{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:50:12Z","timestamp":1791366612523,"version":"4.3.1"},"reference-count":60,"publisher":"Georg Thieme Verlag KG","issue":"08","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The high-intensity focused ultrasound (HIFU) technique has become precise, incisionless, and ablative for treating essential tremor (ET) and Parkinson's disease (PD), driven by advances in magnetic resonance imaging (MRI) thermometry and tractography. The current review integrates the main clinical outcomes associated with established and emerging HIFU targets, synthesizing efficacy data, adverse effect (AE) patterns, and procedural characteristics relevant to clinical decision-making. In ET, ventral intermediate nucleus (VIM) thalamotomy results in tremor reductions ranging from 56 to 81%, with a long-term sustained benefit of approximately 73%. In tremor-dominant PD (TdPD), VIM ablation achieves tremor suppression of approximately 62%. Comparatively, HIFU-guided subthalamotomy provides broader motor benefits, with 53 to 57.8% improvement in the Movement Disorder Society's Unified Parkinson's Disease Rating Scale, Part III (MDS-UPDRS III), as well as significant reductions in rigidity and bradykinesia. Pallidotomy improves \u201coff\u201d state motor symptoms and dyskinesias, whereas pallidothalamic tractotomy leads to 52% global motor improvement and 91% tremor reduction. The AEs vary according to the targets. In VIM procedures, gait imbalance (16\u201340%) and sensory disturbances (9\u201326%) predominate, along with dysarthria and dysmetria. Lesions to the subthalamic nucleus (STN) are most commonly associated with dysarthria (10\u201326%) and gait instability (15\u201348%). Procedures targeting the globus pallidus internus (GPi) or pallidothalamic tract (PTT) may also present with gait instability or dysarthria, which are generally mild and transient. Although the SDR has historically limited eligibility, recent evidence demonstrates that patients with SDR \u2264 0.40 may still experience meaningful improvement, supporting more individualized selection. In the current therapeutic landscape, HIFU offers immediate clinical benefits, absence of implanted hardware, and simplified recovery, positioning it as an alternative or complementary therapy to deep brain stimulation (DBS).<\/jats:p>","DOI":"10.1055\/s-0046-1827056","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:19:04Z","timestamp":1786663144000},"page":"001-013","source":"Crossref","is-referenced-by-count":0,"title":["The emerging role of high-intensity focused ultrasound (HIFU) as a symptomatic treatment for Parkinson's disease and essential tremor: a narrative review"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5306-6908","authenticated-orcid":false,"given":"Karina Silveira","family":"Massruha","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Dist\u00farbios do Movimento, S\u00e3o Paulo SP, Brazil."},{"name":"Einstein Hospital Israelita, Departamento de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4279-9634","authenticated-orcid":false,"given":"Ananda Carolina Moraes de","family":"Falcone","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Dist\u00farbios do Movimento, S\u00e3o Paulo SP, Brazil."},{"name":"Einstein Hospital Israelita, Departamento de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4709-8952","authenticated-orcid":false,"given":"Isadora Santos","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Dist\u00farbios do Movimento, S\u00e3o Paulo SP, Brazil."},{"name":"Einstein Hospital Israelita, Departamento de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3565-5328","authenticated-orcid":false,"given":"Jacy Bezerra","family":"Parmera","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Dist\u00farbios do Movimento, S\u00e3o Paulo SP, Brazil."},{"name":"Einstein Hospital Israelita, Departamento de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7200-2289","authenticated-orcid":false,"given":"Polyana Vulcano de Toledo","family":"Piza","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita, Departamento de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1968-9595","authenticated-orcid":false,"given":"Rodrigo Gobbo","family":"Garcia","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita, Centro de Medicina Intervencionista, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5542-4527","authenticated-orcid":false,"given":"Ellison Fernando","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita, Departamento de Imagem, S\u00e3o Paulo SP, Brazil."},{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Instituto de Radiologia, Departamento de Neurorradiologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6918-6865","authenticated-orcid":false,"given":"Luis Filipe de Souza","family":"Godoy","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita, Departamento de Imagem, S\u00e3o Paulo SP, Brazil."},{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Instituto de Radiologia, Departamento de Neurorradiologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1785-3330","authenticated-orcid":false,"given":"Stephany Tueini","family":"Toogood","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita, Departamento de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6835-2558","authenticated-orcid":false,"given":"Anna Verena de Carvalho","family":"Leite","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita, Departamento de Neurologia, S\u00e3o Paulo SP, 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