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 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 for patients with essential tremor.
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
- The Diann Shaddox Foundation for Essential Tremor Research
- The International Essential Tremor Foundation
- Hope Net
- APTES
- Tremor Action Network
Notable Papers
Suggested Reading: Focused Ultrasound: Transforming treatment of Neurodegenerative Diseases August 2022
Suggested Reading: Focused Ultrasound for Essential Tremor Market Study (2021)
Krauss J, Upadhyay N, Purrer V, Borger V, Daamen M, Maurer A, Schmeel C, Radbruch A, Wüllner U, Boecker H. Beyond the cerebello-thalamo-cortical tract: Remote structural changes after VIM-MRgFUS in essential tremor. Parkinsonism Relat Disord. 2025 Mar;132:107318. doi: 10.1016/j.parkreldis.2025.107318. Epub 2025 Feb 3. PMID: 39913957
Hvingelby VS, Kjeldsen P, Bergholt B, Schechtmann GA, Danielsen EH, Møller M, Johnsen EL, Mardosiene S, Lund TE, Grauballe D, Geneser M, Sørensen TV, Bak LØ, Andreasen M, Andersen ASM, Andersen L, Meier K, Juhl N, Tankisi A, Jespersen B, Eriksen CF, Rasmussen M, Eriksen WB, Barrutia B, Kromann M, Baandrup I, Bjørn J, Stjernholm R, Bræmer-Madsen C, Jørgensen SM, Sørensen JCH, Glud AN. Magnetic Resonance-Guided Focused Ultrasound Treatment for Essential Tremor: A Single-Center Experience. Mov Disord Clin Pract. 2025 Feb 19. doi: 10.1002/mdc3.70012. PMID: 39968962
Baumann CR, Fleisch A, Mahendran S, Uhl M, Freudinger C, Efthymiou E, Oertel MF, Stieglitz LH, Büchele F. Thalamic Deep Brain Stimulation Versus Magnetic Resonance-Guided Focused Ultrasound in Tremor Patients: A Retrospective Single-Surgeon Comparison. Mov Disord. 2025 Feb 27. doi: 10.1002/mds.30153. PMID: 40013514
Wu Y, Xu W. Addressing Methodological Variability and Enhancing Efficacy Assessment in Focused Ultrasound Thalamotomy for Parkinson’s Tremor. Mov Disord. 2025 Feb 4. doi: 10.1002/mds.30136. PMID: 39902592
Aharonson V, Lazebnik T, Sinai A, Nassar M, Senderova I, Constantinescu M, Tov LL, Schlesinger I. Novel Objective Tool to Assess Tremor Reveals Unilateral Focused Ultrasound Improves Tremor Bilaterally. Neurol Ther. 2025 Jan 22. doi: 10.1007/s40120-024-00705-7. PMID: 39843652
Ponomarchuk E, Tsysar S, Kadrev A, Kvashennikova A, Chupova D, Pestova P, Papikyan L, Karzova M, Danilova N, Malkov P, Chernyaev A, Buravkov S, Sapozhnikov O, Khokhlova V. Boiling Histotripsy in Ex Vivo Human Brain: Proof-of-concept. Ultrasound Med Biol. 2025 Feb;51(2):312-320. doi: 10.1016/j.ultrasmedbio.2024.10.006. Epub 2024 Oct 30. PMID: 39482208
Aubignat M, Roussel M, Aarabi A, Tir M, Lefranc M, Godefroy O. Cognitive impacts of unilateral MR-guided focused ultrasound thalamotomy: a meta-analysis and a call for systematic neuropsychological assessment. J Neurosurg. 2024 Dec 27:1-9. doi: 10.3171/2024.7.JNS24906. PMID: 39729615
Oshima S, Kim A, Sun XR, Rifi Z, Cross KA, Fu KA, Salamon N, Ellingson BM, Bari AA, Yao J. Predicting Post-Operative Side Effects in VIM MRgFUS Based on THalamus Optimized Multi Atlas Segmentation (THOMAS) on White-Matter-Nulled MRI: A Retrospective Study. AJNR Am J Neuroradiol. 2024 Dec 27. doi: 10.3174/ajnr.A8448. PMID: 39730158
Jha R, Wadhwa A, Chua MMJ, Cosgrove GR, Rolston JD. Tremor Severity and Operative Parameters Predict Imbalance in Patients Undergoing Focused Ultrasound Thalamotomy. Mov Disord Clin Pract. 2024 Dec;11(12):1542-1549. doi: 10.1002/mdc3.14237. Epub 2024 Oct 25. PMID: 39450579
Zhang L, Cui S, Bi H, Chen Q, Kan M, Wang C, Pu Y, Cheng H, Huang B. The research focus and frontiers in surgical treatment of essential tremor. Front Neurol. 2024 Dec 11;15:1499652. doi: 10.3389/fneur.2024.1499652. eCollection 2024. PMID: 39722689
Click here for additional references from PubMed.
Pre- and post-treatment assessment videos courtesy of University of Virginia