Home Diseases and Conditions Essential Tremor

Essential Tremor

Last Updated:
Development Stage

Early Stage

Focused ultrasound research is in the laboratory phase and is not yet available for patients.

Clinical Trials

Focused ultrasound for this condition is being researched in clinical trials.

International Approval

Focused ultrasound is approved to treat this condition outside the US. Patients can seek commercial treatment at participating international sites.

FDA Approved

The US Food and Drug Administration has approved focus ultrasound for this condition. Patients can seek commercial treatment at participating sites.

Early Stage

Clinical Trials

International

FDA Approved

Focused ultrasound is cleared to treat this condition both within and outside the US. Patients can seek commercial treatment at participating sites. There are also clinical trials that may be of interest to patients.

Essential tremor (ET) is the most common movement disorder, affecting an estimated 3% of the population, or approximately 10 million individuals in the United States. ET is commonly viewed as a relatively benign disease.

However, the associated disabling aspects of ET, such as significant tremor of the hands, can impair patients’ ability to eat, shave, write, perform household activities, and function in the workplace.

The underlying etiology of ET is unclear, but cases often run in families (familial tremor). It has been estimated that approximately 50% of all cases are due to a genetic mutation, and the pattern of inheritance is most consistent with autosomal dominant transmission (i.e. dominant trait).

Focused Ultrasound Therapy

Focused ultrasound is a noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with essential tremor. This novel technology focuses multiple beams of ultrasound energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue.

How it Works
Where the focused ultrasound beams converge, they produce precise ablation (thermal destruction of tissue), enabling ET to be treated noninvasively. The primary target is a region in the thalamus called the ventral intermediate nucleus (Vim), but other adjacent targets and white matter pathways are also in use.

Advantages

  • It is a noninvasive, single treatment that enables patients to recover rapidly and quickly return to activities of normal life (usually the next day).
  • Compared to RF ablation or DBS, focused ultrasound offers a reduced risk of infection, of damage to the non-targeted area, and of blood clot formation.
  • Focused ultrasound offers rapid resolution of symptoms.
  • In contrast to lesioning performed with stereotactic radiosurgery, focused ultrasound does not use ionizing radiation, thus avoiding the side effects of exposure to radiation.
  • Because it is non-invasive, focused ultrasound could be an option for medically refractory ET patients (those who do not respond well to medication) who do not want to undergo surgery.

Clinical Trials

A clinical trial in Toronto, Ontario, Canada is using low intensity focused ultrasound to impact patients with multiple types of disorders, including many types of tremors, dystonia, epilepsy, and addictive substance abuse conditions.  

A clinical trial in Europe is using focused ultrasound to treat patients with bilateral tremor.  

A clinical trial is recruiting patient for 3-D tractography targeting for essential tremor.

A clinical trial is using transcranial ultrasound to treat essential tremor in the USA.

There is a clinical trial in Toronto Western Hospital recording intracranial measurement for patients with treatment for movement disorders.

There is a second clinical trial in Toronto, evaluating the clinical outcomes for patients treated for essential tremor.  

A clinical trial in Taiwan is treating patients with refractory essential tremor, Parkinson’s disease tremor or dystonia using focused ultrasound.  

There is a clinical trial in China for patients with a reduced SDR.

The Foundation updates these pages regularly, but with the increasing number of clinical trials, we want to be sure that our audience has the latest information available. Therefore, we also added the website search information for the above trials. If you click here, it will take you to the latest information available from https://www.clinicaltrials.gov/. 

Treatment Sites

Please see a list of possible treatment sites here.

Regulatory & Reimbursement

The Exablate system manufactured by Insightec earned FDA approval to treat essential tremor in July 2016. It is also approved for treating essential tremor in Europe, Korea, Canada, Japan, Russia, Taiwan, and the Middle East. 

The FDA approved staged bilateral treatment for essential tremor on December 20, 2022. Treatments are approved for the second side at least 9 months after the initial treatment.

In the US, all treatment sites have been approved for payment under Medicare.

Commercial coverage and Medicaid will typically follow Medicare but should be evaluated with each company and region. Some facilities have a cash payment option, for those who are not willing to wait for insurance decisions for payment. Prices vary, but a rough estimate is $40,000.

Device manufacturer, Insightec has established an informational website, including patient stories and access to treatment site information. They have also set up a Reimbursement Support Manager, who can help with questions about the status of reimbursements. Her contact information is: Kim Martin, Reimbursement Support Manager, 1-(866) 392-8478.

