly Parkinson’s disease, where it helps manage tremor, stiffness and movement difficulties. It is also highly effective for essential tremor, especially when medications are no longer effective or inappropriate. In addition, DBS is an established treatment for dystonia, helping reduce involuntary muscle contractions. In specialised centres like Queen Square, it may also be used for certain forms of epilepsy and obsessive-compulsive disorder (OCD) when other therapies have not provided relief.

What Is MRgFUS? (MR-Guided Focused Ultrasound)

MRgFUS is a non-invasive procedure that uses high-intensity focused ultrasound waves to create a precise lesion in a targeted area of the brain. MRI imaging is used throughout the procedure to ensure accuracy.

How MRgFUS works

MRgFUS is a completely non-invasive procedure, meaning there are no incisions, no drilling and no implanted hardware. During the treatment, MRI technology is used to map the brain in real time, ensuring exceptional precision and safety. Focused ultrasound energy is then directed at a specific target within the brain, heating and destroying the small area responsible for generating tremor. Because of its accuracy and immediate effect on the targeted tissue, many patients experience noticeable symptom relief straight away.

Further enhancement of this process was the subject of a recent study by Queen Square’s world-leading neurosurgeons, published in The BMJ Neurology Open, which marks the first clinical use of FAT1 imaging to guide MRgFUS. Traditionally, clinicians have relied on generalised brain maps to estimate the location of the target area deep within the brain – the Ventral Intermediate Nucleus (Vim) – which is extremely small and hard to visualise on standard MRI scans. FAT1 imaging overcomes this by giving surgeons a clear, direct view of the individual patient’s Vim, enabling treatment to be far more precise.

Conditions treated

MRgFUS is primarily used to treat essential tremor, especially in cases where medication is no longer effective. It is also an option for individuals with tremor-dominant Parkinson’s disease, offering significant improvement when symptoms are unilateral. In some regions, MRgFUS may also be used to treat select neuropathic pain conditions, depending on local regulatory approval and clinical availability.

DBS v MRgFUS – understanding the key differences

Understanding the differences helps you make an informed decision. However, all patients will need to be assessed for suitability.

 Invasiveness
• DBS: requires surgical implantation of electrodes through a ‘burr hole’ made in the skull.
• MRgFUS: completely incisionless, meaning no cuts in the skin or burr holes required.

Reversibility
• DBS: adjustable and reversible, stimulation can be turned off or modified
• MRgFUS: permanent lesion, not reversible

Adjustability over time
• DBS: fully adjustable – ideal for progressive conditions like Parkinson’s
• MRgFUS: no adjustments possible after the procedure, though re-treatment reamins an option in case of re-occurrence.

Treatment areas
DBS: can treat both sides during one procedure
MRgFUS: Procedure is performed to treat tremor on one side only, typically the dominant side. Treatment of the second side is possible after 6-9 months.

Results timeline
• DBS: improvement builds over programming sessions
• MRgFUS: immediate symptom relief

Recovery time
• DBS: longer recovery due to incisions and implanted hardware, lifetime of aftercare
• MRgFUS: same-day recovery, outpatient procedure

Which treatment is better for you?

Choosing which treatment will work best for you will depend on a variety of factors, including a patient’s condition, goals and medical suitability. At Queen Square, our patients will receive a full assessment to determine suitability. We will also discuss your options in detail to ensure you are fully informed as to the best and most suitable treatment for your individual needs.

MRgFUS may be better for you if:

• You want an incisionless and relatively non-invasive treatment.
• You prefer a one-time procedure
• Your symptoms affect mainly one side
• You want immediate improvement
• You prefer a treatment without implanted hardware
• You have a medical condition that may make you more suited to an outpatient procedure, which does not require anaesthetic.

DBS may be better for you if:

• You need symptom control on both sides
• Your condition is progressive and needs long-term adjustment
• You want a reversible and customisable option
• You have multiple Parkinson’s symptoms beyond tremor
• You don’t mind having implanted hardware

Is MRgFUS as effective as DBS?

For essential tremor and tremor-dominant Parkinson’s, both treatments are highly effective.
However, MRgFUS excels in providing effective tremor control on one side of the body and offers the advantage of a rapid recovery period. In contrast, DBS is generally considered superior for patients who present with more complex Parkinson’s symptoms or who require treatment on both sides, as it allows for more comprehensive management of the disease.

What next?

MRgFUS and DBS are both groundbreaking therapies that provide life-changing results. MRgFUS offers a fast, incision-free solution with immediate tremor relief, while DBS remains extremely effective for long-term, adjustable symptom control, especially for Parkinson’s disease.

Choosing between them depends on your medical profile, lifestyle preferences and long-term treatment goals. Both procedures are NICE-approved and recognised by NHS England.

If you are considering either treatment, it is always best to speak to a neurologist who specialises in movement disorders. At Queen Square Imaging Centre, we have the world’s leading team of neurosurgeons for the MRgFUS procedure and are renowned globally for our highly effective and exceptional care. To learn more or discuss your options, contact us and speak to our friendly team – we’re here to guide you every step of the way.