Older woman knitting with needles

Treatment for Essential Tremors

Community offers a quick, incision-free treatment that improves tremor of the hand. It is based on MR-guided Focused Ultrasound (MRgFUS) technology, which uses high -intensity focused ultrasound guided by Magnetic Resonance Imaging (MRI).

Ultrasound has the capability to pass through skin, muscle, fat and bone without the need for incisions, electrodes or inserted probes. So during the procedure, ultrasound waves pass through the brain without a need for an incision. Ultrasound energy is non-ionizing, meaning the patient is not being exposed to radiation during the procedure.

The whole procedure is conducted inside an MRI imaging scanner so the physician can plan, guide and target the area easily.

Targeting Essential Tremor: Patient Stories

James Johnson, Kathy Kershner and John Wilson came to Community Health Network to receive treatment for essential tremor. Using MR-guided focused ultrasound technology, Jill Donaldson, MD, performs the procedure that will help James and John get relief from the essential tremors they have suffered from for years.

Learn what James, Kathy and John are thinking as they prepare for the incision-free procedure and their impressions upon returning to recovery.

James Johnson

It looks like 15 years ago how I used to sign my name. I think it's a miracle.

Kathy Kershner

I'm going to be able to write my name, and people will be able to read it again.

John Wilson

Once you hold out your hand, it's just amazing to see the result.

Benefits of Guided MRI Treatment

Patients who have undergone the ultrasound procedure have shown an immediate and significant reduction in tremor, resulting in improvement in performing daily activities such as, eating, drinking and writing. Learn more about its benefits in the blog and video below.

Blog: A Steady Future for Essential Tremor Patients

What is Essential Tremor?

Essential Tremor (ET) is a neurological condition that causes uncontrollable shaking of the hands, head and voice. In the initial stages, the tremor is mild, and it progresses over time. In some patients, the severity of the tremor becomes unbearable, interfering significantly with daily activities, such as eating, dressing, writing, etc. Essential tremor is more common in people age 40 and older, but there are many people afflicted at an early age, with diagnoses of patients in their 20’s and even in adolescence.

The cause of essential tremor is still not fully understood, but years of previous surgical work has identified the Vim nucleus of the thalamus in the brain, which can be treated to alleviate the tremor. The thalamus is a structure deep in the brain that coordinates and controls muscle activity.

Symptoms of Essential Tremor

The primary symptoms associated with essential tremor include:

  • Uncontrollable shaking that occurs for brief periods of time
  • Begins gradually, usually on one side of the body
  • Occurs in the hands first, affecting one hand or both
  • Can include a shaking voice or tremor of the head
  • Nodding head
  • Worsening during periods of emotional stress and purposeful movement
  • Balance problems (in rare cases)

Meet the Physician

Jill Donaldson, MD, Neuravive neurosurgeonJill Donaldson, MD, Neurosurgeon

Dr. Donaldson is a board-certified neurosurgeon with interests in spinal disorders, brain tumors, tremors and trigeminal neuralgia. She is specially trained in the MR-guided ultrasound technique to treat essential tremor. For more information about her expertise, please visit her Find a Doctor profile.

Contact Us

This tremor treatment is available at Community Hospital North in Indianapolis, Indiana. To schedule a consultation and learn if it may be right for you, please call 800-708-6068.

Learn more at https://insightec.com/essential-tremor-treatment.

Frequently Asked Questions

Learn more below about patient eligibility and what to expect before, during and after MR-guided ultrasound tremor treatment.

Step-By-Step Guide (PDF)

Treatment Eligibility and Requirements

General requirements include:

  • Patients must have a confirmed diagnosis of essential tremor. Patients will be examined for overall health and severity of tremor to determine eligibility for treatment.
  • Essential tremor patients should have tried at least one medication for essential tremor and found that it does not help and/or has undesirable side effects.
  • Patients must be at least 22 years old.

In general, people who cannot go into an MRI will not be able to go through the treatment. This includes patients with metallic implants, patients who are claustrophobic, and patients who are allergic to contrast agents - a dye used during MR imaging.