Additional Information 

Notable Papers

Suggested Reading: Focused Ultrasound: Transforming treatment of Neurodegenerative Diseases August 2022

Suggested Reading: Focused Ultrasound for Essential Tremor Market Study (2021)

Suggested Reading: Focused Ultrasound for Essential Tremor Market Study (2021) 

Kim YJ, Chen J, Rolston J, Cosgrove G. 1607 Bilateral Magnetic Resonance Imaging-Guided Focused Ultrasound Thalamotomy: Outcomes in a Large, Prospective Cohort. Neurosurgery. 2026 Apr 1;72(Supplement_1):195. doi: 10.1227/neu.0000000000003964_1067. PMID: 41837689 

Paio F, Bulgarelli G, Tagliamonte M, Bovi T, Longhi M, Nicolato A, Sala F, Petralia B, Bonetti B, Tinazzi M, Ricciardi GK, Tamburin S. How do we FUS? Peri-procedural management of magnetic resonance-guided focused ultrasound: An EMEA regional survey. Parkinsonism Relat Disord. 2026 Mar 12;146:108284. doi: 10.1016/j.parkreldis.2026.108284. PMID: 41844501 

Bruno F, Saltarelli G, Di Cerbo G, Innocenzi A, Di Terlizzi S, Sucapane P, Cerone D, Catalucci A, Palumbo P, Arrigoni F, Barile A, Di Cesare E, Pistoia F, Splendiani A. Temporal muscle thickness on brain MRI as a surrogate marker of sarcopenia and treatment response in tremor patients undergoing MRgFUS thalamotomy. Neuroradiol J. 2026 Apr;39(2):247-253. doi: 10.1177/19714009251362817. Epub 2025 Jul 27. PMID: 40717041 

Manorenj S, Kumar SS. Magnetic Resonance-Guided Focused Ultrasound (MRgFUS) for Movement Disorders: A Practical Guide for Neurologists. Neurol India. 2026 Mar 1;74(2):184-193. doi: 10.4103/neurol-india.Neurol-India-D-25-00354. Epub 2026 Mar 11. PMID: 41817057 

McDannold N, Chua MMJ, Blitz S, White PJ, Fletcher SM, Oliveira TR, Rolston JD, Cosgrove GR. Predicting tremor control and side effects during focused ultrasound thalamotomy using MR temperature imaging. J Neurosurg. 2026 Mar 13:1-14. doi: 10.3171/2025.10.JNS251763. PMID: 41825071 

Hamani C, Elias WJ, Baltuch GH, Gross RE, Rosenow JM, Schwalb JM, Air EL, Machado AG, Sweet J, Willie JT, Rolston JD, Englot DJ, Lipsman N, Zemmar A, Neimat JS, Cosgrove GR, Asaad WF, Ali R, Pilitsis JG, Danish SF. Magnetic resonance-guided focused ultrasound for the management of tremor: update on the position statement of the American Society for Stereotactic and Functional Neurosurgery. J Neurosurg. 2026 Mar 27:1-9. doi: 10.3171/2025.11.JNS251828. PMID: 41894813 

Tisch S. Focussed ultrasound thalamotomy and functional MRI as windows to neural networks underlying essential tremor. Neurotherapeutics. 2026 Mar 27:e00893. doi: 10.1016/j.neurot.2026.e00893. PMID: 41904108 

Yuen J, Khayat H, Fakhroo FA, Buongermini R, Germann J, Boutet A, Fasano A, Lozano AM. Is it safe to have Deep Brain Stimulation after MRI-guided focused ultrasound ablation? A report of three cases and review of literature. Stereotact Funct Neurosurg. 2026 Mar 6:1-17. doi: 10.1159/000551355. PMID: 41790583 

Sabet H, Abbas A, Salama EY, AbuHamdia A, El-Moslemani M, Aldehri M, Alnaami I. Deep brain stimulation and magnetic resonance-guided focused ultrasound for essential tremor: a meta-analysis of effectiveness and safety. Neurosurg Rev. 2026 Mar 9;49(1):264. doi: 10.1007/s10143-025-04076-x. PMID: 41801476 

Venkatesan S, Sorrentino Z, Mampre D, Chandra V, Hilliard J. Contemporary and evolving perspectives on surgical therapies for essential tremor: deep brain stimulation and focused ultrasound. Expert Rev Neurother. 2026 Mar 11:1-18. doi: 10.1080/14737175.2026.2642844. PMID: 41814782 

