This April, during Parkinson’s Awareness Month, patients living with disabling tremors have a non-surgical option that most have never heard of, and HIFU for Parkinson’s disease may be the reason.
For patients living with tremor-dominant Parkinson’s disease, the shaking often becomes the most disabling part of their condition. Holding a cup, writing, using a phone, and performing simple daily tasks become difficult or impossible. Medication helps many patients, but not always completely, and adjusting doses over time creates its own complications.
The question that brings many patients into a neurosurgeon’s office: is there anything that treats the tremor itself, without brain surgery?
What HIFU Is, and How It Targets Parkinson’s Tremors
High-intensity focused ultrasound, or HIFU, uses precisely targeted sound waves to create a small, controlled change in a region of the brain called the thalamus. The thalamus acts as a relay station for signals, and in patients with Parkinson’s tremor, it sends abnormal signals that produce the shaking. HIFU interrupts that circuit.
The procedure is performed inside an MRI scanner, which gives the care team real-time brain imaging throughout. No incisions are made, and no device is implanted. Patients remain awake so they can provide feedback during targeting, which allows the surgeon to confirm the tremor is responding before the final treatment is applied.
The FDA cleared HIFU for tremor-dominant Parkinson’s disease in 2018, following approval for essential tremor in 2016. The underlying technique is called a thalamotomy: the creation of a precise lesion in the ventral intermediate nucleus of the thalamus that permanently disrupts the abnormal tremor signal. It does not reverse Parkinson’s disease, and it does not address other Parkinson’s symptoms such as rigidity, gait changes, or cognitive changes. It targets tremor specifically.
Who Is a Candidate for HIFU, and Who Is Not
HIFU is not a fit for every patient with Parkinson’s disease. It works best for patients whose primary disabling symptom is tremor, specifically patients whose tremor has not responded adequately to medication, or whose medication side effects have become a problem on their own.
The procedure treats one side of the body at a time. A patient whose right hand shakes is a candidate for treatment on the left side of the thalamus, which controls the right side of the body. Bilateral treatment, meaning both sides, requires a staged approach and a careful evaluation of risks and benefits by the treating neurosurgeon.
Not every skull is suitable for focused ultrasound. The density and thickness of the skull bone affects how well the sound waves can be focused on the target. Pre-procedure imaging identifies this early, so patients find out during evaluation whether HIFU is technically feasible for them.
Conditions that may disqualify a patient include unstable cardiac disease, prior surgery at the target site, significant cognitive impairment, and certain skull characteristics. A fellowship-trained functional neurosurgeon evaluates each patient individually before any recommendation is made.
What to Expect on the Day of the Procedure
The procedure begins with a lightweight stereotactic frame fitting. The frame stabilizes the head during imaging and treatment. Patients then move into the MRI suite, where the Exablate Neuro system, the FDA-cleared focused ultrasound device, is positioned around the head.
Treatment is delivered in stages. The care team starts with low-energy test pulses and monitors how the patient’s tremor responds. Between pulses, patients are asked to hold a cup, draw a spiral, or perform simple movements. This real-time feedback is what distinguishes HIFU from procedures done under general anesthesia: the surgeon can see, in the moment, whether targeting is accurate and whether improvement is occurring.
The full procedure takes two to two and a half hours. Patients are discharged the same day. Tremor improvement is often immediate. Patients notice a difference before they leave the building.
Recovery can involves a few days of mild fatigue or unsteadiness. Most patients return to normal daily activity within one to two weeks. The improvement in the treated area is often long-term.
How NJBS Approaches HIFU for Parkinson’s Patients
NJBS operates a dedicated Movement Disorders Center, where fellowship-trained neurosurgeons and neurologists evaluate and treat patients with Parkinson’s disease, essential tremor, and related conditions. Dr. Hooman Azmi, one of our functional and restorative neurosurgery experts at NJBS, specializes in the surgical treatment of Parkinson’s disease and movement disorders, including both HIFU and deep brain stimulation.
The practice’s conservative-first approach applies here. HIFU is considered after a thorough review of medication options, dosing adjustments, and other non interventional options.. When tremor remains disabling despite those efforts, the conversation about a procedure begins. For patients who qualify, HIFU offers something most interventions cannot: meaningful tremor relief without a single incision.
That is the purpose of Parkinson’s Awareness Month: making sure patients know what options exist before they stop asking.
Frequently Asked Questions
Is HIFU a cure for Parkinson's disease?
Can HIFU be repeated if the tremor returns?
How does HIFU compare to deep brain stimulation?
What does recovery look like after HIFU?
Is HIFU covered by insurance?
Take The Next Step
If you or someone you care for is living with Parkinson’s tremors that have not responded fully to medication, a consultation with an NJBS functional neurosurgeon is a reasonable next step.
NJBS serves patients across northern New Jersey and the greater tri-state area, with offices in Paramus, Hackensack, Montclair, Montvale, Annandale, and Englewood. No referral is required to schedule a consultation.
