Deep brain stimulation and magnetic resonance–guided focused ultrasound for essential tremor: a meta-analysis of effectiveness and safety

We compared the effectiveness and safety of deep brain stimulation (DBS) and magnetic resonance-guided focused ultrasound (MRgFUS) in patients with essential tremor (ET). A comprehensive search was conducted across four databases (Web of Science, Scopus, PubMed, and Cochrane CENTRAL) till June 2025. Clinical trials and observational studies comparing DBS and MRgFUS in patients with ET were included. Meta-analysis was performed using RevMan version 5.4 and OpenMetaAnalyst, applying a random-effect model. Five cohort studies (463 patients) were included. In the total Clinical Rating Scale for Tremor (CRST) score, there was a significant difference between the two groups favoring DBS (mean difference (MD): 5.12, 95% confidence interval (CI): [1.08, 9.16], P = 0.01), while in part A of the CRST, there was no significant difference (P = 0.15). No significant difference was found between the two groups in response rate as well (P = 0.56). Paresthesia (13.3% vs. 2.2%; risk ratio (RR): 4.57, 95% CI: [1.31, 15.94], P = 0.02), gait instability (26.56% vs. 4.06%; RR: 2.85, 95% CI: [1.14, 7.08], P = 0.025), and dysphagia (7.77% vs. 1.37%; RR: 3.40, 95% CI: [1.01, 11.46], P = 0.049) were significantly more frequent in the FUS group compared with DBS. Other serious but rare adverse events (AEs), such as infection and hemorrhage, were more common in the DBS group, but none significantly differed between the two groups. Both DBS and MRgFUS showed similar response rates; however, DBS may provide greater improvement in the total CRST score, potentially due to the comparison of bilateral DBS against predominantly unilateral MRgFUS. Regarding safety, MRgFUS was more associated with sensory and motor AEs, while infrequent but potentially serious complications were only reported with DBS. Future high-quality prospective studies with larger sample sizes and longer follow-up periods are needed.