Paio F, Ricciardi GK, Bulgarelli G, Tagliamonte M, Mantovani E, Zucchella C, Bovi T, Longhi M, Lombardi Z, Polloniato PM, Zivelonghi E, Cavedon C, Montemezzi S, Nicolato A, Sala F, Petralia B, Bonetti B, Tinazzi M, Tamburin S. Staged Bilateral Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor: Prospective Single-Centre Cohort and Systematic Review With Meta-Analysis. Eur J Neurol. 2026 Apr;33(4):e70535. doi: 10.1111/ene.70535. PMID: 41914664 

Sastre-Bataller I, Conde-Sardón R, Campins-Romeu M, Morata-Martínez C, Baviera-Muñoz R, Pérez-García J, Losada-López M, Ibáñez-Juliá MJ, León-Guijarro JL, Lozano AM, Gutiérrez-Martín A, Martínez-Torres I. Magnetic resonance-guided focused ultrasound thalamotomy in essential tremor subtypes: a phenotype-based insight into gait and balance. Brain Commun. 2026 Mar 11;8(2):fcag076. doi: 10.1093/braincomms/fcag076. eCollection 2026. PMID: 41907317 

Nguyen NC, Asturias A, Feltrin FS, Oz OK, Shah BR. Chronic Alteration in Cerebral FDG Metabolism After MRI-guided HIFU for Essential Tremor: A Clinical Case With PET and MRI Correlation. Clin Nucl Med. 2026 Mar 1;51(3):e174-e176. doi: 10.1097/RLU.0000000000005987. Epub 2025 May 19. PMID: 40392117 

Muraki T, Matsuzawa H, Kawabori M, Narita T, Kobayashi H, Terasaka S, Fujimura M. Bayesian probabilistic density mapping of the decussating dentato-rubro-thalamic tract to predict clinical tremor improvement in MRgFUS. J Neurosurg. 2026 Feb 13:1-9. doi: 10.3171/2025.9.JNS251021. PMID: 41687107 

Liu J, Krauss J, Purrer V, Borger V, Essler M, Radbruch A, Wüllner U, Upadhyay N, Boecker H. Functional network reorganization following VIM-MRgFUS for essential tremor. Neurotherapeutics. 2026 Feb 27:e00864. doi: 10.1016/j.neurot.2026.e00864. PMID: 41764014 

Mei CS, Zong S, Madore B, Cosgrove GR, McDannold NJ. Focus correction in MR thermography for increased targeting precision during focused ultrasound procedures. Magn Reson Med. 2026 Feb;95(2):951-961. doi: 10.1002/mrm.70089. Epub 2025 Sep 24. PMID: 40991818 

Chavira-Hernandez G, Fasano A. Current Approach to Surgical Management of Tremor Disorders. Semin Neurol. 2026 Feb 6. doi: 10.1055/a-2789-0271. PMID: 41539330 

Abe K, Hori H, Hori T, Taira T. Focused ultrasound therapy for neurological disease. J Med Ultrason (2001). 2026 Jan 28. doi: 10.1007/s10396-025-01602-8. PMID: 41606354 

Jameel A, Smith J, Akgun S, Bain P, Nandi D, Jones B, Quest R, Gedroyc W, Yousif N. Creation and clinical utility of a 3D atlas-based model for visualising brain nuclei targeted by MR-guided focused ultrasound thalamotomy for tremor. Biomed Phys Eng Express. 2026 Jan 21;12(1). doi: 10.1088/2057-1976/ae356f. PMID: 41505797 

Tashiro N, Yasaka M, Miyagi Y. Delayed dysgeusia in five patients following MRI-guided focused ultrasound surgery targeting the ventral intermediate nucleus of the ‍thalamus for essential tremor. Rinsho Shinkeigaku. 2026 Jan 14. doi: 10.5692/clinicalneurol.cn-002149. PMID: 41535001 

Monteiro JDS, de Oliveira RR, Gonçalves OR, Silva BBE, Paula IDR, Oliveira Machado Pereira MA, Lima DS, Parmera JB, Cury RG, Mota Telles JP. Magnetic resonance-guided focused ultrasound for essential tremor patients with low skull density ratio: A systematic review and meta-analysis. Parkinsonism Relat Disord. 2026 Jan;142:107936. doi: 10.1016/j.parkreldis.2025.107936. Epub 2025 Jun 27. PMID: 40617709 

Suthananthan I, Scantlebury N, Boudah A, Rohringer C, Schwartz ML, Lipsman N, Abrahao A. Access to MRgFUS Thalamotomy for Essential Tremor in Ontario: Geographic & Socioeconomic Referral Patterns. Can J Neurol Sci. 2025 Dec 10:1-10. doi: 10.1017/cjn.2025.10494. PMID: 41367133 