  • Since the procedure is done in the bore of the MRI scanner, there is a physical weight limit, which is generally in the range of 300 lbs.
  • If you have any kind of metallic implants, such as pacemakers, neurostimulators, spine or bone fixation devices, total joints, metal clips, screws, etc., you may not be a candidate. Any metallic implants must be non-magnetic to prevent injury to the patient from the MR’s strong magnetic field.
  • If you are not generally healthy enough to withstand the treatment and lie still in the same position for approximately 3 hours, you may not be a suitable candidate for this treatment.
  • If you have had a recent myocardial infarction (heart attack) or have congestive heart failure (fluid around the heart), unstable angina pectoris (chest pain), or spinal conditions, are you should discuss these issues with your doctor.
  • If you have extensive scarring on the scalp, you may not be a good candidate.
  • If you have any tumors inside the skull, you may not be a good candidate.
  • If you are on dialysis, you may not be a good candidate.
  • If you have an active infection or severe hematological, neurological or other uncontrolled disease, you may not be a good candidate.

Please discuss all these conditions with your physician so your doctor can properly evaluate your suitability for this tremor treatment.

Risks and Complications

Overall, the procedure is safe for treating essential tremor. Infrequent complications that have been reported are listed below. You should talk to your doctor about the likelihood of experiencing any of these risks:

  • Short periods of dizziness, pain, headaches or other sensations during treatment, which most often end shortly after treatment.
  • Temporary or permanent sensory effects (tingling) in your fingers or elsewhere in your body. These sensations are typically mild to moderate in intensity and can last as briefly as the length of the sonication or up to several days.
  • Nausea/vomiting. It is unclear if this is related to medications used during the treatment or the procedure itself.
  • Bruising in the area of the IV catheter following the procedure, similar to that experienced after blood draws. Any bruising should resolve on its own within a week.
  • There is also a chance that your tremor may return some months or years post treatment.

Any questions concerning risks and/or complications of the procedure should be discussed with your doctor.

Before, During and After Treatment

Before Treatment

Once you have been evaluated as a suitable candidate, there may be a CT scan scheduled in order to determine if the shape and thickness of your skull are suitable for the Exablate Neuro device. Your entire scalp will be shaved and cleaned. A urinary catheter will be placed in order to drain your bladder during the procedure, and you will likely wear some form of compression stockings during the procedure. You may need to start taking medication to minimize risks of DVT (a blood clot). You will be administered medications for comfort. Most doctors use conscious sedation, which means you are awake during the procedure, but you may feel groggy; you and your doctor will decide which type of sedation is best for you. A stereotactic frame will be attached to your head to prevent any movement of the skull during sonications. A silicon helmet will be placed around the head to allow cool water to circulate, minimizing potential heating near the scalp. Your heart rate, blood pressure and blood oxygen levels will be monitored throughout the procedure.

During the Treatment

You will be moved inside the MR device and will be given a Stop Sonication Button to hold during the procedure. The procedure will be performed from a computer in the room adjoining the MR suite. A series of MR images are taken for the purpose of planning the treatment. Your physician will mark the area to be treated, and low energy sonications will be administered to elicit physiological responses from you in order to ensure they have located the proper spot in the brain.

After each sonication, a neurologist or neurosurgeon will evaluate feedback and given tasks in order to determine the effect of the sonication on the tremor itself. You must remain still throughout the treatment session. The procedure may last anywhere from 1 to 3 hours, depending on the amount of energy that can be focused during each sonication. The time is dependent on many factors associated with the shape and thickness of the your skull.

After Treatment

You will be removed from the MR machine, and the stereotactic frame will be removed. Once you are stable, all the monitoring equipment and catheters will be removed. You will have a final 20-minute MRI scan without a frame and then rest as prescribed by your physician.

You will receive specific discharge instructions from your doctor. Usually nothing is required, although your doctor may recommend over-the-counter pain relief medication. Most patients are able to return to work and normal activities within days.

It is important that you discuss with your doctor ahead of time who will handle your follow-up care. Be sure to arrange follow-up phone calls and/or office visits for after the procedure. You should also know who to contact in case of an emergency after the procedure.