Deep Brain Stimulation DBS vs Focused Ultrasound Which Treatment is Better for Tremors?

Deep Brain Stimulation DBS vs Focused Ultrasound Which Treatment is Better for Tremors?

Tremors can majorly disrupt a person’s daily life. Tremors can make common tasks like drinking from a cup or buttoning a shirt frustratingly difficult. For those suffering from Parkinson’s or other essential tremors, the best initial option may be a combination of several medications. As symptoms at the patient’s treatment goals become more disruptive, and patient-initiated pharmaceutical options become more disruptive, a more advanced therapeutic option may be required.

The two options that are most frequently discussed include MR-guided Focused Ultrasound (MRgFUS) and Deep Brain Stimulation (DBS). Tremors are of similar therapeutic goals, and a greater quality of life from the effects of tremors is the goal of all therapeutic interventions. However, Focused Ultrasound and DBS are options.

Which treatment option is best? The answer ranges from the more of these interventions, the more the patient and the family are willing to invest, to the more the patient is willing to invest.

This patient is suffering from a tremor disorder.

Tremor disorder caused by the involuntary movements of the head and appendicular muscles is commonly seen in the subgroup of the multiple system atrophy disorder.

Essential tremor and Parkinson’s disease share many of the same symptoms.

Symptoms of Essential Tremor

• Shaking hands while writing or causing hands to shake while writing.
• Difficulty holding things steadily.
• Shaking while using your hands.
• Voice tremors.
• Head shaking.

Symptoms of Parkinson’s Disease

• Tremors while at rest.
• Stiff muscles.
• Slow movements.
• Trouble walking.
• Loss of balance.
• Reduced facial expressions.

When symptoms persist despite medication, doctors may recommend advanced tremor treatments, such as Focused Ultrasound or Deep Brain Stimulation.

How Are Tremors Diagnosed?

Before therapy can begin, specialists need to perform evaluations to determine the advanced treatment. This can be broken down into three categories.

1. Neurological Evaluation

The doctor needs to look at things such as tremor severity, coordination and balance, and response to medication.

2. Imaging Studies

The doctor will need a way to see the brain in order to determine if there is a target area to treat and to rule out any other neurological disorders.

3. General Health Evaluation

It is important to know the health of the heart and if there are any issues with blood pressure, diabetes, or cognitive function.

A lot of information is needed to select the most precise treatment option.

What is Deep Brain Stimulation?

During Deep Brain Stimulation, doctors implant thin electrodes into the brain. These electrodes are connected to a battery placed under the skin to treat and control the tremors using wireless brain stimulation.

DBS has been effective for a variety of neurodegenerative disorders for a number of years, including:

• Parkinson’s Disease
• Essential Tremor
• Certain types of Dystonia
• Movement disorders

Advantages of DBS

• Adjustable Treatment
• Doctors have the flexibility to change the DBS settings as needed based on their patients’ developing symptoms.
• Works on Both Sides of the Body
• All patients have tingling on both sides of the body.

In most patients, there is lasting improvement in tremors.

DBS Limitations

• Brain surgery is involved.
• There is a battery to replace under the skin.
• There is a little possibility of infection.
• There is a small chance of bleeding.
• The recovery process is longer compared to the use of other types of technology.

MR-Guided Focused Ultrasound

MR-Guided Focused Ultrasound is an advanced technology which focuses on the area of the brain responsible for tremors using ultrasound waves.

Advantages of Focused Ultrasound

• The use of a scalpel is not involved.
• There is a faster recovery.
• There is a lower chance of an infection.
• Improvement is often seen as a result of the procedure itself.

Limitations of Focused Ultrasound

As DBS is involved in the long-term use of the data.

Recovery Time

Compared to other methods, Focused Ultrasound has a faster recovery time and a shorter hospital stay.

Flexibility

DBS provides change control and flexible settings. Focused Ultrasound creates a permanent lesion, meaning the patient lacks flexibility.

Suitability

For patients who are against traditional surgery or are not able to get surgery, Focused Ultrasound is the ideal option. DBS may be better for younger patients who need a long-term, flexible option.

Tremor Control

Both methods can achieve significant improvements in tremor control in certain patients, and the option that can be chosen can be determined through a medical evaluation.

Which Treatment is Better?

This is also a question that cannot be definitively answered.

DBS is usually better for:

• Younger patients
• Patients with bilateral tremors
• Late-stage Parkinson’s Disease
• Patients with an adjustable long-term need

Focused Ultrasound is generally better for:

• Patients with a treatment preference for the surgery to be avoided
• Older patients
• Patients who are not able to undergo surgery
• Patients with tremors that are not responsive to medication

The final choice should depend solely on the assessment and opinion of a trained specialist.

Recovery and Long-term Result

Recovery After DBS

The recovery is more extensive and tumbles with the surgery since the device needs the patient to be programmed multiple times, along with the follow-ups.

Recovery After Focused Ultrasound

Activity can be resumed relatively quickly, even post-surgery, since the recovery is in the days and no extensive follow-up is to be expected, but there’s the possibility of the patient complaining about temporary imbalance and/or tingling.

Both procedures post-surgery can have a tremendous improvement for the patient if the surgery is suitable for the respective patient.

Conclusion

Deep Brain Stimulation (DBS) and MR-guided Focused Ultrasound have been emerging technologies in the treatment options for the tremors associated with Essential Tremor and Parkinson’s disease. DBS has the benefit of being a well-established technique that is adjustable, and chronic symptom control is achievable. Focused Ultrasound as an alternative therapy is not only non-invasive and novel but also offers a rapid recovery.

Treatment selection will be dependent on the combination of symptom burden, age and health of the patient, personal considerations and the objectives for the treatment. An accurate diagnosis, in combination with an experienced neurologist, is necessary to select both of these options.

Patients with tremor disability ought to talk to a qualified movement disorders clinician about the options best suited for their illness.

Frequently Asked Questions

1. Is Focused Ultrasound safer than DBS?
Focused Ultrasound is non-invasive and does not involve surgical cuts, and may avoid some of the risks associated with surgery, which are related to DBS.

2. Will both DBS and Focused Ultrasound treat tremors and completely cure it?
Both modalities will greatly reduce tremors but will not completely cure the underlying neurodegenerative disease.

3. Which has faster treatment recovery — DBS or Focused Ultrasound?
Focused Ultrasound has a quicker recovery because it is a surgery that does not require incisional refurbishment.