Botta D, Ndengera M, Momjian S, Velarde M, Jorge J, Delattre BMA, Guillemin PC, Bratanov C, Lingenberg A, Constanthin PE, Lorton O, Stadelmann JV, Courvoisier S, Lovblad KO, Schaller K, Gallay MN, Kurz FT, Fleury V, Salomir R. 7T MRI quantitative susceptibility mapping for magnetic resonance-guided focused ultrasound thalamotomy: methodology and anatomo-clinical correlations in a retrospective pilot study. Quant Imaging Med Surg. 2025 Dec 1;15(12):12836-12849. doi: 10.21037/qims-2025-713. Epub 2025 Nov 21. PMID: 41367782 

Sharma VD, Berry DS, Cosentino S, Louis ED. Effects of surgical therapies on cognitive function in patients with essential tremor. J Neurol Sci. 2025 Dec 20;480:125697. doi: 10.1016/j.jns.2025.125697. PMID: 41455463 

Hooshmand SJ, Liu T, Ali R, Kaufmann T, Lehman V, Klassen B, Jackson L. Chorea After MR-Guided Focused Ultrasound Thalamotomy. Tremor Other Hyperkinet Mov (N Y). 2025 Dec 2;15:59. doi: 10.5334/tohm.1085. eCollection 2025. PMID: 41357297 

Sakharova G, Krokhmal A, Galimova R, Khatmullina A, Nabiullina D, Buzaev I, Avzaletdinova D, Chupova D, Khokhlova V. The use of alendronate to enhance transcranial transmission of focused ultrasound for successful ablations in brain. Ultrasonics. 2026 Jan;157:107796. doi: 10.1016/j.ultras.2025.107796. Epub 2025 Aug 19. PMID: 40848325 

Sit V, Kumar R, Scantlebury N, Boshmaf SZ, Sivadas S, Rohringer CR, Triantafilou A, Gopinath G, Sewell IJ, Davidson B, Lam B, Hamani C, Schwartz ML, Abrahao A, Lipsman N, Rabin JS. Non-motor outcomes following focused ultrasound thalamotomy for tremor. Parkinsonism Relat Disord. 2026 Jan;142:108106. doi: 10.1016/j.parkreldis.2025.108106. Epub 2025 Oct 28. PMID: 41202510 

Henn MC, Useinovic N, Cahill J, Shi H, Shafie B, Smith H, Joyce M, Valuev T, Lopez-Ramos CG, Raslan AM, Cleary DR. Preoperative treatment with bisphosphonates does not change the thermal response of focused ultrasound thalamotomy. Stereotact Funct Neurosurg. 2025 Dec 5:1-19. doi: 10.1159/000549833. PMID: 41348673 

Garate Andikoetxea B, Serna Requejo G, Gonzalez-Quarante LH, Domínguez Echávarri PD, Rodriguez-Oroz MC, Sanchez-Catasus CA. T1/T2-weighted Ratio to Improve MRI-guided Focused Ultrasound-induced Chronic Lesion Contrast in Patients with Tremor Syndrome. Radiology. 2025 Dec;317(3):e250669. doi: 10.1148/radiol.250669. PMID: 41400472 

Montero-Pardo C, Rocon E, Dosen S, Dideriksen JL, Gutierrez A, Perez-Sanchez JR, Luque-Buzo E, Louis ED, Grandas F, Oliveira-Barroso F. Emerging Noninvasive Approaches for the Suppression of Pathological Tremor. IEEE Rev Biomed Eng. 2025 Dec 16;PP. doi: 10.1109/RBME.2025.3639754. PMID: 41406268 

Peters J, Maamary J, Barnett Y, Kuhn AA, Jonker B, Tisch S. Surgical Treatment of Tremor Syndromes: A Guide to the Clinician. Mov Disord Clin Pract. 2025 Dec 22. doi: 10.1002/mdc3.70441. PMID: 41424260 

van der Stouwe AMM, Jameel A, Gedroyc W, Jones B, Charlesworth G, Molloy S, Tai Y, Nandi D, Bain PG. Double lesion MRgFUS thalamotomy for essential tremor: 4.5-year outcomes and framework for assessing loss of efficacy and tremor progression. Br J Neurosurg. 2025 Dec;39(6):787-790. doi: 10.1080/02688697.2024.2354282. Epub 2024 Jul 17. PMID: 39016204 

Click here for additional references from PubMed.

Pre- and post-treatment assessment videos courtesy of University of Virginia