Dr. Dolhun Explains Deep Brain Stimulation and Focused Ultrasound as Treatments for Parkinson’s

Rachel Dolhun, MD, DipABLM, is a movement disorder specialist, lifestyle medicine physician and principal medical advisor at MJFF.

The following story appeared in our Fall/Winter 2024 edition of The Fox Focus on Parkinson's newsletter. For this story and more, download the full edition.

When medication is not enough to ease the tremors, slowness and stiffness of Parkinson's disease (PD), your doctor might recommend a surgical treatment. These include deep brain stimulation (DBS) and MRI-guided focused ultrasound (FUS).

DBS involves placing thin electrodes in the brain. These are connected to a programmable stimulator that is placed under the skin in the chest. The device delivers electrical impulses to areas of the brain that control movement. FUS works in the same areas of the brain but uses ultrasound energy to destroy cells that control movement. DBS was FDA approved for Parkinson's in 1997 and FUS in 2018.

DBS and FUS for Symptom Relief

Neither DBS or FUS is a cure for Parkinson's. But both can ease tremor, slowness, stiffness and extra movement (dyskinesia) or muscle spasms (dystonia). They also may give more time without symptoms ("on" time) and smooth ups and downs in symptoms (motor fluctuations). In general, neither provide relief for non-motor symptoms, freezing of gait or imbalance.

DBS and FUS are most effective in people who benefit from levodopa but have side effects or complications like dyskinesia, "off" time (when symptoms return) or motor fluctuations. But they also can help people who have tremor that does not respond to medication.

Following both DBS and FUS, many people are able to decrease or discontinue medications, at least for some time.

Distinctions Between DBS and FUS

DBS and FUS differ in technique, benefits and side effects.

Differences in Technique

DBS requires incisions and placement of wires and a battery ("hardware") that stay in place as long as you have the device. DBS needs regular programming to find personalized settings that maximize benefit and limit side effects and to balance settings with medication. It also requires battery maintenance and replacement over time.

With FUS, there are no incisions or placement of medical devices. It is a one-time procedure.

Differences in Benefits

DBS is reversible by removing or disabling the system. DBS can be done on one or both sides of the brain to ease symptoms on both sides of the body. Benefits may last 10 to 15 years or more.

FUS provides immediate symptom relief. It is permanent and irreversible, as may be any related side effects. FUS can currently only be done on one side of the brain, so it eases symptoms for only side of the body. FUS may last five years or more; longer-term studies are currently limited due to the relative newness of the procedure.

Over time, both treatments may feel less effective as motor symptoms increase or new, especially non-motor, symptoms arise.

Differences in Side Effects

DBS has low risks of infection, bleeding, stroke and seizure. It can cause numbness, tingling, speech changes and other symptoms, but these may be eased or eliminated with programming adjustments.

FUS has a lower risk of infection or bleeding, but can cause slurred speech, unsteadiness and other symptoms.

Choosing the Right Treatment

Only you, your loved ones and your care team can decide which is best for you. Consider these tips:

• Gather information about all potential treatments. MJFF offers several resources on deep brain stimulation and focused ultrasound.
• Discuss your symptoms with a movement disorder specialist and neurosurgeon and ask whether you are a better candidate for DBS or FUS.
• Chat with others who've had these procedures. Ask why they chose DBS or FUS, about their experience and what they wish they would have known. Connect through support groups or online forums, such as MJFF's Parkinson's Buddy Network.

Visit michaeljfox.org/ask-the-md to learn more about living well with Parkinson's and recent Parkinson's research topics.

The medical information contained in this newsletter is for general information purposes only. The Michael J. Fox Foundation for Parkinson's Research has a policy of refraining from advocating, endorsing or promoting any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment decisions related to Parkinson's disease and any other medical condition be made in consultation with a physician or other qualified medical professional.

• Rachel Dolhun, MD, DipABLM

  Principal Medical Advisor